PMID- 11136946
OWN - NLM
STAT- MEDLINE
DCOM- 20010125
LR  - 20220408
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 32
IP  - 1
DP  - 2001 Jan
TI  - Venous thromboembolism after acute stroke.
PG  - 262-7
AB  - BACKGROUND: Treatment for venous thromboembolism (VTE) is highly effective in 
      preventing morbidity and mortality, yet pulmonary embolism (PE) accounts for up 
      to 25% of early deaths after stroke. This is because the current diagnostic 
      paradigm is reactive rather than proactive: the clinician responds to VTE when it 
      becomes symptomatic, in the expectation that initiation of treatment will prevent 
      progression to more serious manifestations. This approach is flawed, because 
      sudden death from PE is frequently unheralded and nonfatal symptomatic pulmonary 
      emboli are often unrecognized or misdiagnosed. SUMMARY OF COMMENT: Morbidity and 
      mortality from PE could be reduced either by more effective thromboprophylaxis or 
      earlier diagnosis and treatment of established VTE. The fact that early use of 
      short-term, low-dose, unfractionated heparin (UFH) is not associated with 
      sustained, clinically meaningful benefit suggests that a fundamental change in 
      the diagnostic approach to VTE is needed, one which requires a greater 
      appreciation that clinically apparent events are merely the tip of the 
      thromboembolism iceberg. CONCLUSIONS: Research into a strategy of screening for 
      subclinical VTE in these patients is needed, with a view to identifying a 
      subgroup at risk of progression to symptomatic and life-threatening events, in 
      whom outcome might be improved by anticoagulation.
FAU - Kelly, J
AU  - Kelly J
AD  - Elderly Care Department, St. Thomas' Hospital, London, England.
FAU - Rudd, A
AU  - Rudd A
FAU - Lewis, R
AU  - Lewis R
FAU - Hunt, B J
AU  - Hunt BJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrin Fibrinogen Degradation Products)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (fibrin fragment D)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Stroke. 2001 Jun;32(6):1443-8. PMID: 11387512
MH  - Anticoagulants/therapeutic use
MH  - Diagnosis, Differential
MH  - Fibrin Fibrinogen Degradation Products/metabolism
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Leg/blood supply
MH  - Pelvis/blood supply
MH  - Predictive Value of Tests
MH  - Pulmonary Embolism/*complications/mortality/*prevention & control
MH  - Risk Assessment
MH  - Stroke/blood/*complications/drug therapy
MH  - Treatment Outcome
MH  - Venous Thrombosis/blood/*complications/diagnosis/*prevention & control
RF  - 93
EDAT- 2001/01/04 11:00
MHDA- 2001/02/28 10:01
CRDT- 2001/01/04 11:00
PHST- 2001/01/04 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2001/01/04 11:00 [entrez]
AID - 10.1161/01.str.32.1.262 [doi]
PST - ppublish
SO  - Stroke. 2001 Jan;32(1):262-7. doi: 10.1161/01.str.32.1.262.