Thrombosis research
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Thrombosis research · Nov 1999
Randomized Controlled Trial Multicenter Study Clinical TrialThromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy.
Venous thromboembolism remains an important cause of maternal mortality. For women at risk during pregnancy, the recommended venous thromboembolismprophylaxis is unfractionated heparin. ⋯ Recurrence of venous thromboembolism and safety of treatments were assessed. Dalteparin administered once daily was safe and effective in thromboprophylaxis during pregnancy and postpartum.
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Thrombosis research · Oct 1999
Tissue factor and tissue factor pathway inhibitor levels during and after cardiopulmonary resuscitation.
Disseminated intravascular coagulation frequently occurs after global ischemia and reperfusion due to cardiac arrest. The present study was performed to demonstrate the role of tissue factor for coagulation pathway activation, as well as to investigate the precise time course of tissue factor pathway inhibitor (TFPI) during and after cardiopulmonary resuscitation (CPR). Thirty-two of out-of-hospital cardiac arrest patients were classified into two groups, those who achieved return of spontaneous circulation (ROSC) (n=13) and those without ROSC (n=19). ⋯ However, we could not find differences in the levels of the two markers between the patients with ROSC and those without ROSC. In conclusion, we demonstrated persistent elevation of the tissue factor levels associated with low TFPI during and after CPR in patients with out-of-hospital cardiac arrest. These results indicate the activation of the extrinsic coagulation pathway without adequate TFPI generation, which may contribute to thrombin activation and fibrin formation after whole-body ischemia and reperfusion.
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Thrombosis research · Aug 1999
ReviewThe use of prothrombin complex concentrates in the treatment of hemorrhages induced by oral anticoagulation.
Bleeding events are a common adverse effect in oral anticoagulation that frequently depend on the duration and intensity of treatment. Major bleeding events, particularly intracerebral hemorrhages, are a serious complication in cases that require the rapid reversal of anticoagulation. ⋯ Due to the time-consuming administration and increased risk of volume overload, the administration of fresh frozen plasma is less advisable in such instances. The application of prothrombin complex concentrates requires a precautious risk-benefit evaluation, including an estimation of contraindications and repeated laboratory monitoring for dose adjustment.
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Thrombosis research · Aug 1999
ReviewIndications for prothrombin complex concentrates in massive transfusions.
A major hemorrhagic insult may require massive transfusions to maintain oxygen transport and hemostasis. Thus an adequate transfusion budget must consider losses, patient's blood volume, critical levels of laboratory parameters, replacement rates of coagulation factors from the extravascular space, and the efficacy of blood products. The substitution of large quantities of blood or red cell concentrates can induce and aggravate a complex haemostatic disorder. ⋯ For hemostatic support, platelet concentrates and fresh frozen plasma are the treatment of choice. Localization and persistence of bleeding, hepatic disease, and vitamin K deficiency due to medication or intestinal malabsorption may require the supplementary use of prothrombin complex concentrates. Furthermore, antithrombin and fibrinogen concentrates may be indispensable.
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Thrombosis research · Aug 1999
ReviewClinical efficacy of prothrombin complex concentrates and recombinant factor VIIa in the treatment of bleeding episodes in patients with factor VII and IX inhibitors.
An overview is given on APCCs and recombinant FVIIa for the treatment of bleeding episodes in hemophiliacs with FVIII or FIX inhibitors or in patients with acquired hemophilia. The initial dose of activated plasma-derived PPCs, mainly FEIBA, is up to 100 U/kg body weight, and the maintenance dosage is up to 100 U/kg body weight twice daily. The single dosage of recombinant FVIIa is about 60-90 microg/kg body weight, which has to be repeated every 2 to 6 hours depending on the bleeding situation.