6 members of a family with a tendency to thrombosis and defective fibrinolysis were examined. After stimulation of plasminogen activator release from the vessel wall by local venous occlusion or by submaximal physical exercise, they had a lower plasminogen activator activity in blood than a healthy control group (P < 0.01). 5 of the examined members suffered from recurrent venous thrombosis. The defect appeared to be autosomal dominant.
Deep venous thrombosis (DVT) often leads to chronic venous insufficiency and the present study was conducted in order to investigate the effectiveness of catheter-directed thrombolysis in patients with proximal DVT of the lower extremity (iliac vein involved), with respect to recanalisation and maintenance of venous valve function.A prospective clinical investigation was carried out with puncture of the popliteal vein for continuous infusion of r-alteplase. Twelve patients suffering from recent proximal DVT were treated: In 10 patients the left extremity was affected, in two the right. Three of the 12 patients had factor V Leiden mutation in the heterozygote form, one of whom also had prothrombin mutation in heterozygote form.Ten of the 12 had their venous thrombosis successfully lysed and were discharged with an open venous system in the affected limb. The lysed venous segments remained patent in all ten, with normal venous valve function, as evaluated by Doppler reflux testing. The median follow-up time was five months (range 0-9 months). In one patient, the proximal thrombus (iliac) was lysed successfully, but the femoral vein could not be opened, probably because of an old thrombus remaining from a previous DVT episode. In the other patient, the venous thrombus was lysed successfully, but the vein rethrombosed after one day.Catheter-directed thrombolysis appears feasible in patients with recent proximal DVT and the short-term results are good in terms of venous patency and valve function. A randomised trial is necessary to test whether this treatment modality is superior to conventional anticoagulation therapy.
Plasma concentration of antithrombin III (AT III) was measured by both immunological and functional assays before, during and after treatment with haemodialysis in 42 patients with chronic renal failure on regular long-term haemodialysis. Intravenous heparin administration during the haemodialysis session was found not to induce a consumption of the circulating AT III.
S ummary . We have earlier demonstrated that in a family with a tendency to recurrent venous thrombosis the release of tissue plasminogen activator (t‐PA) activity in blood after stimulation was abnormally low. This observation could be related either to an impaired release of t‐PA into the blood stream or to a masking of the released t‐PA by a high concentration of PA inhibitor(s). In order to distinguish between these two possibilities the family was reinvestigated using various newer techniques, including an ELISA for t‐PA, an assay for quantitation of the fast‐acting PA inhibitor and SDS polyacrylamide gel electrophoresis followed by fibrin‐enzymography. Hereby the family members were demonstrated to have a high concentration in plasma of the PA inhibitor. After stimulation the release of t‐PA into the blood was normal, the t‐PA activity, however. was immediately inactivated by complex formation with the fast‐acting PA inhibitor.
Key Clinical Message Heparin‐induced thrombocytopenia ( HIT ) is a serious adverse reaction to heparin treatment with a high risk of thrombosis. Heparin must be discontinued immediately and replaced with alternative anticoagulants that do not interact with HIT antibodies. In this case, a lung cancer patient, diagnosed with HIT was successfully treated with apixaban.
Introduction: The need for anticoagulation therapy increases with age, mainly due to the increased prevalence of atrial fibrillation. Time in therapeutic range (TTR) is a marker of the quality of the therapy as TTR is inversely correlated with adverse reactions. We developed a bioanalyst-led management program for control of warfarin treatment in elderly disabled patients in their own home and maintain a high TTR. Material and Methods: Residents in nursing home settings were included. Visiting nurses measured INR with a point of care testing device. If INR was within Therapeutic Range (TR), the nurse dosed warfarin unaltered. If INR was out of TR, the visiting nurse contacted a specially trained bioanalyst by phone. An explanation was sought, and a new dosage plan was made. Results: A total of 579 patients were included; 356 females (61%). Mean age was 79.6 years. Approximately 10% were residents in nursing home settings and the rest in domiciliary care. TTR was 72%. The subtherapeutic values were 15% and supratherapeutic values 13%. In total, 139 patients died during the study period. Ten deaths could be related to possible side effects of warfarin treatment. Conclusions: Our results indicate that a bioanalyst-led program is able to simplify anticoagulation monitoring, while maintaining INR control similar to a specialized clinic. Furthermore, we avoided hospitalizations when INR was unacceptably high by treating the patient with oral vitamin-K at home. Our findings could be helpful when planning warfarin treatment in elderly, fragile patients.
Proximal deep venous thrombosis (DVT) often leads to venous outflow obstruction in chronic venous insufficiency (CVI). This paper presents our clinical experience with iliac vein stent placement.Between January 2001 and November 2004 balloon dilation and stent placement for the relief of iliac vein obstruction was intended in ten patients suffering from venous claudication. Median age was 35 years (range 21-42). Eight patients had earlier been treated for proximal DVT on the left side and two patients had May-Thurner syndrome. Ultrasound scanning was performed on all patients for the detection of iliac vein obstruction. It was a requirement that all patients had an open deep venous system without reflux distally to the occlusion. The procedure was carried out under local anaesthesia and all patients were anticoagulated postoperatively.There was one technical failure and nine patients were treated successfully. In one of these patients the stent rethrombosed after two days but the thrombus was lysed and the patient was restented more distally. All patients were discharged with an open venous system. At follow-up, eight of the nine stents were patent. Five patients had normal walking distance and three had improved. The median follow-up time was 32.5 months (range 6-53 months).The correction of iliac vein obstruction with the placement of stents in patients with venous claudication seems to be an effective, safe method which is minimally invasive. Short term patency is satisfactory but the long term results of stents in the venous system are not known and longer follow-up is required.
