Thrombosis research
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Thrombosis research · Apr 2016
ReviewManagement of cancer-associated disseminated intravascular coagulation.
Cancer may be complicated by the occurrence of disseminated intravascular coagulation (DIC). DIC is characterized by a widespread and intravascular activation of coagulation (leading to intravascular fibrin deposition) and simultaneous consumption of coagulation factors and platelets (potentially resulting in bleeding). Clinically, DIC in cancer has in general a less fulminant presentation than the types of DIC complicating sepsis and trauma. ⋯ Eventually this process may lead to exhaustion of platelets and coagulation factors and bleeding (for example at the site of the tumor) may be the first clinical symptom indicating the presence of DIC. In some cases, the clinical presentation of DIC in cancer may be reminiscent of thrombotic microangiopathies, which is understandable in view of the role of endothelium in both conditions. The therapeutic cornerstone of DIC is treatment of the underlying disorder but supportive treatment, specifically aimed at the hemostatic system may be required.
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Thrombosis research · Apr 2016
Comparative StudyAccuracy of point of care coagulometers compared to reference laboratory measurements in patients on oral anticoagulation therapy.
Vitamin K antagonists (VKA) are widely prescribed throughout the world. Patients on VKA therapy require international normalized ratio (INR) monitoring of venous blood to ensure the response remains within the therapeutic window. Point-of-care devices (POC-INR) can safely and easily monitor VKA efficacy but need to be evaluated in practice. The aim of this study was to assess the precision and accuracy of a new POC-INR (Qlab) compared to the laboratory plasma technique and the CoaguChek-XS system. ⋯ This study suggests that the Qlab has accuracy limitations with clinical consequences. New POC-INR devices require careful evaluation prior to clinical implementation.
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Thrombosis research · Apr 2016
PO-26 - Whole blood rotational thromboelastometry (ROTEM) to detect hypercoagulability in patients with myeloproliferative neoplasms (MPN).
Essential Thrombocythemia (ET) and Polycythemia Vera (PV) are two MPNs characterized by a "clonal" overproduction of one or more blood cell lines, hypercoagulability, and an increased incidence of thrombosis. ROTEM is a point of care global coagulation assay performed in whole blood, able to evaluate platelets and fibrinogen contributions to the clotting process. Until now few studies evaluated the thromboelastometry profile of MPN patients. ⋯ Project funded by "AIRC-IG2013" grant Nr. 14505 from the "Italian Association for Cancer Research" (A.I.R.C.).
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Thrombosis research · Apr 2016
PO-07 - Excluding pulmonary embolism in cancer patients using the Wells rule and age-adjusted D-dimer testing: an individual patient data meta-analysis.
Among patients with clinically suspected pulmonary embolism (PE), imaging and anticoagulant treatment can be safely withheld in approximately one-third of patients based on the combination of a "PE unlikely" Wells score and a D-dimer below the age-adjusted threshold. The clinical utility of this diagnostic approach in cancer patients is less clear. ⋯ Among cancer patients with clinically suspected PE, imaging and anticoagulant treatment can be withheld in 1 out of every 8 patients by the original Wells rule and age-adjusted D-dimer testing. The simplified Wells rule was neither efficient nor safe in this population.
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Thrombosis research · Apr 2016
Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): patterns of use and outcomes.
Few studies have evaluated the use and outcomes of inferior vena cava filters (IVCF) insertion in cancer patients with deep venous thrombosis (DVT) or pulmonary embolism (PE). ⋯ An IVCF was placed in approximately 20% of acute VTE patients with cancer and use varied widely between hospitals and cancer types. Most patients did not have a contraindication for anticoagulation. There was no benefit in short-term mortality or risk of PE; there was increased risk of DVT and subsequent bleeding.