Late results of treatment of deep vein thrombosis

Kakkar, Vijay V.; Howe, C. T.; Laws, J. W.; Flanc, C

doi:10.1136/bmj.1.5647.808

Cited by 48 publications

(12 citation statements)

References 3 publications

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“…The results show that thrombolysis is more effective with streptokinase than with either heparin or Arvin, and the findings in the following paper confirm this conclusion (Kakkar et al, 1969b). There seems little to choose between heparin and Arvin as regards their anticoagulant potential.…”

Section: Discussionsupporting

confidence: 69%

Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Vv¹,

Flanc²,

Howe³

et al. 1969

BMJ

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250

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Symptomatic infection developed in 16 of the 45 untreated bacteriuric women (36%). Loin pain and fever developed in onlv two of these subjects, whereas in the remainder the symptoms were frequency and dysuria. Comparison of these findings with the natural history of asymptomatic significant bacteriuria in pregnancy shows that the total incidence of symptomatic infection is similar. The distinguishing feature between the natural history of asymptomatic significant bacteriuria in pregnant and non-pregnant women is the severity of symptoms. Asscher et a!. (1966) showed that in pregnancy the urine is continuously maintained at optimal pH for the growth of urinary pathogens. It may be that the greater severity of symptomatic infections arising in pregnant bacteriuric women is related to this.A single course of treatment initially cured bacteriuria in 80 U, of cases, but was soon followed by relapses and reinfections, particularly in women who had been shown to have radiological abnormalities. One year after treatment, therefore, the cure rates among treated and untreated bacteriuric subjects no longer showed a significant difference. Not surprisingly, therefore, treatment failed to prevent the development of symptoms of overt infection. Moreover, it has been shown that the reinfections which followed treatment were more commonly associated with the development of symptoms than the persistent or relapsing infections in the untreated or unsuccessfully treated subjects. This would suggest that bacteriuric women may have developed tolerance to the particular organism harboured in their urinary tract and that treatment can temporarily upset this equilibrium. The occurrence of tolerance to the pyrogenic substances of Gram-negative bacteria in animals and humans with urinary tract infections has been demonstrated by McCabe (1963) and may explain the more frequent development of symptoms in subjects who are reinfected after treatment.Our observations suggest that a search for significant bacteriuria in non-pregnant female populations does not satisfy either of the principal requirements of a good screening procedure. In many instances it fails to detect urinary tract infection at an early and reversible stage of its natural history (Sussman et al., 1969), and treatment suitable for use on a large scale fails to alter its natural history. The present study still leaves an important gap in our understanding of the clinical significance of bacteriuria-namely, its relationship to the ultimate development of scarring and contraction of the kidneys and of renal failure. It is hoped that long-term follow-up of the bacteriuric and control subjects of this study will help us to provide an answer. At present it seems likely that even if persistent bacteriuria did lead to progressive renal damage its eradication would be difficult, costly, time-consuming, and probably hazardous.

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Section: Discussionsupporting

confidence: 69%

Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Vv¹,

Flanc²,

Howe³

et al. 1969

BMJ

Self Cite

250

View full text Add to dashboard Cite

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“…Thus, altogether 13 of the 17 patients in the streptokinase group had no clinical signs of their previous thrombosis. Four patients had moderate signs such as oedema, varicose veins and/or pathological pigmentation, Previous studies on the late results of streptokinase or heparin therapy in deep vein thrombosis are few, although optimistic results have been reported (2,4,6). To our knowledge, only 2 reports on originally randomized trials have so far been published.…”

Section: Discussionmentioning

confidence: 93%

Streptokinase or Heparin in the Treatment of Deep Vein Thrombosis

Arnesen

Høiseth

1982

Journal of Internal Medicine

207

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In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4 % of the streptokinase-treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 64 years. Seven patients had died and there were no other drop-outs. Thus, 35 patients were subjected to the follow-up study consisting of phlebography and clinical examination. The evaluations were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p cO.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In contrast, 3 of the heparin-treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment at present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes.

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“…High deep vein thrombosis is predominantly found to give rise to valvular insufficiency and postthrombotic syndrome sequelae (5,15). The present study was designed to compare the results of treatment of high thrombosis with special reference to posttherapeutic valvular function using two regimes A L ' I~I Mrd S i ' N t l d 20.5…”

Section: Discussionmentioning

confidence: 99%

Rapid Thrombolysis and Preservation of Valvular Venous Function in High Deep Vein Thrombosis

Watz

Savidge

1979

Journal of Internal Medicine

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ABSTRACT. The results of streptokinase and heparin treatment are compared in a 4‐year prospective study with special reference to preservation of high valvular venous function. An objective assessment was based upon phlebographic examinations before, during and 1–2 months after therapy. Complete lysis was demonstrated in 44% of high thromboses treated with streptokinase and in 6% treated with heparin. Retrograde phlebography revealed normal function of the proximal femoral valves in 92% of streptokinase‐treated high thromboses, compared with 13% of those treated with heparin. These phlebographic results were considered to be a valid prognostic indicator of the eventual development of the postthrombotic syndrome. Allergic reactions were seen in 39% and minor haemorrhagic complications in 18% of the streptokinase‐treated cases. The therapeutic benefit of streptokinase therapy in this study was found to outweigh any disadvantages incurred by observed complications.

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Late results of treatment of deep vein thrombosis

Cited by 48 publications

References 3 publications

Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Streptokinase or Heparin in the Treatment of Deep Vein Thrombosis

Rapid Thrombolysis and Preservation of Valvular Venous Function in High Deep Vein Thrombosis

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