A Randomised Trial of Subcutaneous Low Molecular Weight Heparin (CY 216) Compared with lntravenous Unfractionated Heparin in the Treatment of Deep Vein Thrombosis

The standard treatment of deep vein thrombosis is given by continuous intravenous infusion of unfractionated heparin. This entails hospitalisation, nursing care, immobility and repeated laboratory tests (e.g. activated partial thromboplastin time [APTT], platelet count). In addition approximately 10% of patients suffer major haemorrhages. The potential advantages of a low molecular weight heparin (CY 216) given subcutaneously were explored in a randomised trial with blind quantitative evaluation of venograms. The study included 166 patients and both “therapeutic efficacy” and “intention to-treat” analyses showed that subcutaneous CY 216 in fixed doses based only on body weight was more effective on the Arnesen and Marder phlebographic scores than continuous i. v. standard heparin with daily dose adjustment according to results of coagulation tests. There was no increase in the risks of pulmonary embolism, haemorrhage or clot extension.

Short- and long-term prognosis, functional outcome following ICU for elderly

Among 1532 ICU patients we analysed 295 elderly patients (19%) aged more than 70-years-old. We determined prospectively the immediate and subsequent one-year outcome with a study of the predictive value of their ICU admission parameters. Then we followed the ICU survivors over the year after discharge (1, 6, 12 months) by quality of life questionnaires. ICU mortality was 26.7%; SAPS was the only predictor of short term mortality. On ICU discharge, 216 elderly were followed at 1, 6, 12 months; the one-year cumulative mortality was 49% from ICU discharge, majority of deaths occurring over the first month. Age, previous health status and SAPS had a predictor value of one-year mortality for ICU survivors. 103 patients were alive at one year: 88% returned to home, 72% had a relatively good functional status allowing an independent life, and 82% had the same or improved functional status.

Superior vena caval thrombosis and recurrent pericarditis caused by a bronchogenic cyst

A 49-year-old man with a past history of multiple episodes of acute pericarditis was admitted with a recurrence of symptoms combined with the superior vena caval syndrome. A bronchogenic cyst, located beneath the carina, was discovered. At operation, the cyst was partially resected, and superior vena caval flow was restored by a Gore-Tex prosthesis. Ten months later the superior vena caval syndrome reappeared. Angiography demonstrated subtotal stenosis of the graft, which was considered to be thrombotic due to the discontinuance of oral anticoagulants. Reoperation, however, showed no thrombosis, but kinking of the graft. The folded portion of the prosthesis was resected, since when the patient has done well.

Treatment of Severe Pulmonary Embolism by Rapid Injection of Urokinase

Twenty severe pulmonary emboli (8 of which occured within S days of an operation) were treated by the injection, in a few minutes, of 10,000 to 15,000 CTA units/kg of Urokinase by peripheral (6 cases) or central (14 cases) IV route in conjunction with immediate effective heparinization, These severe pulmonary emboli were characterized mainly by a state of shock reversible a few hours after the administration of Urokinase ; 50% devascularization shown by diagnostic angiography, improved by an average of 41% in angiography 5 days after administration of Urokinase; hypoxemia in unaided breathing (average PaO2 : 40 Torr). Three deaths occurred 7, 31 and 40 days after Urokinase. In comparison with classic methods of treatment with Urokinase (UKII 85% - UKI 15%), this procedure is well tolerated, less dangerous (in terms of the bleeding factor), less costly and simpler ; but its efficacy, while evident, should be determined with accuracy.