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Encyclopedia > Deep vein thrombosis
Deep vein thrombosis
Classification & external resources
ICD-10 I80.2
ICD-9 453.40
DiseasesDB 3498
eMedicine med/2785 
MeSH D020246
This article is about Deep-vein thrombosis. For other uses of DVT, see DVT (disambiguation).

Deep-vein thrombosis (also known as deep-venous thrombosis or DVT and colloquially as economy class syndrome) is the formation of a blood clot ("thrombus") in a deep vein. It commonly affects the leg veins, such as the femoral vein or the popliteal vein or the deep veins of the pelvis. Occasionally the veins of the arm are affected (known as Paget-Schrötter disease). Thrombophlebitis is the more general class of pathologies of this kind. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... DVT is a TLA that can mean: Deep vein thrombosis Design validation test Driving Van Trailer This page disambiguates a three-character combination which might be any or all of an abbreviation, an acronym, an initialism, a word in English, or a word in another language. ... A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... Deep vein is a term used to describe a vein that is deep in the body. ... Diagram of an insect leg A leg is the part of an animals body that supports the rest of the animal above the ground and is used for locomotion. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Grays Fig. ... The politeal vein parrallels the popliteal artery but carries the blood from the knee joint and muscles in the thigh and calf back to the heart. ... Look up ARM in Wiktionary, the free dictionary. ... Paget-Schroetter disease (also Paget-von Schrötter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... It has been suggested that this article or section be merged into deep vein thrombosis. ...

Contents

Signs and symptoms

There may be no symptoms referrable to the location of the DVT, but the classical symptoms of DVT include pain, swelling and redness of the leg and dilatation of the surface veins. In up to 25% of all hospitalized patients, there may be some form of DVT, which often remains clinically inapparent (unless pulmonary embolism develops). “Hurting” redirects here. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... Diagram of an insect leg A leg is the part of an animals body that supports the rest of the animal above the ground and is used for locomotion. ...


There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of the affected and the contralateral limb at a fixed point (to objectivate edema), and palpating the venous tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis. Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ...


A careful history has to be taken considering risk factors (see below), including the use of estrogen-containing methods of hormonal contraception, recent long-haul flying, and a history of miscarriage (which is a feature of several disorders that can also cause thrombosis). A family history can reveal a hereditary factor in the development of DVT. Hormonal contraception refers to birth control methods that act on the hormonal system. ... Miscarriage or spontaneous abortion is the natural or accidental termination of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined at a gestation of prior to 20 weeks. ... A genetic disorder or a clinical phenotype. ...


It is vital that the possibility of pulmonary embolism be included in the history, as this may warrant further investigation (see pulmonary embolism).


Complications As a complication, post-thrombotic syndrome can develop. Post-phlebitic syndrome occurs in 10% of patients with deep vein thrombosis (DVT). It presents with leg oedema, pain, nocturnal cramping, venous claudication, skin pigmentation, dermatitis and ulceration (usually on the medial aspect of the lower leg). In phlegmasia alba dolens, the leg is pale and cool with a diminished arterial pulse due to spasm. It usually results from acute occlusion of the iliac and femoral veins due to DVT. In phlegmasia cerulea dolens, there is an acute and nearly total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and oedematous. Venous gangrene may supervene. Post-thrombotic syndrome refers to the long-term effects that can occur after venous thrombosis. ...


Diagnosis

Homan's sign is used in clinical practice to diagnose DVT. Homans sign is said to be present when sharp dorsiflexion of the ankle by the examiner elicits sharp pain in the calf. ...


The gold standard is intravenous venography, which involves injecting a peripheral vein of the affected limb with a contrast agent and taking X-rays, to reveal whether the venous supply has been obstructed. Because of its invasiveness, this test is rarely performed. In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Radiocontrast agents (or simply contrast agents) are compounds used to improve the visibility of internal bodily structures in an X-ray image. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ...


Impedance plethysmography and Doppler ultrasonography are non-invasive alternatives. Impedance phlebography, or impedance plethysmography, is a non-invasive medical test that measures small changes in electrical resistance of the calf or other regions of the body. ...


Probability scoring

In 2006, Scarvelis and Wells overviewed a set of clinical criteria for DVT,[1] on the heels of a widely adopted set of clinical criteria for pulmonary embolism.[2][3] For the Manfred Mann album, see 2006 (album). ...


Wells score or criteria: (Possible score -2 to 9)

1) Active cancer (treatment within last 6 months or palliative) -- 1 point
2) Calf swelling >3cm compared to other calf (measured 10cm below tibial tuberosity) -- 1 point
3) Collateral superficial veins (non-varicose) -- 1 point
4) Pitting edema (confined to symptomatic leg) -- 1 point
5) Swelling of entire leg - 1 point
6) Localized pain along distribution of deep venous system -- 1 point
7) Paralysis, paresis, or recent cast immobilization of lower extremities -- 1 point
8) Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks -- 1 point
9) Previously documented DVT -- 1 point
10) Alternative diagnosis at least as likely -- Subtract 2 points

Interpretation:

Score of 2 or higher - deep vein thrombosis is likely. Consider imaging the leg veins.
Score of less than 2 - deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis.

D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ...

Imaging the leg veins

Compression ultrasound scanning of the leg veins, combined with duplex measurements (to determine blood flow), can reveal a blood clot and its extent (i.e. whether it is below or above the knee). Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ... A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... For other uses, see Knee (disambiguation). ...


Blood tests

In a low-probability situation, current practice is to commence investigations by testing for D-dimer levels. This cross-linked fibrin degradation product is an indication that thrombosis is occurring, and that the blood clot is being dissolved by plasmin. A low D dimer level should prompt other possible diagnoses (such as a ruptured Baker's cyst, if this has not been considered as part of the history). D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... Plasmin is an important degrading enzyme (EC 3. ... A Bakers cyst, otherwise known as a popliteal cyst, is a benign swelling found behind the knee joint. ...


Other blood tests usually performed at this point are:

Schematics of shorthand for complete blood count commonly used by physicians. ... Coagulation is a complex process by which blood forms solid clots. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is a commonly performed test for the system of coagulation, especially its intrinsic pathway. ... Fibrin is a protein involved in the clotting of blood. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ...

Therapy

  • Anticoagulation is the usual treatment for DVT. In general, patients are initiated on a brief course (i.e., less than a week) of heparin treatment while they start on a 3- to 6-month course of warfarin (or related vitamin K inhibitors). Low molecular weight heparin (LMWH) is preferred,[5] though unfractionated heparin is given in patients who have a contraindication to LMWH (e.g., renal failure or imminent need for invasive procedure). In patients who have had recurrent DVTs (two or more), anticoagulation is generally "life-long." The Cochrane Collaboration has meta-analyzed the risk and benefits of prolonged anti-coagulation.[6]
  • Elastic compression stockings should be routinely applied.[5] The stockings in almost all trials were stronger than routine anti-embolism stockings and created either 20-30 mm Hg or 30-40 mm Hg. Most trials used knee-high stockings. A meta-analysis of randomized controlled trials by the Cochrane Collaboration showed reduced incidence of post-phlebitic syndrome.[7] The number needed to treat is quite potent at 4 to 5 patients need to prevent one case of post-phlebitic syndrome.[8]
  • Inferior vena cava filter reduces pulmonary embolism[9] and is an option for patients with an absolute contraindiciation to anticoagulant treatment (e.g., cerebral hemorrhage) or those rare patients who have objectively documented recurrent PEs while on anticoagulation, an inferior vena cava filter (also referred to as a Greenfield filter) may prevent pulmonary embolisation of the leg clot. However these filters are themselves potential foci of thrombosis,[10] IVC filters are viewed as a temporizing measure for preventing life-threatening pulmonary embolism.
  • Hospitalization should be considered in patients with more than two of the following risk factors as these patients may have more risk of complications during treatment[11]:
    • bilateral DVT, renal insufficiency, body weight <70 kg, recent immobility, chronic heart failure, and cancer

Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... Vitamin K1 (phylloquinone). ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... An inferior vena cava filter, also IVC filter a type of vascular filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs). ... An inferior vena cava filter, also IVC filter a type of vascular filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs). ... An inferior vena cava filter, also IVC filter a type of vascular filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs). ...

Prophylaxis (Prevention)

Clinical practice guidelines by the American College of Chest Physicians (ACCP) provide recommendations on DVT prophylaxis in hospitalized patients [12]. A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions and criteria in specific areas of healthcare, as defined by an authoritative examination of current evidence (evidence-based medicine). ...


General Medical Inpatients

Regarding general medical inpatients the guidelines state, "In acutely ill medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, including active cancer, previous VTE, sepsis, acute neurologic disease, or inflammatory bowel disease, we recommend prophylaxis with LDUH (Grade 1A) or LMWH (Grade 1A)[12]." Enoxaparin or unfractionated heparin may be used.[13] Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...


Since publication of the ACCP guidelines, an additional randomized controlled trial [14] and meta-analysis [15] including the trial have been published. The meta-analysis concluded " Anticoagulant prophylaxis is effective in preventing symptomatic venous thromboembolism during anticoagulant prophylaxis in at-risk hospitalized medical patients. Additional research is needed to determine the risk for venous thromboembolism in these patients after prophylaxis has been stopped." With regards to which patients are at risk, most studies in the meta-analysis were of patients with New York Heart Association Functional Classification (NYHA) III-IV heart failure. Regarding patients at lesser risk of DVT, the trial above[14] and an earlier trial[16] are relevant yet inconclusive. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the extent of heart failure. ...


Surgery Patients

In patients who have undergone surgery, low molecular weight heparins (LMWH) are routinely administered to prevent thrombosis. LMWH can only currently be administered subcutaneously by injection. Prophylaxis for pregnant women who have a history of thrombosis may be limited to LMWH injections or may not be necessary if their risk factors are mainly temporary. A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ...


Early and regular ambulation (walking) is a treatment that predates anticoagulants and is still recognized and used today. Walking activates the body's muscle pumps, increasing venous velocity and preventing stasis. Intermittent pneumatic compression (IPC) machines have proven protective in bed- or chair-ridden patients at very high risk or with contraindications to heparins. IPC machines use air bladders that are wrapped around the thigh and/or calf. The bladders alternately inflate and deflate, squeezing the muscles and increasing blood velocity by as much as 500%. IPC machines have been proven effective on knee and hip surgery patients (a population with a risk as high as 80% with no prophylactic treatment) of developing DVT and PE. Alternatively, between 150-300mg of aspirin can be taken. The term stasis has several meanings: A state of stabilty, in which all forces are equal and opposing, therefore they cancel out each other. ...


There is clinical evidence to suggest that wearing compression socks while travelling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers. J Scurr et al. 2001 Lancet.[17].See also Economy class syndrome Economy class syndrome was coined in the late 1990s when it turned out that people who has traveled long distances by aeroplane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. ...


Pathogenesis

Main article: Thrombosis

Many factors are involved in the formation of a thrombus (clot). Virchow's triad is a group of 3 factors known to affect clot formation: rate of flow, the consistency (thickness) of the blood, and qualities of the vessel wall. Among the risk factors are advanced age, obesity, infection, immobilization, female sex, use of oral contraceptives, tobacco usage and air travel ("economy class syndrome", a combination of immobility and relative dehydration) are some of the better-known causes.[18] Thrombophilia (tendency to develop thrombosis) often expresses itself with recurrent thromboses. Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... The following are considered the contributors of Virchows Triad: Alterations in blood flow (hemostasis) Injury to the vascular endothelium Alterations in the constitution of blood (hypercoagulability) The origin of the term Virchows Triad is of historical interest. ... Oral contraceptives are chemicals taken by mouth to inhibit normal fertility. ... This article refers to the tool of travel. ... Economy class syndrome was coined in the late 1990s when it turned out that people who has traveled long distances by aeroplane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. ... Thrombophilia is the propensity to develop thrombosis (blood clots) due to an abnormality in the system of coagulation. ...


It is recognised that thrombi usually develop first in the calf veins, "growing" in the direction of flow of the vein. DVTs are distinguished as being above or below the popliteal vein. Very extensive DVTs can extend into the iliac veins or the inferior vena cava. The risk of pulmonary embolism is higher in the presence of more extensive clots. Popliteal refers to anatomical structures locatedin the back of the knee: popliteal artery popliteal vein popliteal fossa popliteal nerves ... In human anatomy, iliac vein refers to several anatomical structures located in the pelvis: External iliac vein - terminates at the common iliac vein, drains the femoral vein. ... This article may be too technical for most readers to understand. ...


Epidemiology

DVTs occur in about 1 per 1000 persons per year. About 1-5% will die from the complications (i.e. pulmonary embolism).


DVT is much less common in the pediatric population. About 1 in 100,000 people under the age of 18 experiences deep vein thrombosis, possibly due to a child's high rate of heartbeats per minute, relatively active lifestyle when compared with adults, and fewer comorbodities (e.g. malignancy).


See also

A Venogram is a medical procedure that uses an dye injected into veins to make the veins visible for x-rays. ...

References

  1. ^ Scarvelis D, Wells P (2006). "Diagnosis and treatment of deep-vein thrombosis.". CMAJ 175 (9): 1087-92. PMID 17060659. Free Full Text. 
  2. ^ Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. American Family Physician. 2003; 68(4):759-?. Available at: http://www.aafp.org/afp/20030815/practice.html. Accessed on: December 8, 2006.
  3. ^ Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (2000). "Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.". Thromb Haemost 83 (3): 416-20. PMID 10744147. 
  4. ^ Watson L, Armon M. "Thrombolysis for acute deep vein thrombosis". Cochrane Database Syst Rev: CD002783. PMID 15495034. 
  5. ^ a b Snow V et al (2007). "Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians". Ann Intern Med 146 (3). 
  6. ^ Hutten BA, Prins MH (2006). "Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism". Cochrane database of systematic reviews (Online) (1): CD001367. DOI:10.1002/14651858.CD001367.pub2. PMID 16437432. 
  7. ^ Kolbach D, Sandbrink M, Hamulyak K, Neumann H, Prins M. "Non-pharmaceutical measures for prevention of post-thrombotic syndrome". Cochrane Database Syst Rev: CD004174. DOI:10.1002/14651858.CD004174.pub2. PMID 14974060. 
  8. ^ Kakkos S, Daskalopoulou S, Daskalopoulos M, Nicolaides A, Geroulakos G (2006). "Review on the value of graduated elastic compression stockings after deep vein thrombosis". Thromb Haemost 96 (4): 441-5. PMID 17003920. 
  9. ^ Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral F, Huet Y, Simonneau G (1998). "A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group". N Engl J Med 338 (7): 409-15. PMID 9459643. 
  10. ^ (2005) "Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study". Circulation 112 (3): 416-22. PMID 16009794. 
  11. ^ Trujillo-Santos J, Herrera S, Page MA, et al (2006). "Predicting adverse outcome in outpatients with acute deep vein thrombosis. findings from the RIETE Registry". J. Vasc. Surg. 44 (4): 789-93. DOI:10.1016/j.jvs.2006.06.032. PMID 16926081. 
  12. ^ a b Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126 (3 Suppl):338S-400S. http://www.chestjournal.org/cgi/content/full/126/3_suppl/338S PMID 15383478
  13. ^ King CS, Holley AB, Jackson JL, Shorr AF, Moores LK (2007). "Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: A metaanalysis". Chest 131 (2): 507–16. PMID 17296655. 
  14. ^ a b Lederle FA, Sacks JM, Fiore L, Landefeld CS, Steinberg N, Peters RW, Eid AA, Sebastian J, Stasek JE Jr, Fye CL. The prophylaxis of medical patients for thromboembolism pilot study. Am J Med. 2006;119:54-9. PMID 16431185
  15. ^ Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146:278-88. PMID 17310052
  16. ^ Gardlund B. Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases. The Heparin Prophylaxis Study Group. Lancet. 1996 May 18;347(9012):1357-61. PMID 8637340
  17. ^ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001;12(9267):1485-9. PMID 11377600.
  18. ^ Tsai A, Cushman M, Rosamond W, Heckbert S, Polak J, Folsom A (2002). "Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology.". Arch Intern Med 162 (10): 1182-9. PMID 12020191. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ...

External links


  Results from FactBites:
 
Deep Vein Thrombosis and Pulmonary Embolism (blood clots) on MedicineNet.com (852 words)
Superficial thrombophlebitis occurs in veins close to the skin surface, and usually causes pain, swelling, and redness in the area of the vein.
The reason for this is that a piece of the clot in deep vein from a DVT can break off and travel through the deep veins back to the heart, and eventually be pumped by the heart into the arteries of the lung.
DVTs can occur anywhere in the body but are most frequently found in the deep veins of the legs, thighs, and pelvis.
eMedicine - Deep Venous Thrombosis : Article by Craig Feied, MD, FACEP, FAAEM, FACPh (10161 words)
DVT is common in patients with local trauma and stasis, such as that associated with a leg cast, and in those who smoke, are obese, or travel in confined circumstances (the so-called coach-class syndrome).
DVT that is isolated to the anterior tibial vein results in PTE in 30% of cases and is responsible for many deaths.
Feied CF: Deep Vein Thrombosis and Pulmonary Embolism.
  More results at FactBites »

 
 

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