Journal of thrombosis and haemostasis : JTH
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J. Thromb. Haemost. · Jul 2007
Multicenter StudyTreatment characteristics and the risk of inhibitor development: a multicenter cohort study among previously untreated patients with severe hemophilia A.
The development of inhibitory antibodies against infused factor (F) VIII is a major complication of treatment of patients with severe hemophilia A. ⋯ These findings show that intensive treatment periods are associated with an increased risk of inhibitor development in previously untreated patients with severe hemophilia A. Our results do not support the notion that age at first exposure is associated with the risk of developing inhibitors.
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J. Thromb. Haemost. · Jul 2007
Multicenter Study Clinical Trialvon Willebrand factor/factor VIII concentrate (Haemate P) dosing based on pharmacokinetics: a prospective multicenter trial in elective surgery.
While plasma-derived concentrates containing large amounts of von Willebrand factor (VWF) are effective in treating von Willebrand disease (VWD), optimal dosing remains to be fully characterized. ⋯ Haemate P provided effective and safe hemostasis in VWD subjects undergoing elective surgery. Selection of Haemate P loading dose on the basis of VWF PK proved feasible.
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J. Thromb. Haemost. · Jul 2007
Multicenter StudyProspective evaluation of the '4Ts' score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is a severe disease that is often difficult to diagnose. A clinical scoring system, the '4Ts' score, has been proposed to estimate its probability before laboratory testing, and a particle gel immunoassay (H/PF4 PaGIA) has also been developed for rapid detection of HIT antibodies. ⋯ The use of the 4Ts score with PaGIA appears to be a reliable strategy to rule out HIT.
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J. Thromb. Haemost. · Jul 2007
ReviewApproach to the diagnosis and management of mild bleeding disorders.
Symptoms suggestive of the presence of a mild bleeding tendency are commonplace. Whilst the majority with such symptoms are healthy, it is important to identify those with bleeding disorders in order to manage symptoms, to minimize risk from invasive procedures and to avoid unnecessary exposure to blood products. Thorough clinical assessment remains the cornerstone of the diagnostic strategy for mild bleeding disorders, although the sensitivity and specificity of the clinical history and examination are limited. ⋯ Prevention and treatment of hemorrhage in subjects with mild bleeding disorders includes the application of general measures, including attention to surgical technique, measures specific to the precise diagnosis, and less specific treatments that enhance hemostasis and coagulation or inhibit fibrinolysis. The last of these includes the widely prescribed drugs desmopressin, aprotinin, epsilon aminocaproic acid and tranexamic acid. Data are now available on their efficacy and safety in a range of clinical situations.