The Netherlands journal of medicine
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In critically ill patients, heparin-induced thrombocytopenia (HIT) is estimated to account for approximately 1 to 10% of all causes of thrombocytopenia. HIT exerts a strong procoagulant state. In case of suspected HIT, it is an important clinical decision to stop heparin and start treatment with alternative nonheparin anticoagulation, awaiting the results of laboratory testing for the final diagnosis of HIT (bridging therapy). Fondaparinux acts by factor Xa inhibition and expresses no cross-reactivity with HIT antibodies. Excretion of fondaparinux is mainly renal. We describe our early experience with fixed low-dose fondaparinux bridging therapy and monitoring of anticoagulant activity for safety reasons. ⋯ In this small sample of critically ill patients suspected of HIT, bridging therapy with fixed low-dose fondaparinux resulted in prophylactic and therapeutic anti-Xa levels. Monitoring of anticoagulant activity is advised in patients with renal insufficiency.
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Case Reports
Therapeutic hypothermia after prolonged cardiopulmonary resuscitation for pulseless electrical activity.
We report an 18-year-old female patient with cardiac arrest due to pulseless electrical activity caused by a massive pulmonary embolism. Cardiopulmonary resuscitation was continued for more than one hour. ⋯ She recovered uneventfully without neurological deficit. Therapeutic hypothermia may be effective for neuroprotection in non-VFcardiac arrest.
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Phaeochromocytoma is a rare catecholamine-secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality if left untreated. Surgical resection is the only curative therapy. During surgery there is a high risk of massive release of catecholamines, which can result in potentially fatal hypertensive crises and cardiac arrhythmias. ⋯ Guidelines for the preoperative medical management of the patient with a phaeochromocytoma are mainly based on retrospective studies and case reports. We reviewed the relevant literature on this subject. In addition, we compared the several preoperative treatment protocols of the eight university medical centres in the Netherlands.