cardiovascular-agents and Venous-Thrombosis

Fibrinogen is cleaved by thrombin to fibrin, which provides the blood clot with its essential structural backbone. As an acute phase protein, the plasma levels of fibrinogen are increased in response to inflammatory conditions. In addition to fibrinogen levels, fibrin clot structure is altered by a number of factors. These include thrombin levels, treatment with common cardiovascular medications, such as aspirin, anticoagulants, statins and fibrates, as well as metabolic disease states such as diabetes mellitus and hyperhomocysteinaemia. In vitro studies of fibrin clot structure can provide information regarding fibre density, clot porosity, the mechanical strength of fibres and fibrinolysis. A change in fibrin clot structure, to a denser clot with smaller pores which is more resistant to lysis, is strongly associated with cardiovascular disease. This pathological change is present in patients with arterial as well as venous diseases, and is also found in a moderate form in relatives of patients with cardiovascular disease. Pharmacological therapies, aimed at both the treatment and prophylaxis of cardiovascular disease, appear to result in positive changes to the fibrin clot structure. As such, therapies aimed at 'normalising' fibrin clot structure may be of benefit in the prevention and treatment of cardiovascular disease.

Topics: Arterial Occlusive Diseases; Blood Coagulation; Cardiovascular Agents; Cardiovascular Diseases; Fibrin; Fibrinogen; Fibrinolysin; Fibrinolysis; Humans; Porosity; Venous Thrombosis

An International Task Force made up of a panel of 16 experts has reviewed and objectively evaluated all aspects of chronic venous disease of the leg (CVDL). All available publications on CVDL from 1983 to 1997 were identified through computerized search in Medline and by a manual search. Next, three different screenings were performed in order to select only relevant papers providing a level of scientific evidence that was considered moderate to strong. Final conclusions and further therapeutic recommendations were made based on these publications. Medication, compression, local therapy, sclerotherapy, and surgery are the accepted available therapeutic options for CVDL. For edema, the following recommendations can be made: edema is an early sign of CVDL, but before starting any treatment, nonvenous causes of edema should be excluded. Medication and compression are the therapeutic options for edema that are accepted by the Task Force. Evaluation of their efficacy is based on objective measures of edema. Several well-conducted, placebo-controlled trials have shown efficacy of drugs such as micronized purified flavonoid fraction, rutosides, calcium dobesilate, and coumarin rutin. Graduated compression stockings have been shown to be effective; compression needs to be exerted at least at 35 mm Hg. Bandages, if properly applied, both fixed and stretched, can produce favorable results. Sclerotherapy or surgery is not indicated unless there is saphenofemoral or saphenopopliteal reflux. In the absence of such reflux or following deep venous thrombosis, there is no evidence to support sclerotherapy or surgery.

Topics: Anticoagulants; Bandages; Calcium Dobesilate; Cardiovascular Agents; Chronic Disease; Controlled Clinical Trials as Topic; Coumarins; Diosmin; Edema; Femoral Vein; Hemostatics; Humans; Leg; Placebos; Rutin; Saphenous Vein; Sclerotherapy; Vasodilator Agents; Venous Insufficiency; Venous Thrombosis

15% of cerebral venous thrombosis (CVT) patients have poor outcomes despite anticoagulation. Uncontrolled studies suggest that endovascular approaches may benefit such patients. In this study, we analyze Nationwide Inpatient Sample (NIS) data to evaluate the safety and efficacy of endovascular therapy (ET) versus medical management in CVT. We also examined the yearly trends of ET utilization in the United States.. International Classification of Diseases, Ninth Revision, Clinical Modification codes were utilized to identify CVT patients who received ET. To make the data nationally representative, weights were applied per NIS recommendations. Since ET was not randomly assigned to patients and was likely to be influenced by disease severity, propensity score weighting methods were utilized to correct for this treatment selection bias. Outcome variables included in-hospital mortality and discharge disposition. To determine if our primary outcomes were associated with ET, we used weighted multivariable logistic regression analyses.. Of the 49,952 estimated CVT cases, 48,704 (97%) received medical management and 1248 (3%) received ET (mechanical thrombectomy [MT] alone, N = 269 [21%], MT ± thrombolysis, N = 297 [24%], and thrombolysis alone, N = 682 [55%]). Patients who received ET were older with more CVT associated complications including venous infarct, intracranial hemorrhage, coma, seizure, and cerebral edema. There was a significant yearly rise in the use of ET, with a trend favoring MT versus thrombolysis alone. ET was independently associated with an increased risk of death (odds ratio 1.96, 95% confidence interval 1.15-3.32).. Patients receiving ET experienced higher mortality after adjusting for age and CVT associated complications. Large, well designed prospective randomized trials are warranted for further evaluation of the safety and efficacy of ETs.

Topics: Adult; Aged; Cardiovascular Agents; Databases, Factual; Endovascular Procedures; Female; Humans; Inpatients; Intracranial Thrombosis; Male; Middle Aged; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; United States; Venous Thrombosis

Cydonia oblonga Miller (COM) is traditionally used in Uyghur medicine for the prevention of cardiovascular disease. The present study is designed to explore the effects of COM extracts on models and markers of thrombosis and related biomarkers.. 20, 40, 80 mg/kg/day COM aqueous extracts and 5mg/kg/day aspirin, orally for 14 days were compared to untreated controls in mice on bleeding and clotting times, using the tail cutting and glass slide methods and for death rates in collagen-epinephrine pulmonary thrombosis, thrombolysis in vitro and euglobulin lysis time (ELT). In rats, common carotid artery FeCl3-induced thrombus and inferior vena cava thrombosis occlusion time, plasma concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandine F1α (6-keto-PGF1α) were measured.. Compared to controls, COM extracts dose-dependently prolonged bleeding by 2.17, 2.78 and 3.63 times, vs. aspirin 2.58, and the clotting time by 1.44, 2.47 and 2.48 times, vs. aspirin 1.91. COM reduced pulmonary embolus mortality by 27, 40 and 53%, vs. 47% for aspirin. COM dose-dependently increased thrombolysis by 45, 55 and 63%, vs. 56% for aspirin, and shortened ELT to 71, 61 and 43%, vs. 43% for aspirin. In rats, venous occlusion time was prolonged. Arterial and venous thrombus weights were dose-dependently reduced in COM groups. TXB2 decreased and 6-keto-PGF1α increased with COM and aspirin, with an association between 6-keto-PGF1α/TXB2 and arterial or venous thrombus weight for all products, and for occlusion time with COM but not for aspirin.. We confirm the experimental effects of COM on hemostasis and thrombosis. Further exploration of putative clinical effects appear justified.

Topics: 6-Ketoprostaglandin F1 alpha; Animals; Blood Coagulation; Cardiovascular Agents; Carotid Artery Thrombosis; Chlorides; Collagen; Epinephrine; Ferric Compounds; Fibrinolysis; Hemostasis; Male; Mice, Inbred ICR; Phytotherapy; Plant Extracts; Plant Leaves; Pulmonary Embolism; Rats, Wistar; Rosaceae; Thromboxane B2; Vena Cava, Inferior; Venous Thrombosis

A 4 year-old boy was admitted to our clinic with symptoms of pain and ecchymosis in his right leg and foot after injection of benzathine penicilline. There was a localized gangrenous area at the femoral injection site. Doppler ultrasonography showed no arterial flow in the femoral artery and clear evidence of acute thrombosis of the superficial femoral and popliteal veins. Femoral arterial and venous thrombectomy and fasciotomy were performed immediately. After surgery the boy was treated by Iloprost infusion and enoxaparine. One week later necrotic changes had regressed, fasciotomies were closed and only the distal phalanx of the third toe needed amputation. Early surgical intervention and standard management combined with Iloprost infusion may help in healing the lesions by increasing extremity perfusion and may prevent extremity loss.

Topics: Amputation, Surgical; Anti-Bacterial Agents; Anticoagulants; Cardiovascular Agents; Child, Preschool; Combined Modality Therapy; Drug Eruptions; Enoxaparin; Fasciotomy; Gangrene; Humans; Iloprost; Infusions, Intravenous; Injections; Leg; Male; Penicillin G Benzathine; Thrombectomy; Toes; Treatment Outcome; Venous Thrombosis

We describe a patient who presented with typical symptoms of submassive pulmonary embolism associated with newly diagnosed cardiomyopathy. Contrast enhanced computed tomography demonstrated extensive venous thrombosis, and late enhancement cardiovascular magnetic resonance imaging was consistent with dilated cardiomyopathy with midwall fibrosis. We discuss the images and aetiology of the cardiomyopathy.

Topics: Adult; Anticoagulants; Cardiomyopathy, Dilated; Cardiovascular Agents; Fibrosis; Humans; Magnetic Resonance Imaging; Male; Myocardium; Pulmonary Embolism; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis

Topics: Acute Disease; Anticoagulants; Cardiovascular Agents; Catheter Ablation; Chronic Disease; Fibrinolytic Agents; Humans; Laser Therapy; Pulmonary Embolism; Sclerotherapy; Thrombectomy; Varicose Veins; Vascular Surgical Procedures; Vena Cava Filters; Venous Thrombosis

Topics: Cardiovascular Agents; Catheter Ablation; Chronic Disease; Diagnostic Imaging; Endoscopy; Humans; Leg Ulcer; Ligation; Lower Extremity; Microcirculation; Sclerotherapy; Stockings, Compression; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency; Venous Thrombosis