Thrombosis research
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Thrombosis research · Dec 2012
A low TAFI activity and insufficient activation of fibrinolysis by both plasmin and neutrophil elastase promote organ dysfunction in disseminated intravascular coagulation associated with sepsis.
We hypothesized that thrombin activatable fibrinolysis inhibitor (TAFI) and the activation of fibrinolysis by both plasmin and neutrophil elastase is insufficient to overcome fibrinolytic shutdown, contributing to multiple organ dysfunction syndrome (MODS) in sepsis-induced disseminated intravascular coagulation (DIC). ⋯ Activation of fibrinolysis both by plasmin and neutrophil elastase cannot overcome fibrinolytic shutdown, leading to MODS and a poor outcome in sepsis-induced DIC. The systemic activation of neutrophils and a low TAFI activity are also involved in the pathogenesis of MODS.
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Thrombosis research · Dec 2012
ReviewSystematic review: 3-factor versus 4-factor prothrombin complex concentrate for warfarin reversal: does it matter?
Prothrombin complex concentrates are used for rapid reversal of vitamin K antagonists in patients with bleeding or those requiring surgery or invasive procedures. Current guidelines suggest 4-factor products are preferred over 3-factor prothrombin complex concentrates. ⋯ More reliable correction of the international normalized ratio was seen with 4-factor compared to 3-factor prothrombin complex concentrates which may have clinical implications since 4-factor products are unavailable in some countries.
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Thrombosis research · Dec 2012
Severe bleeding in surgical and trauma patients: the role of fibrinogen replacement therapy.
Fibrinogen is in a central position in the coagulation system, playing an important role in platelet aggregation and establishing the fibrin network. Fibrinogen is also the first coagulation factor to become critically low during surgery and after major trauma. Hemostatic support has traditionally involved using transfusion of allogeneic blood products, including fresh frozen plasma; however, there is a lack of conclusive evidence supporting the clinical effectiveness of fresh frozen plasma in these situations. ⋯ The availability of point-of-care testing using viscoelastic techniques to guide fibrinogen substitution has enabled the development of transfusion algorithms that lead to individualized, goal-directed, and targeted use of fibrinogen concentrates to improve clinical outcomes. Fibrinogen replacement has become the standard-of-care in several major surgical centers in Europe and is recommended in current European trauma treatment guidelines. Future prospective studies will help to establish the critical threshold and target levels for fibrinogen substitution in different acute-care situations and should encourage more widespread use of this rational and effective approach to the treatment of bleeding-induced coagulopathies.
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Congenital fibrinogen deficiency is a rare bleeding disorder, affecting either the quantity (afibrinogenemia, hypofibrinogenemia) or quality (dysfibrinogenemia) of circulating fibrinogen. There is a strong association between fibrinogen activity levels and clinical bleeding severity. Patients with afibrinogenemia experience frequent, often severe, spontaneous bleeds into the muscles and joints and are at significant risk of intracranial hemorrhage. ⋯ Fibrinogen replacement should also be considered in pregnant women with other fibrinogen deficiencies. The risk of thrombosis presents an additional management challenge in these patients, often necessitating the concurrent use of anticoagulants and fibrinogen. Although basic guidelines have been developed, further studies are needed to help optimize treatment in different patient groups under different clinical circumstances and to improve our understanding of thrombotic events.
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Thrombosis research · Dec 2012
Multicenter StudyClinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER).
Registries are essential to obtain information on the whole spectrum of patients with pulmonary embolism (PE). The aim of the Italian Pulmonary Embolism Registry (IPER) is to report on demographics, clinical features, management, and outcomes of patients diagnosed with PE in everyday clinical practice. ⋯ Patients with PE have a considerable risk of death during the hospital stay, PE being the most common cause of early mortality.