High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics.

نویسندگان

  • A R Mackenzie
  • R B Laing
  • J G Douglas
  • M Greaves
  • C C Smith
چکیده

Injecting drug use, mainly of heroin, currently represents a major public health issue in the North East of Scotland. The recent tendency of the committed injecting drug user to inject into the groin has created novel problems for the Infection Unit. Data are presented on 20 consecutive patients admitted between 1994 and 1999 with iliofemoral venous thromboses, often complicated by severe soft tissue infections and bacteraemia as a result of heroin injection into the femoral vein. Nine had coexistent groin abscesses, four had severe streptococcal soft tissue infection of the right thigh, groin and lower abdomen, and two had coincidental soft tissue infections of the upper limb. Nine were bacteraemic on admission. All of the patients were chronic injecting drug users with a median injection duration of 6.5 years. The 18 patients tested for hepatitis C virus were all seropositive. None of the 14 patients tested was positive for HIV. Seventeen patients were treated with subcutaneous low molecular weight heparin (tinzaparin), three having received intravenous unfractionated heparin initially. The tinzaparin was self administered and given for a median duration of seven weeks. One patient declined to have any treatment. Three months after presentation eight patients were asymptomatic, seven had a persistently swollen leg, and five were lost to follow up. None developed clinically apparent pulmonary embolism after institution of anticoagulant therapy. The management of iliofemoral venous thrombosis in injection drug users is problematic because of poor venous access, non-compliance with prescribed treatment, ongoing injecting behaviour, and coexistent sepsis. It is unlikely that a randomised trial of standard treatment with heparin and warfarin versus low molecular weight heparin alone would be practical in this patient group. These retrospective data indicate that the use of tinzaparin in injecting drug users is feasible and appears to result in satisfactory clinical responses. The possibility of concomitant infection in injecting drug users with venous thrombosis should always be addressed, as it appears to be a common phenomenon. Early drainage of abscesses and antimicrobial chemotherapy, often administered intramuscularly or orally because of lack of peripheral venous access, is central to the appropriate care of these patients.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Fever and haemoptysis in an injecting drug user.

CASE REPORT A 46-yr-old injecting drug user was admitted with a history of repeated haemoptysis, pleuritic chest pain and fevers. He had a neutrophilia and elevated C-reactive protein. A pulmonary embolus was diagnosed by computed tomography (CT) pulmonary angiography and he was treated with low molecular weight heparin. He received i.v. antibiotics (flucloxacillin, amoxicillin, gentamicin and ...

متن کامل

Iliofemoral Venous Thrombosis Mainly Related to Iliofemoral Venous Obstruction by External Tumor Compression in Cancer Patients

BACKGROUND To study iliofemoral venous thrombosis related to iliofemoral venous obstruction in cancer patients. METHODS In this case series study, 829 cancer patients were surveyed for iliofemoral obstruction/thrombosis within 10 years. The criteria for inclusion were: (1) presence of unilateral lower-extremity swelling; (2) computed tomography (CT) scans showing a tumor with external compres...

متن کامل

The needle and the damage done: clinical and behavioural markers of severe femoral vein damage among groin injectors.

AIM To identify factors associated with severe femoral vein (FV) damage among groin injectors (GIs) on oral opioid substitution treatment. DESIGN A cohort study. SETTING Drug treatment centres in South East England. PARTICIPANTS GIs attending an ultrasound 'health-check' clinic. MEASURES Femoral ultrasonography and clinical grading of venous disease in each leg. METHOD Comparison of 6...

متن کامل

Long-term outcome of transfemoral thrombectomy in patients with acute iliofemoral vein thrombosis

 Abstract Background: The optimal therapy of acute iliofemoral venous thrombosis is still a matter of debate. The purpose of our study was to evaluate the late results of iliofemoral thrombectomy with regard to the prevention of the development of a Post Thrombotic Syndrome (PTS). Methods: During 2000-2003, 18 patients underwent transfemoral venous thrombectomy for acute iliofemoral venous thro...

متن کامل

Study on Prevalence of Alcohol Abuse among Injecting Drug Users in Tehran and 5 Major Cities of Iran

Background: Alcohol use could be a risk factor for high risk sexual behaviors and injection especially among injecting drug users (IDUs). Data presented in this abstract extracted from the “Study on situation of HIV, Latent Tuberculosis (TB) and Active TB Infection among IDUs Receiving Harm Reduction Services in Tehran and 5 large cities in Iran” which had been conducted from June to December 2...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Postgraduate medical journal

دوره 76 899  شماره 

صفحات  -

تاریخ انتشار 2000