Regular Exercise Reduces Risk Of Blood Clots
21 Nov 2007
According to a new study published in Journal of Thrombosis and Haemostasis, regular participation in sports reduces the risk of developing blood clots by 39 percent in women and 22 percent in men.
Researchers from Leiden University Medical Center in the Netherlands evaluated 7,860 people aged 18-70. Patients who had suffered their first blood clot in a leg vein or lung artery were compared with control subjects who had never experienced blood clots. 31 percent of the patients and 40 percent of the control group participated in sports on a regular basis.
Overall figures for both sexes showed that participating in sports at least once per week, regardless of the type of sport or its intensity, reduced the risk of developing a blood clot in a lung artery by 46 percent and a blood clot in a leg vein by 24 percent. "Women were shown to be even more likely to reap the benefits of regular sporting activities than men," says F.R. Rosendaal, co-author of the study. "When we excluded women who were pregnant or receiving oral contraceptive or hormone replacement therapy - all possible causes of blood clots - the risk for women was reduced by 55 percent."
The authors note that, while strenuous activity is known to increase the risk of blood clot development in the elderly, regular exercise is also shown to greatly benefit the heart, and that the net effect of elderly sports participation may be positive.
The findings also show that people who did not participate in sports were more than four-times as likely to develop a blood clot if they were obese (with a body mass index of 30 or greater) than lean (with a body mass index of less than 25). "When we looked at the results, we found that, overall, the mere fact that people took part in a sporting activity at least once a week was enough to lower their risk of blood clots," say the authors.
Article adapted by Medical News Today from original press release.
Showing posts with label Pulmonary Embolism. Show all posts
Showing posts with label Pulmonary Embolism. Show all posts
Wednesday, November 21, 2007
Monday, November 12, 2007
Treatment of pulmonary embolism in critical illness
Treatment of pulmonary embolism in critical illness
A very helpful review appeared recently in Chest. Key points follow:
Assessment
Get a bigger bang for the buck with CT by measuring RV and LV diameters. RV/LV diameter ratios over 0.9 are concerning for right ventricular dysfunction.
Echocardiography is useful in the assessment of RV function.
Biomarkers (troponin, BNP, ProBNP) are potentially useful indicators of RV damage and wall stress. Given the shorter half life of BNP and ProBNP these markers are more useful than troponin for assessment of patient progress in real time. Q 12 hour determinations are suggested by the authors.
Assessment of RV function by any means is useful for assessing risk. Negative predictive power exceeds positive predictive power.
Hemodynamic support
Judicious volume infusion can improve RV function. Theoretical adverse effects of RV over distension are cited.
Norepinephrine is favored for vasopressor support. However, this is based largely on animal data. High level comparative clinical studies are not available.
Antithrombotic and antiembolic strategiesIntravenous anticoagulants are favored over subcutaneously administered anticoagulants if the patient is critically ill.
Concerning contraindications the authors state: Only rarely is anticoagulant treatment flatly contraindicated (eg, active hemorrhage in the brain or another vital organ, uncontrolled bleeding threatening tissue perfusion); but in those situations, consideration of prompt placement of a vena cava filter (see below) and clot removal (see above) should be undertaken.
The established indication for intravenous thrombolytic therapy is PE causing shock. Potential indications are deterioration despite standard treatment and normotensive patients with RV dysfunction.
Link: http://doctorrw.blogspot.com/
A very helpful review appeared recently in Chest. Key points follow:
Assessment
Get a bigger bang for the buck with CT by measuring RV and LV diameters. RV/LV diameter ratios over 0.9 are concerning for right ventricular dysfunction.
Echocardiography is useful in the assessment of RV function.
Biomarkers (troponin, BNP, ProBNP) are potentially useful indicators of RV damage and wall stress. Given the shorter half life of BNP and ProBNP these markers are more useful than troponin for assessment of patient progress in real time. Q 12 hour determinations are suggested by the authors.
Assessment of RV function by any means is useful for assessing risk. Negative predictive power exceeds positive predictive power.
Hemodynamic support
Judicious volume infusion can improve RV function. Theoretical adverse effects of RV over distension are cited.
Norepinephrine is favored for vasopressor support. However, this is based largely on animal data. High level comparative clinical studies are not available.
Antithrombotic and antiembolic strategiesIntravenous anticoagulants are favored over subcutaneously administered anticoagulants if the patient is critically ill.
Concerning contraindications the authors state: Only rarely is anticoagulant treatment flatly contraindicated (eg, active hemorrhage in the brain or another vital organ, uncontrolled bleeding threatening tissue perfusion); but in those situations, consideration of prompt placement of a vena cava filter (see below) and clot removal (see above) should be undertaken.
The established indication for intravenous thrombolytic therapy is PE causing shock. Potential indications are deterioration despite standard treatment and normotensive patients with RV dysfunction.
Link: http://doctorrw.blogspot.com/
Tuesday, July 3, 2007
Four Non-stop Hours Of Travel Doubles DVT Risk
Four Non-stop Hours Of Travel Doubles DVT Risk
01 Jul 2007
Regardless of whether a passenger is traveling by plane, bus or car, after four hours of continuous seated travel, the risk of developing Deep Vein Thrombosis (DVT) doubles, says the World Health Organization (WHO). However, the absolute risk, at 1 in every 6,000 passengers, is low.
WHO also stated that taking two or more flights in succession or over a short period also raised the risk of developing DVT. The main reason is that after a long flight the risk takes about four weeks to wear off.
The two most common manifestations of developing venous thromboembolism (VTE) are deep vein thrombosis (DVT) and pulmonary embolism. DVT is a condition in which a thrombus, or a blood clot develops in a deep vein - generally in the lower leg. The patient might feel pain and tenderness and notice a swelling around the affected area. DVT can be treated. When associated with thromboembolism DVT can be life-threatening.
Thromboembolism is when a DVT blood clot breaks loose and becomes lodged in the lung and blocks blood flow - what is known as pulmonary embolism. With pulmonary embolism the patient may feel chest pains and experience breathing difficulties. If left untreated VTO can lead to death.
For car, plane and bus passengers to run a higher risk of DVT during long trips, they need to remain seated and immobile.
Other factors that may influence VTE risk during long trips:
Obesity
Being taller than 1.9 meters (nearly 6ft 3 inches)
Being shorter than 1.6 meters (5ft 3 inches)
Oral contraceptive use
Inherited blood disorders leading to increased clotting tendency
Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Non-communicable Disease and Mental Health, said "The study does confirm that there is an increased risk of venous thromboembolism during travel where the passenger is seated and immobile for over four hours, whether in a plane, train, bus or car. However, it is important to remember that the risk of developing VTE when travelling remains relatively low".
Although this study did not investigate preventive measures against DVT and VTE, experts recommend passengers observe the following tips:
Exercise your calf muscles with up-and-down movements of the feet at the ankle joints. This encourages blood flow in the calf muscle veins - which in turn reduces blood stagnation.
Avoid wearing tight clothing when you travel
There are special socks you can wear. Many airlines supply them; you can also buy them at most airports and several pharmacies.
WRIGHT project report
Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
01 Jul 2007
Regardless of whether a passenger is traveling by plane, bus or car, after four hours of continuous seated travel, the risk of developing Deep Vein Thrombosis (DVT) doubles, says the World Health Organization (WHO). However, the absolute risk, at 1 in every 6,000 passengers, is low.
WHO also stated that taking two or more flights in succession or over a short period also raised the risk of developing DVT. The main reason is that after a long flight the risk takes about four weeks to wear off.
The two most common manifestations of developing venous thromboembolism (VTE) are deep vein thrombosis (DVT) and pulmonary embolism. DVT is a condition in which a thrombus, or a blood clot develops in a deep vein - generally in the lower leg. The patient might feel pain and tenderness and notice a swelling around the affected area. DVT can be treated. When associated with thromboembolism DVT can be life-threatening.
Thromboembolism is when a DVT blood clot breaks loose and becomes lodged in the lung and blocks blood flow - what is known as pulmonary embolism. With pulmonary embolism the patient may feel chest pains and experience breathing difficulties. If left untreated VTO can lead to death.
For car, plane and bus passengers to run a higher risk of DVT during long trips, they need to remain seated and immobile.
Other factors that may influence VTE risk during long trips:
Obesity
Being taller than 1.9 meters (nearly 6ft 3 inches)
Being shorter than 1.6 meters (5ft 3 inches)
Oral contraceptive use
Inherited blood disorders leading to increased clotting tendency
Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Non-communicable Disease and Mental Health, said "The study does confirm that there is an increased risk of venous thromboembolism during travel where the passenger is seated and immobile for over four hours, whether in a plane, train, bus or car. However, it is important to remember that the risk of developing VTE when travelling remains relatively low".
Although this study did not investigate preventive measures against DVT and VTE, experts recommend passengers observe the following tips:
Exercise your calf muscles with up-and-down movements of the feet at the ankle joints. This encourages blood flow in the calf muscle veins - which in turn reduces blood stagnation.
Avoid wearing tight clothing when you travel
There are special socks you can wear. Many airlines supply them; you can also buy them at most airports and several pharmacies.
WRIGHT project report
Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
Saturday, May 19, 2007
SAEM: Clinical Protocol Can Rule Out Pulmonary Embolism
SAEM: Clinical Protocol Can Rule Out Pulmonary Embolism
CHICAGO, May 17 -- Simple clinical criteria to rule out a pulmonary embolism can substitute for blood tests and CT scanning, according to researchers here.
The criteria, making up the so-called the PERC rule, consider eight clinical factors. If all eight are absent (PERC-negative) the probability of pulmonary embolism is quite low, said Jeff Kline, M.D., of the Carolinas Medical Center in Charlotte, N.C., and colleagues, at a Society for Academic Emergency Medicine meeting here.
The PERC rule includes clinical criteria such as age less than 50, pulse rate less than 100, 95% oxygen saturation level, no prior pulmonary embolism or deep vein thrombosis, and no recent surgery.
Ninety percent of the blood tests and ultrafast CT scans to detect pulmonary embolism turn out to be negative, the investigators said.
Over-testing for pulmonary embolism has emerged as a contentious issue, the researchers said. The CT scan may cost $2,500, has the potential for kidney damage in one of 12 patients, and has a heavy radiation dose. Yet physicians are ordering these tests for 2% to 3% of all emergency department patients, or 3.5 million patients a year, Dr. Kline said. Furthermore, the fear of medical malpractice has led to doing tests rather than using the data available through clinical evaluation.
To evaluate PERC, the authors from 2004 to 2006 enrolled 8,138 consecutive or random patients from 13 U.S. academic and community emergency departments staffed by emergency physicians. The patients' chief complaints were chest pain (52%), dyspnea (30%), cough (3%), syncope (2%), or other (12%).
The physicians' evaluations preceded the test results. Tests for pulmonary embolism were D-dimer (72%), CT (54%) and VQ scans (8%).
In the best case, PERC could reduce testing for pulmonary embolism by about 20% to 25%, the researchers said. Fully two-thirds of the testing was done for patients where the physician believed the probability of pulmonary embolism was less than 15%.
The authors found that the emergency physicians thought another diagnosis was more likely than pulmonary embolism in 83% of the cases, and that 67% were at low risk.
Of the patients, 524 (6.9%) were positive for image proven venous thromboembolism (pulmonary embolism or deep vein thrombosis). The median prevalence of positive venous thromboembolism across the 13 emergency departments was 6.7%.
From the entire cohort, 25% were PERC-negative, and only 1.2% of these patients were positive for venous thromboembolism. This equaled a diagnostic sensitivity of 95.6% (93.5 to 97.2%) and a specificity of 25.6% (24.6 to 26.6%).
Among low-risk patients, 1,519 (20% of the cohort) were PERC-negative, 14 (0.9%, 0.5 to 1.5%) were positive for venous thromboembolism, but none died.
Thus, low risk and PERC-negative had a sensitivity of 97.3% and specificity of 21.5%.
The combination of an emergency physician's impression that a patient is at low risk for pulmonary embolism, together with a negative PERC, provides compelling rationale to not order a test for pulmonary embolism, the researchers concluded.
This multicenter collaborative project shows that a careful history and physical examination can achieve the same degree of certainty without the cost and side effects of diagnostic testing.
The ability to document "PERC Rule negative" on the chart will provide physicians with the scientific and medicolegal backstop they need to justify not ordering a test on every patient with even a hint of pulmonary embolism, the investigators said.
Primary source:
Society for Academic Emergency Medicine 2007 MeetingSource reference: Kline J et al "Prospective, Multicenter Validation of the Pulmonary Embolism Rule-Out Criteria," presented May 16.
Abstracts are published in Vol. 14, Issue 5S, the May 2007 supplement of the official journal of the SAEM, Academic Emergency Medicine
CHICAGO, May 17 -- Simple clinical criteria to rule out a pulmonary embolism can substitute for blood tests and CT scanning, according to researchers here.
The criteria, making up the so-called the PERC rule, consider eight clinical factors. If all eight are absent (PERC-negative) the probability of pulmonary embolism is quite low, said Jeff Kline, M.D., of the Carolinas Medical Center in Charlotte, N.C., and colleagues, at a Society for Academic Emergency Medicine meeting here.
The PERC rule includes clinical criteria such as age less than 50, pulse rate less than 100, 95% oxygen saturation level, no prior pulmonary embolism or deep vein thrombosis, and no recent surgery.
Ninety percent of the blood tests and ultrafast CT scans to detect pulmonary embolism turn out to be negative, the investigators said.
Over-testing for pulmonary embolism has emerged as a contentious issue, the researchers said. The CT scan may cost $2,500, has the potential for kidney damage in one of 12 patients, and has a heavy radiation dose. Yet physicians are ordering these tests for 2% to 3% of all emergency department patients, or 3.5 million patients a year, Dr. Kline said. Furthermore, the fear of medical malpractice has led to doing tests rather than using the data available through clinical evaluation.
To evaluate PERC, the authors from 2004 to 2006 enrolled 8,138 consecutive or random patients from 13 U.S. academic and community emergency departments staffed by emergency physicians. The patients' chief complaints were chest pain (52%), dyspnea (30%), cough (3%), syncope (2%), or other (12%).
The physicians' evaluations preceded the test results. Tests for pulmonary embolism were D-dimer (72%), CT (54%) and VQ scans (8%).
In the best case, PERC could reduce testing for pulmonary embolism by about 20% to 25%, the researchers said. Fully two-thirds of the testing was done for patients where the physician believed the probability of pulmonary embolism was less than 15%.
The authors found that the emergency physicians thought another diagnosis was more likely than pulmonary embolism in 83% of the cases, and that 67% were at low risk.
Of the patients, 524 (6.9%) were positive for image proven venous thromboembolism (pulmonary embolism or deep vein thrombosis). The median prevalence of positive venous thromboembolism across the 13 emergency departments was 6.7%.
From the entire cohort, 25% were PERC-negative, and only 1.2% of these patients were positive for venous thromboembolism. This equaled a diagnostic sensitivity of 95.6% (93.5 to 97.2%) and a specificity of 25.6% (24.6 to 26.6%).
Among low-risk patients, 1,519 (20% of the cohort) were PERC-negative, 14 (0.9%, 0.5 to 1.5%) were positive for venous thromboembolism, but none died.
Thus, low risk and PERC-negative had a sensitivity of 97.3% and specificity of 21.5%.
The combination of an emergency physician's impression that a patient is at low risk for pulmonary embolism, together with a negative PERC, provides compelling rationale to not order a test for pulmonary embolism, the researchers concluded.
This multicenter collaborative project shows that a careful history and physical examination can achieve the same degree of certainty without the cost and side effects of diagnostic testing.
The ability to document "PERC Rule negative" on the chart will provide physicians with the scientific and medicolegal backstop they need to justify not ordering a test on every patient with even a hint of pulmonary embolism, the investigators said.
Primary source:
Society for Academic Emergency Medicine 2007 MeetingSource reference: Kline J et al "Prospective, Multicenter Validation of the Pulmonary Embolism Rule-Out Criteria," presented May 16.
Abstracts are published in Vol. 14, Issue 5S, the May 2007 supplement of the official journal of the SAEM, Academic Emergency Medicine
Thursday, May 17, 2007
Ruling Out Pulmonary Embolism With A Simple Bedside Protocol
Medical News Today
Ruling Out Pulmonary Embolism With A Simple Bedside Protocol
16 May 2007
Although clots in the lung (pulmonary embolism or PE) are the second-leading cause of sudden death in the United States, blood tests and ultrafast CT scanning to detect PE are being used on so many patients that over 90% of these tests are negative. In a paper to be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, Jeff Kline, MD, Carolinas Medical Center, Charlotte, NC, will show that the use of simple clinical criteria can eliminate the risk and expense of these unnecessary tests.
The Pulmonary Embolism Rule-out Criteria, or the PERC rule, functions as a way to rule out clots in the lung. The blood test, called D-Dimer, has a very low specificity for PE, leading to many false positives. The CT scan costs $2500, has the potential for kidney damage in 1 in 12 patients, and has a heavy radiation dose that increases lifetime risk of cancer. Yet, doctors are ordering these tests for 2-3% of all Emergency Department patients or 3.5 million cases per year. According to the author, the fear of medical malpractice has led to a culture of doing tests rather than using the data available through clinical evaluation.
The study looked at an 8,138 patient random sample from 13 hospitals. By using a Web-based real-time data collection method and an extremely rigorous study design, it was able to capture the doctor's beliefs at the time of treatment, prior to the time that results were available. Importantly, the study design captured the physicians "gestalt" or gut instinct of how likely they thought PE was on their list. The results showed that fully two thirds of all testing is done in patients where the physician believed that the probability of PE was less than 15%.
In the best case, this study could reduce testing for PE by approximately 20-25%. More importantly, this is a first step toward a culture change of using intelligent clinical criteria instead of expensive technology to rule out life-threatening disease. According to Dr. Kline, "I interpret our data as a manifestation of the erosion of the physician-patient relationship.
Physicians now believe more than ever that every patient with any hint of a life-threatening illness should have the most expensive, most technological 'standard-of-care' diagnostic test ordered to rule out that illness. This multicenter collaborative project shows that we can use a careful history and physical examination to achieve the same degree of certainty without the cost and side effects of diagnostic testing. Patients do not want a technician to check off tests on an order sheet while the physician hurries off to see the next patient. The ability to document 'PERC rule negative' on the chart will provide physicians with the scientific and medicolegal backstop they need to justify not ordering a test on every patient with any hint of PE in their history or physical examination."
The presentation is entitled "Prospective, Multicenter Validation of the Pulmonary Embolism Rule-Out Criteria" by Jeff Kline, MD, of the Carolinas Medical Center. This paper will be presented at the 2007 SAEM Annual Meeting, May 16-19, 2007, Chicago, IL on Wednesday, May 16th, in the Plenary Session beginning at 1:00 PM in Sheraton 4 & 5 of the Sheraton Chicago Hotel & Towers. Abstracts of the papers presented are published in Volume 14, Issue 5S, the May 2007 supplement of the official journal of the SAEM, Academic Emergency Medicine.
Ruling Out Pulmonary Embolism With A Simple Bedside Protocol
16 May 2007
Although clots in the lung (pulmonary embolism or PE) are the second-leading cause of sudden death in the United States, blood tests and ultrafast CT scanning to detect PE are being used on so many patients that over 90% of these tests are negative. In a paper to be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, Jeff Kline, MD, Carolinas Medical Center, Charlotte, NC, will show that the use of simple clinical criteria can eliminate the risk and expense of these unnecessary tests.
The Pulmonary Embolism Rule-out Criteria, or the PERC rule, functions as a way to rule out clots in the lung. The blood test, called D-Dimer, has a very low specificity for PE, leading to many false positives. The CT scan costs $2500, has the potential for kidney damage in 1 in 12 patients, and has a heavy radiation dose that increases lifetime risk of cancer. Yet, doctors are ordering these tests for 2-3% of all Emergency Department patients or 3.5 million cases per year. According to the author, the fear of medical malpractice has led to a culture of doing tests rather than using the data available through clinical evaluation.
The study looked at an 8,138 patient random sample from 13 hospitals. By using a Web-based real-time data collection method and an extremely rigorous study design, it was able to capture the doctor's beliefs at the time of treatment, prior to the time that results were available. Importantly, the study design captured the physicians "gestalt" or gut instinct of how likely they thought PE was on their list. The results showed that fully two thirds of all testing is done in patients where the physician believed that the probability of PE was less than 15%.
In the best case, this study could reduce testing for PE by approximately 20-25%. More importantly, this is a first step toward a culture change of using intelligent clinical criteria instead of expensive technology to rule out life-threatening disease. According to Dr. Kline, "I interpret our data as a manifestation of the erosion of the physician-patient relationship.
Physicians now believe more than ever that every patient with any hint of a life-threatening illness should have the most expensive, most technological 'standard-of-care' diagnostic test ordered to rule out that illness. This multicenter collaborative project shows that we can use a careful history and physical examination to achieve the same degree of certainty without the cost and side effects of diagnostic testing. Patients do not want a technician to check off tests on an order sheet while the physician hurries off to see the next patient. The ability to document 'PERC rule negative' on the chart will provide physicians with the scientific and medicolegal backstop they need to justify not ordering a test on every patient with any hint of PE in their history or physical examination."
The presentation is entitled "Prospective, Multicenter Validation of the Pulmonary Embolism Rule-Out Criteria" by Jeff Kline, MD, of the Carolinas Medical Center. This paper will be presented at the 2007 SAEM Annual Meeting, May 16-19, 2007, Chicago, IL on Wednesday, May 16th, in the Plenary Session beginning at 1:00 PM in Sheraton 4 & 5 of the Sheraton Chicago Hotel & Towers. Abstracts of the papers presented are published in Volume 14, Issue 5S, the May 2007 supplement of the official journal of the SAEM, Academic Emergency Medicine.
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