The Netherlands journal of medicine
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Review
Bleeding in patients using new anticoagulants or antiplatelet agents: risk factors and management.
The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. In case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. Heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. ⋯ Recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. The new-generation anticoagulants include specific inhibitors of factor IIa or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. A limitation of the new class of anti-IIa and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option.
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Substantial progress has been made over the last two decades in our understanding of the immunopathogenesis of antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides. Compelling evidence from in vitro studies and experimental models in conjunction with clinical trials has confirmed that ANCA directly contribute to the evolution and progression of the disease process. Continuous development in our understanding of the mechanisms that drive the disease may ultimately allow us to tailor the multitude of novel therapies, which are rapidly becoming available, to the requirements of individual patients. In this review we endeavour to provide a brief overview of the recent advances in ANCA-associated vasculitides and outline basic principles for diagnosis and treatment of these complex multisystem diseases.
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As opposed to spontaneous respiration wherein small cyclic changes in transpulmonary, negative pressure coincide with lung volume changes, positive pressure (mechanical) ventilation results in a simultaneous rise in transpulmonary pressure and lung volumes. The changes may affect biventricular cardiac loading and function in dissimilar ways, depending on baseline cardiopulmonary function. This review is intended to update current knowledge on the pathophysiology of these heart-lung interactions in helping to explain the common circulatory alterations occurring during airway pressure changes and to better understand mechanisms of disease and modes of action of treatments, during spontaneous and mechanical ventilation.
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To study current clinical practice in blood glucose (BG) control in adult intensive care units (ICUs) in the Netherlands. ⋯ Approximately half of the ICUs in the Netherlands reported having implemented IIT. However, the full guideline as used in the original studies on IIT was hardly ever implemented. Concerns about severe hypoglycaemia, at least in part, hampers implementation of IIT.