Thrombosis research
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Thrombosis research · Jan 2008
Multicenter StudyFactors associated with the timing of diagnosis of venous thromboembolism: results from the MASTER registry.
Signs and symptoms of venous thromboembolism (VTE) are non-specific and thus can make diagnosis difficult, even for an experienced clinician. We aimed to evaluate the timing of diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in Italian hospitals and to identify individual and clinical predictors of timely or delayed diagnosis. ⋯ Substantial delays occur when diagnosing both DVT and PE. The severity of presentation, but not patient risk profile are associated with earlier diagnosis, even in patients with signs or symptoms of PE.
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Thrombosis research · Jan 2008
ReviewHas the incidence of deep vein thrombosis in patients undergoing total hip/knee arthroplasty changed over time? A systematic review of randomized controlled trials.
There is a perception in the orthopaedic and thromboembolism community that the incidence of deep vein thrombosis (DVT) has decreased in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). ⋯ The incidence of DVT in patients undergoing elective TKA appears to have declined in patients receiving warfarin thromboprophylaxis.
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Thrombosis research · Jan 2008
ReviewModeling the action of factor VIIa in dilutional coagulopathy.
Dilutional coagulopathy is observed in patients who have lost blood and had the blood volume replaced with components that do not have plasma procoagulants and anticoagulants. Since both procoagulant and anticoagulant mechanisms contribute to total thrombin generation, it is not clear whether the procoagulant or anticoagulant effects will dominate when both are decreased. Decreasing antithrombin levels leads to increasing thrombin generation in ex vivo models. ⋯ Limited clinical data suggest that factor VIIa has been useful in controlling intractable bleeding in some cases of dilutional coagulopathy. Preliminary data suggest that factor VIIa activation of factors X and IX on activated platelets enhances thrombin generation significantly in a model of dilutional coagulopathy. This may suggest a mechanism to account for the efficacy of factor VIIa in reducing blood loss in some settings of dilutional coagulopathy.
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Thrombosis research · Jan 2008
ReviewWarfarin-induced bleeding complications - clinical presentation and therapeutic options.
Acute bleeding during oral anticoagulant therapy is a major challenge in medicine -with millions of patients receiving oral anticoagulant therapy worldwide, the frequency of severe bleeding episodes ranges from 2% to 13%, according to clinical trial data. The major risk associated with the use of oral anticoagulants is haemorrhage, which might be severe or even life-threatening. Treatment decisions for the reversal of oral anti-coagulation (OAC) depend on factors such as urgency of the situation, as determined by the international normalised ratios (INR), location and seventy of bleeding, and indication for anticoagulation. ⋯ In addition, PCC is associated with a more rapid normalisation of the INR and a better clinical outcome due to the balanced ratio of four vitamin-K-dependent clotting factors plus the coagulation inhibitors protein C and Protein S. PCC products containing four factors are the preferred option for the emergency reversal of OAC, according to some clinical treatment guidelines. Other advantages of PCC over FFP include smaller infusion volumes, no blood group testing and virus-inactivated blood product.
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Thrombosis research · Jan 2008
Comparative StudyDiagnostic accuracy of the Triage D-dimer test for exclusion of venous thromboembolism in outpatients.
We evaluated the diagnostic performance of the Triage D-dimer test, a new fast quantitative point-of-care whole blood D-dimer assay and compared it with the Vidas D-dimer assay. ⋯ The Triage and Vidas D-dimer tests show comparable diagnostic accuracy. Vidas showed a significant higher sensitivity. Our findings strongly suggest lowering the cutoff for the Triage D-dimer test from 400 to 350 ng/mL. In this way specificity lowers from 42 to 38%, but, more importantly, sensitivity increases from 91 to 95%.