Elevated factor VIII: an unfamiliar risk factor for cerebral venous thrombosis

An elevated factor VIII level has been shown to be an independent risk factor for venous thrombosis. However, physicians screen for this factor far less frequently than they screen for other coagulopathies. The causes of increased factor VIII levels are likely a combination of genetic and acquired variables. The authors describe a case of a healthy 48-year-old woman found to have a cerebral venous thrombosis, with her only identifiable risk factor being an elevated factor VIII level.     

Protein C deficiency and splanchnic venous thrombosis. Case report

A patient with splanchnic venous thrombosis due to heterozygous deficiency of protein C is reported. A review of the literature revealed that out of nine previously reported patients an isolated protein C deficiency was present in only one. Anticoagulant regimen carries a risk of hypercoagulability and certain precautions with such regimens are therefore necessary when treating patients in this condition.     

The risk of deep venous thrombosis: a computerized epidemiologic approach

The appropriate use of prophylactic measures to prevent deep venous thrombosis is dependent on the ability of physicians to identify high-risk patients. This problem has been the subject of numerous epidemiologic reports compiled during the last several decades. Described herein is a computerized technique to condense the literature on this subject into a form better suited for practical application. This technique comprises an interactive program that calculates a patient's relative risk of developing a thrombus on the basis of a comparative evaluation of his medical profile. The computer then reports the patient's calculated relative risk along with other information that may pertain to his risk of deep venous thrombosis.     

Hyperhomocysteinaemia as a risk factor for deep-vein thrombosis.

OBJECTIVE: Several studies have shown a relation between hyperhomocysteinaemia and vascular disease. To assess the risk of deep-vein thrombosis (DVT) associated with hyperhomocysteinaemia, we studied plasma homocysteine levels in patients with deep-vein thrombosis and in normal control subjects. MATERIALS AND METHODS: We measured plasma homocysteine levels in 48 patients with deep-vein thrombosis and in 33 healthy controls matched to the patients according to age and sex. Plasma homocysteine levels were measured with high performance liquid chromatography and fluorescence detection. Hyperhomocysteinaemia was defined as a plasma homocysteine level about 15 micromol/L in both groups. The diagnosis of all patients with deep-vein thrombosis (n=48) was verified by Doppler ultrasonography. RESULTS: Plasma homocysteine levels were found to be increased in the deep-vein thrombosis group compared the control group (p<0.001, t-test). The mean plasma homocysteine level in the patients was 17.1 SD 5.13 micromol/L (range 6.4-31.3), and that in the controls was 9.0 SD 1.27 micromol/L (range 6.0-11.5). The association between elevated homocysteine levels and venous thrombosis was stronger among men than among women. CONCLUSIONS: The increased plasma homocysteine levels we have observed may have a causative role in the development of deep-vein thrombosis.     

Proximate versus nonproximate risk factor associated primary deep venous thrombosis: clinical spectrum and outcomes

OBJECTIVE: Although the treatment for acute deep vein thrombosis (DVT) is uniform, the circumstances under which it develops vary widely and may impact outcomes. This study compared clinical features and outcomes in patients who developed a primary DVT associated with a defined risk to those without any proximate risk factor. METHODS: Consecutive patients with a primary DVT and no past venous thromboembolism history from 2000 to 2002 were abstracted for demographics, risk factors, DVT anatomical characteristics, treatment, and outcomes of death and new pulmonary embolism. Comparison between patients with a proximate risk event within 30 days of DVT (Inpt) and those presenting with DVT with no defined proximate event (Outpt) was done by univariable and multivariable statistics. A validated survey was mailed to all living patients to assess long-term sequela. RESULTS: A total of 293 patients with a mean age of 55 years and 49% men had confirmed DVT by objective means (92% duplex) with a mean follow-up of 25 +/- 21 months. Inpts were more likely to have recent surgery or blunt trauma, bilateral DVT, less use of low molecular weight heparin (LMWH), and new pulmonary emboli (all P <.05). Outpts with DVT were more likely to have a history of malignancy, tibial-popliteal DVT compared with iliofemoral DVT, higher use of LMWH, and coumadin. However, there was no difference in mortality. From the patient survey (21% response), Outpts were more likely than Inpts to develop later varicosities and have daily frustration related to their legs (P < .05), but no difference in edema or ulceration. Considering the entire group, independent factors associated with freedom from PE included ambulation (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.1-5.0; P = .04) while bilateral DVT (OR = .26; 95% CI = .09-.76; P = .013) or subcutaneous heparin (OR = 22; 95% CI = .05-.98; P = .047) were associated with greater risk. Independent factors associated with survival included ambulation (OR = 3.0; 95% CI = 1.3-7.2; P = .02), Coumadin use (OR = 2.7; 95% CI = 1.2-6.1; P = .015), and tibiopopliteal DVT (OR = 2.4; 95% = 1.1-5.5; P = .03), while malignancy (OR = 0.1; 95% CI = .05-.24; P < .01) and myocardial infarction (OR = 0.12; 95% CI = .01-.92; P = .04) were associated with lower survival. CONCLUSION: Patients who develop DVT related to a defined proximate risk event (Inpt) generally have more extensive DVT, an increased risk of PE, but less long-term functional morbidity and no difference in long-term mortality compared to those with no proximate risk.     

Liver transplantation using cavoportal transposition: an effective treatment in patients with complete splanchnic venous thrombosis

Complete venous thrombosis of the splanchnic system remains a major challenge in liver transplantation surgery. Some of these patients have been treated successfully by multivisceral transplantation. Cavoportal transposition is another alternative to treat these patients. We reviewed our single-center experience with this technique. Five patients with operatively confirmed complete splanchnic thrombosis were transplanted with the cava portal transposition technique. All survived the procedure; 60% survived long term. This technique is a useful salvage procedure in moribund patients with diffuse portal thrombosis who would otherwise rapidly succumb.     

妇科患者手术期静脉血栓风险评估量表的构建

目的 构建妇科患者手术期静脉血栓风险评估量表,为临床提供有效评估工具.方法 以Virchow血栓形成三要素为理论基础,广泛查阅文献,参考相关指南及临床常用量表形成初始量表条目池,运用Delphi法对15名专家进行2轮咨询.结果 2轮专家咨询问卷有效回收率均为100％,专家权威系数为0.81,专家意见的协调系数分别为0....     

急性下肢深静脉血栓形成危险因素的评估

目的 观察急性下肢深静脉血栓形成(deep venous thrombosis,DVT)患者凝血功能变化及评估其危险因素.方法 全自动凝血分析仪检测62例急性下肢DVT患者(DVT组)和70例健康对照组血浆APTT、PT、TT、纤维蛋白原(fibrinogen,Fbg)及D二聚体(D-dimer)水平;并通过二分类Logistic回归回顾性研究所有患者的临床资料. 结果 (1)DVT组血浆APTT、PT、TT、D二聚体、Fbg水平及D二聚体与Fbg比值(D/F值)都明显高于健康对照组,差异均有统计学意义(P＜0.01);(2)DVT组和对照组血浆D二聚体与Fbg之间都存在正相关性(r=0.475,P＜0.01;r=0.564,P＜0.01);(3)Logistic回归分析表明:急性下肢DVT的发生与患者存在高血压,血浆Fbg水平的升高有关(OR[比值比]=24.99,P＜0.01;OR=4.346,P＜0.01).结论 高血压和升高的血浆纤维蛋白原是急性下肢DVT的独立危险因素.     

Defective fibrinolysis: a risk factor in early femoropopliteal graft thrombosis

Resting plasma fibrinolytic activity and fibrinolytic activity after stimulation by 10 min of venous occlusion (fibrinolytic potential) were estimated in 51 patients before femoropopliteal reconstructive surgery. Twelve patients suffered a graft thrombosis in the first month. Resting plasma fibrinolytic activity was similar in patients with thrombosed grafts and those with functioning grafts. However reduced fibrinolytic potential was found to be a risk factor for graft thrombosis in the month after surgery (P = 0.01). Other risk factors were increasing age (P = 0.007) and the indication for surgery (P = 0.03). Thirty-four patients whose grafts were functioning after 1 month were followed up for a mean of 9 months. A further eight grafts thrombosed. Neither fibrinolytic activity nor fibrinolytic potential were found to be risk factors for late graft thrombosis. Fibrinolytic potential has been shown to be an independent risk factor for early graft thrombosis. Perioperative fibrinolytic stimulation might be a method of improving femoropopliteal graft patency.     

超声引导下介入治疗周围软组织静脉畸形

目的 探讨超声引导下介入治疗周围软组织静脉畸形的有效性和安全性.方法 2004年3月至2007年10月收治静脉畸形患者32例,在实时超声引导下视病灶情况(病灶的部位、深浅与重要组织的毗邻关系等)分别选择缓慢推注无水酒精+博来霉素和单纯博来霉素,3周后若患者未达治愈可重复治疗.患者术后随访6个月-2年.结果 所有患者治疗1-6次,平均3次,操作可在门诊进行,不影响工作和生活.治愈27例(84.4%)、好转5例(15.6%)、无效0例.无异位栓塞等严重并发症发生.结论 超声引导下介入治疗静脉畸形是一种微创、疗效高、可重复、不良反应少、操作简便的方法 .     

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深静脉血栓形成 (DVT)并非少见 ,文献报告的尸检发现率为 35 %～ 5 2 %[1] ,经静脉造影证实有症状的DVT发病率为 1 6‰[2 ] 。DVT的急性期并发症有肺栓塞及股白肿或股青肿 ,慢性期将遗留血栓形成后综合征。前者 ,是DVT病人的主要死亡原因或导致截肢 ;后者 ,使患肢处于失功状态 ,严重影响病人的工作及生活质量。Virchow提出的DVT三大发病原因 :血流缓慢、血液异常和血管损伤 ,至今仍被沿用 ,但有不少新的认识 ,而且DVT发病相关的高危因素 ,业已受到重视。了解DVT的病因及高危因素 ,对正确认识DVT的发生发展 ,指导合理的预防措施与…     

Basilar skull fracture: a risk factor for transverse/sigmoid venous sinus obstruction

In trauma practice, basilar skull fracture is an extremely common finding while transverse/sigmoid venous sinus thrombosis is generally considered quite a rare complication. During evaluation of cervical computed tomography (CT) angiography after trauma, we identified five patients in just three months with unexpected transverse/sigmoid venous sinus obstruction ipsilateral to a basilar skull fracture. This number represented a surprisingly high percentage of our neurosurgical trauma consults for the study period (31%). Three of the five patients were found to have sinus thrombosis: two with right transverse/sigmoid sinus thrombosis experienced significant neurological deficits and prolonged hospital courses even with anti-coagulation therapy; one patient with a left transverse/sigmoid sinus thrombosis had a good outcome with anti-coagulation therapy. The other two of the five patients had outflow obstruction, likely from focal epidural bleeding and extrinsic compression: one patient with partial obstruction in the right transverse-sigmoid junction, due to epidural bleeding, experienced a difficult recovery; one patient with a right sigmoid sinus obstruction presented and remained asymptomatic and experienced a benign hospital course. Two of the five patients had a posterior temporal hemorrhagic area ipsilateral to the affected sinus, suggesting that this finding may have represented hemorrhagic venous infarction rather than traumatic contusion. We propose that a basilar skull fracture in the region of temporal or occipital bone should be considered as a significant risk factor for the development of transverse/sigmoid venous sinus obstruction and may be an under-recognized and treatable cause of increased intracranial pressure. Failure to detect this complication may explain, in part, unexpected clinical outcomes.