International angiology : a journal of the International Union of Angiology
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Clinical Trial
Duplex screening as a method of quality assurance of perioperative thromboembolism prophylaxis.
Improvements in thrombosis prophylaxis in both the operative and non-operative fields aim to reduce further the not inconsiderable residual risk of suffering a deep vein thrombosis or embolism. The goal of the study was to establish the part played in a quality assurance strategy by early diagnosis of a thrombosis and by knowledge of the hospital's internal patient-risk profile in order to counter the unpredictability of thromboembolic complications and make rational decisions about thromboembolism prophylaxis. ⋯ Duplex ultrasound screening for asymptomatic deep vein thrombosis thus proves to be a suitable instrument for internal hospital quality control in thrombosis prophylaxis. Its routine use can be recommended at least in high-risk patients, not only from the medicolegal aspect but also from the purely economic aspect.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy of a low molecular weight heparin administered intravenously or subcutaneously in comparison with intravenous unfractionated heparin in the treatment of deep venous thrombosis. Certoparin-Study Group.
The main objective of the study presented was to test if thrombus regression can be improved by treatment with an intravenously or subcutaneously administered low molecular weight heparin (LMWH). Patients with acute deep vein thrombosis were randomly assigned to receive either intravenous UFH (131 patients), intravenous (i.v.) LMWH (128 patients), or 8000 IU of the same LMWH bid subcutaneously (s.c.) (128 patients). All patients were treated with heparin for 14 to 16 days. Vitamin-K-antagonist prophylaxis was started between Day 12 and Day 14 after enrollment into the study. ⋯ S.c. treatment with a LMWH (certoparin) (b.i.d.) is at least as effective as UFH i.v. The hypothesis of increased efficacy of subcutaneous LMWH in resolving venous thrombi will have to be confirmed by an independent study comparing s.c. LMWH with UFH. The i.v. continuous infusion of the LMWH for 12 to 16 days does not result in a higher venous re-opening rate than intravenous standard heparin.
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Randomized Controlled Trial Clinical Trial
Transcutaneous oxygen pressure as predictive parameter for ulcer healing in endstage vascular patients treated with spinal cord stimulation.
This study was designed to test the hypothesis that initial TcPO2 helps predict clinical outcome in vascular patients treated with spinal cord stimulation. A randomized-controlled study with one year follow-up was made in 86 Fontaine stage IV patients with endstage peripheral arterial occlusive disease (PAOD) undergoing 21 day intravenous prostaglandin E1 (PGE1) therapy for nonhealing ulcers. ⋯ Spinal cord stimulation appears to provide a major benefit for lesion improvement in stage IV patients with non-reconstructible PAOD. Patients with an initial TcPO2 > 10 mmHg will respond better to the stimulation therapy. With pain relief and ulcer healing quality of life improved. Effects on limb salvage do not appear.
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Duplex ultrasonography has gained enormous importance in the vascular practice over the last decade. Technological development with the colour application as well as the high resolution imaging have altered the diagnostic approach, treatment and follow-up of the vascular patients. ⋯ This article presents an overview of the revolutionary role of the ultrasonic investigations in the arterial and venous disease and outlines the possible limitations of the technique. Financial aspects of its use in the health care system and potential advents in the near future are also discussed.