Thrombosis research
-
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.
-
Thrombosis research · Dec 2012
Treatment responses for disseminated intravascular coagulation in 25 children treated with recombinant thrombomodulin: a single institution experience.
Recombinant thrombomodulin (rTM), which degrades factors Va and VIIIa by activating protein C, has been developed as a new drug for treating disseminated intravascular coagulation (DIC). ⋯ The efficacy of rTM cannot be assessed from the present dataset, due to several limitations such as the small heterogenous patient cohort, and the lack of age- and disease-matched controls. Nevertheless, this case-series remains important in terms of enabling further prospective control studies to evaluate the efficacy of rTM in children.
-
Thrombosis research · Nov 2012
Validation of the Caprini risk assessment model in Chinese hospitalized patients with venous thromboembolism.
Venous thromboembolism (VTE) occurs frequently in at-risk hospitalized patients, and prophylaxis of VTE is significantly underused. We sought to preliminarily assess the validity of Caprini risk assessment model, a famous individual VTE risk assessment model, in Chinese hospitalized patients with VTE. ⋯ Our study preliminarily suggests that the Caprini risk assessment model is a practical and effective tool to assess the risk of VTE among unselected Chinese inpatients and may also be useful in predicting the risk of VTE recurrence. However, future studies with control group and prospective validation of the model in Chinese inpatients are needed.
-
Thrombosis research · Nov 2012
Clinical TrialThe effect of total hip/knee replacement surgery and prophylactic dabigatran on thrombin generation and coagulation parameters.
Total hip/knee replacement surgery (THR/TKR respectively) is associated with an increased risk of venous thromboembolism. Dabigatran is recommended as a thromboprophylactic agent post orthopaedic surgery. The aim of this study was to assess the post-operative (Day-1 and Day-2) effect of prophylactic Dabigatran on: the thrombin generation (TG) assay; prothrombin fragment 1.2 (F1.2); thrombin-antithrombin complexes (TAT); D-dimer (D-D); and other coagulation parameters. METHODS AND SAMPLES: Nineteen patients (12 THR, 7 TKR) who received 110 mg dabigatran 4 hours post-operatively, then 220 mg the following day, were recruited. Blood was collected: pre-operatively (Pre-); peri-operatively (Peri-); 19 hours after 110 mg dabigatran (Day-1); and 17 hours after 220 mg dabigatran (Day-2). The TG assay was measured using the Calibrated Automated Thrombogram and a low concentration of tissue factor. Other coagulation parameters measured included activated partial thromboplastin time (APTT), thrombin-time (TT), ecarin-clotting time (ECT) and Hemoclot tests. ⋯ The effect of dabigatran on the TG assay, showed a spurious increase in ETP and Peak-thrombin due to its interference with the TG assay. Dabigatran reduced TAT, but not F1.2, suggesting that thrombin was still being generated after surgery, but was blocked by Dabigatran.
-
Thrombosis research · Oct 2012
Evaluation of ticagrelor pharmacodynamic interactions with reversibly binding or non-reversibly binding P2Y(12) antagonists in an ex-vivo canine model.
As ticagrelor, clopidogrel and cangrelor therapies may be used in the same clinical setting, their potential pharmacodynamic interactions are of interest. Hence, we investigated possible interactions between these agents in dogs using a variety of switching protocols. ⋯ The extent of the pharmacodynamic drug-drug interactions observed between clopidogrel and cangrelor or ticagrelor apparently depends on the level of receptor occupancy when clopidogrel is administered. Importantly, no significant pharmacodynamic interaction occurred between ticagrelor/clopidogrel when clopidogrel was given at clinical trough IPA levels with ticagrelor. No significant pharmacodynamic interaction occurred with cangrelor and ticagrelor.