TROMBOSI VENOSA PROFONDA IDIOPATICA INIZIALE
Duration
of anticoagulant therapy after initial idiopathic venous
thromboembolism.
Frazee LA-
Ann. Pharmacother. 2003- Oct 37, 10,
1489-96
Revisione della letteratura 1967-2003 aprile-
I dati rilevano un rischio uguale dopo un primo episodio rispetto ai pz con fattori di rischio permanente.
Il livello di coagulazione ottimale è ancora da verificare.
Forse non differenza tra 3 e 6 mesi.
Clinical
impact of bleeding in patients taking oral anticoagulant therapy for
venous
thromboembolism. A meta-analysis. Ann Intern Med
2003,139,893-900
Anomalies
of the inferior vena cava in patients with iliac venous thrombosis.
Ann Int Med
2002,136,37
Durante l’embriogenesi la vena cava si forma dall’unificazione di tre condotti venosi. Se questo processo non si completa si possono verificare delle anomalie congenite che hanno una prevalenza da 0,07-all’8,7%.
Sospettare quando trombosi vene iliache in età < a 30 anni.- Rischio di recidiva maggiore.
La trombosi può
essere innescata da sforzo muscolare intenso, viaggi in macchina
prolungata.
EMBOLIA POLMONARE
Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events
Grifoni S-Una
disfunzione del ventricolo dx alla dimissione dopo una embolia
polmonare si associa a recidiva di trombosi venosa.
La disfunzione VD veniva diagnosticata in base ad uno o più dei
seguenti criteri: dilatazione ventricolare dx senza
ipertrofia.movimento settale paradosso sistolico del setto
interventricolare,, evidenza doppler di ipertensione polmonare. OR 3,79
Arch Intern med 2006 Oct 23; 166(19): 2151-6
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J Vasc Surg. 2007 Feb;45(2):328-34.
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Paget-Schroetter syndrome treated with thrombolytics and immediate surgery.
Department of Surgery, Divisions of Cardiothoracic Surgery and Interventional Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA. molin001@umn.edu
INTRODUCTION: Reviewed are the results of the emergent treatment of effort thrombosis of the subclavian vein. The protocol calls for immediate thrombolysis, followed by surgery at the time of the acute event. The one-stage procedure includes decompression of the thoracic inlet by subclavicular removal of the first rib, subclavius muscle, scalenectomy, and vein patch plasty of the stenotic segment of the vein. METHODS: Between July 1985 through June 2006, 114 patients presented with Paget-Schroetter syndrome (effort thrombosis of the subclavian vein), 97 of which (group I) were seen < or =2 weeks of onset of symptoms. They underwent an emergent protocol treatment in which thrombolysis is immediately followed by surgery at the time of the acute event. In addition, another 17 patients (group II) were referred to our institution after being treated elsewhere with initial thrombolysis, but with surgery deferred a mean 34 days (range, 2 weeks to 3 months) after the initial event. All patients underwent the same lytic and surgical protocol. Operability was determined by the findings on the venogram. Routine postoperative anticoagulation for 8 weeks was implemented with warfarin and clopidogrel. RESULTS: There was 100% success in re-establishing the flow and normal caliber of the subclavian vein in the 97 patients in group I. Seven patients showed some residual stenosis that required balloon plasty and implant of a stent. Postoperative duplex ultrasound imaging documented patency in all 97 patients (100%). The 17 patients with delayed surgery (group II) showed progression of the fibrosis, with vein obstruction in 12 (70%). Only five patients (29%) were operable with successful results. The remaining 12 patients were inoperable owing to extensive fibrosis and occlusion of the inflow, and all 12 have remained disabled for the use of their arm. CONCLUSIONS: The emergent approach to treat Paget-Schroetter syndrome seems to render the optimal results, with 100% effectiveness in re-establishing venous flow and normal caliber to the vessel. When properly conducted, this operation avoids the use of stents or balloon plasty with excellent long-term results, leaving the patients unrestricted for physical activities.
Marzo 2007