Prevention and treatment of venous thromboembolism - International Consensus Statement (Guidelines according to scientific evidence)

All patients at moderate to high risk for the development of venous thrombo- embolism should receive prophylaxis. The approaches of proven value include low-dose heparin, low molecular weight heparin, oral anticoagulants and intermittent pneumatic compression.

https://journals.sagepub.com/doi/pdf/10.1177/1076029612474840

Prevention and Treatment of Venous Thromboembolism: International Consensus Statement (Guidelines according to scientific evidence)

Thrombosis and disseminated intravascular coagulation are common complications of cancer. Specific conditions associated with cancer such as stasis due to immobilization or blood flow obstruction, surgery, infections, endothelium damage due to chemotherapeutic agents and abnormalities of blood coagulation contribute to the hypercoagulable and thrombophilic state of cancer patients. This procoagulant state in cancer arises mostly from the capacity of tumor cells to express and release procoagulant activities (cancer procoagulant and tissue factor). Decreased levels of inhibitors of coagulation, impaired fibrinolysis, the presence of antiphospholipid antibodies and an acquired activated protein C resistance contribute to the hypercoagulable state. The activation of coagulation is also implicated in tumor proliferation through interactions of coagulation with inflammation and increased tissue factor pathway inhibitor. Laboratory diagnosis of the thrombophilic state include (1) elevation of clotting factors, fibrinogen/fibrin degradation products, hyperfibrinogenemia and thrombocytosis and (2) elevation of specific markers of activation of coagulation: fibrinopeptide A, fragment 1 + 2, thrombin-antithrombin complexes and D-dimers. However, none of the tests has any predictive value for the occurrence of thrombotic events in one individual patient. In patients with venous thromboembolism a noninvasive screening for occult cancer is able to detect a relatively high incidence of hidden cancer and the search for thrombophilia seems important in patients without known cancer.

The thrombophilic state in cancer patients.

Prevention and Treatment of Venous Thromboembolism

The veins of the brain have no muscular tissue in their thin walls and possess no valves. They emerge from the brain and lie in the subarachnoid space. They pierce the arachnoid mater and the meningeal layer of the dura and drain into the cranial venous sinuses. The cerebral venous system can be divided into a superficial and a deep system. The superficial system comprises sagittal sinuses and cortical veins, which drain superficial surfaces of both cerebral hemispheres. The deep system consists of the lateral sinus, straight sinus and sigmoid sinus along with draining deeper cortical veins. Both of these systems mostly drain into internal jugular veins. Generally, venous blood drains into the nearest venous sinus or, in the case of blood draining from the deepest structures, into deep veins. The superficial cerebral veins are interlinked with anastomotic veins of Trolard and Labbé. Thus, the superolateral surface of the hemisphere drains into the superior sagittal sinus while the posteroinferior aspect drains into the transverse sinus. The veins of the posterior fossa are variable in course, and angiographic diagnosis of their occlusion is difficult. The entire deep venous system is drained by internal cerebral and basal veins, which join to form the great vein of Galen that drains into the straight sinus. Though variation in the superficial cerebral venous system is a rule, anatomic configuration of the deep venous system can be used as anatomic landmarks. Since thrombosis or surgical sacrifice of the cerebral veins may lead to venous infarction with serious complications, angiographic and surgical anatomy of the venous system should be seriously investigated for each individual patient. Copyright © 2008 S. Karger AG, Basel Cerebral Venous System Understanding cerebral venous system is important to describe the pathophysiology and treatment of cerebral venous thrombosis. Especially when surgery is planned, one has to be able to recognize the major veins and sinuses and to describe their direction of flow. A surgery that involves sacrificing some

Handbook of Cerebral Venous Thrombosis

Objectif: La frequence de la resistance a la proteine C activee (PCa) dans la maladie thrombo-embolique veineuse est encore mal precisee (entre 8,3 et 64 p. 100). Methodes: Nous avons etudie la resistance a la PCa chez 175 patients ayant des antecedents de thromboses veineuses profondes ou superficielles. Le test utilise est fonde sur le temps de coagulation APTT avec et sans PCa. Les resultats sont exprimes en rapport temps avec PCa sur temps sans PCa. Une population-temoin de 50 sujets consideres comme sains a permis de definir la valeur inferieure limite (moyenne des rapports - 2 deviations standard) a 2,!4. Resultats: Nous trouvons 29 patients (soit 17 p. 100) resistants a la PCa selon cette definition. Deux sujets consideres comme sains (4 p, 100) sont resistants a la PCa. Nos resultats ne montrent pas d'influence de l'âge, du sexe sur les resultats de la resistance a la PCa. Les episodes thrombotiques sont essentiellement des thromboses veineuses profondes et/ou des embolies pulmonaires souvent recidivantes et frequemment associees a la prise d'un traitement hormonal ou a la grossesse. Commentaires: En comparant nos resultats avec ceux actuellement publies, 3 a 5 p. 100 des sujets d'une population consideree comme normale et 15 a 25 p. 100 des sujets ayant des antecedents thrombo-emboliques sont resistants a la PCa. La resistance a la PCa semble donc le plus frequent facteur pouvant predisposer aux accidents thrombotiques, comparativement aux autres causes de thrombophilie familiale

Resistance to activated protein C in venous thromboembolic complications. Incidence and clinical manifestations

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Resistance to activated protein C in venous thromboembolic complications. Incidence and clinical manifestations