Journal of thrombosis and haemostasis : JTH
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J. Thromb. Haemost. · Mar 2006
Meta Analysis Comparative StudyDiagnosis of deep vein thrombosis and pulmonary embolism in pregnancy: a systematic review.
Diagnosing deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnancy is challenging. Many of the common diagnostic tests, including compression ultrasonography (CUS), ventilation-perfusion scintigraphy (VQ scan) and helical computed tomography (hCT) that have been extensively investigated in non-pregnant patients, have not been appropriately validated in pregnancy. Extrapolating results of diagnostic studies of DVT and PE in non-pregnant patients to those who are pregnant may not be correct because during pregnancy, physiologic and anatomic changes may affect diagnostic test results, presentation and natural history of VTE. ⋯ From our systematic analysis of published studies investigating diagnostic testing for a clinical suspicion of DVT in pregnancy we conclude that; (i) two studies support withholding anticoagulant therapy in pregnant women with a clinical suspicion of DVT and normal results on serial IPG (impedance plethysmography), however, IPG is no longer used; (ii) one study demonstrated that a normal CUS at presentation combined with a normal D-dimer test or an abnormal D-dimer test combined with normal serial CUS appears promising for safely excluding DVT in pregnant patients, but too few patients were included in this pilot-study to draw firm conclusions; and (iii) one study investigated pregnant patients with a clinical suspicion of PE and this study concluded that in patients with normal or non-diagnostic VQ scans, withholding anticoagulant therapy might be safe, but this needs confirmation in larger studies. Recommendations on diagnostic testing of pregnant patients with a clinically suspected DVT or PE are provided.
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J. Thromb. Haemost. · Mar 2006
Letter Randomized Controlled Trial Comparative Study Clinical TrialOral surgery in patients on oral anticoagulant therapy: a randomized comparison of different INR targets.
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J. Thromb. Haemost. · Mar 2006
Letter Clinical TrialThe effect of vitamin K supplementation on anticoagulant treatment.
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J. Thromb. Haemost. · Mar 2006
Multicenter Study Clinical TrialIncidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan.
Venous thromboembolism (VTE) has been considered to be a rare surgical complication in Japan. ⋯ Venous thromboembolism is common in Japanese patients undergoing major abdominal surgery. Pharmacologic thromboprophylaxis is considered essential, particularly in those patients with multiple, potential risk factors.