Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jun 2003
ReviewUpdate on Novo Nordisk's clinical trial programme on NovoSeven.
Recombinant coagulation factor VIIa (rFVIIa; Novoseven, Novo Nordisk A/S, Bagsvaerd, Denmark) is registered in most regions of the world for the treatment of bleeding episodes in haemophilia patients with inhibitors to factor VIII or IX. Since its initial availability, there have been several case stories on the investigational use of rFVIIa as a haemostatic agent in a variety of bleeding patients. Novo Nordisk recognizes the need to establish clinical guidance, and when possible, regulatory approvals for indications with bleeding episodes of various aetiologies. ⋯ The remaining focus is on the prophylactic use of rFVIIa to improve haemostasis during surgery (orthotopic liver transplantation and liver resection), with the aim of avoiding or reducing the need for blood transfusions. In addition, Novo Nordisk is also continuing studies in haemophilia patients with inhibitors to increase therapeutic knowledge within this indication. Studies addressing dosages and regimens in subpopulations are presently ongoing.
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Blood Coagul. Fibrinolysis · Jun 2003
ReviewSpecialised services commissioning and primary care trusts.
Specialised services commissioners play an important role in the maintenance of excellent treatment standards within the UK. This review describes the involvement of the primary care trusts (PCTs) in specialised commissioning, as well as existing arrangements for the provision of specialised services in haemophilia. The article also examines the aims, objectives and preliminary findings of the ministerial review of commissioning arrangements for specialised services in England and some other parts of the UK, which is currently underway.
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Blood Coagul. Fibrinolysis · Jun 2003
Case ReportsCombined plasmapheresis and immunosuppression as rescue treatment of a patient with catastrophic antiphospholipid syndrome occurring despite anticoagulation: a case report.
We report the case of a 33-year-old female with known primary antiphospholipid syndrome who, despite full-dose oral anticoagulation, presented with myocardial infarction, acute respiratory distress syndrome, purulent bronchitis, and septic shock. Antiphospholipid antibodies and anti-beta2-glycoprotein-1 titres were markedly elevated. The patient was diagnosed with catastrophic antiphospholipid syndrome and treated with unfractionated intravenous heparin. ⋯ This treatment led to a rapid decrease of antiphospholipid antibody and anti-beta2-glycoprotein-1 titres, and the patient's condition gradually improved. Upon discharge from the hospital, pulmonary infiltrates had markedly regressed, and she was feeling well. Given the high mortality of catastrophic antiphospholipid syndrome, this report emphasizes the need for rapid diagnosis and effective multimodal treatment in an intensive care unit setting for these patients.