Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jul 2008
ReviewConsensus opinion for the selection and use of therapeutic products for the treatment of haemophilia in Spain.
The period between isolation of HIV in the early 1980s and the development of effective viral inactivation procedures able to eradicate the virus from the blood supply was long and unfortunately many recipients of blood-derived products became infected; this translated into a devastating impact on their quality of life, quality of care as well as on their life expectancy. Some years later, hepatitis C virus infection was identified as another known blood-borne disease complicating the treatment of haemophilia. ⋯ The aim of the present publication was to review some of the crucial aspects related to the choice of haemostatic concentrates for the treatment of haemophilia and other inherited bleeding disorders, to analyse the current situation in the United States, Canada and European Union countries and to report the most relevant aspects of the Spanish consensus opinion of haemophilia-treating doctors for the use of therapeutic products for haemophilia recently issued. Essentially, it suggests that a gradual switch to recombinant concentrates may be a beneficial decision for patients with haemophilia and for the National Health Service.
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Blood Coagul. Fibrinolysis · Jul 2008
Comparative StudyWhat is the optimal anticoagulation level with argatroban during percutaneous coronary intervention?
Argatroban is increasingly used in patients with heparin-induced thrombocytopenia. Although the recommended activated clotting time during percutaneous coronary intervention is 300-450 s, this recommendation is based on the limited data. This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by thrombolysis in myocardial infarction major bleeding) of argatroban during percutaneous coronary intervention according to activated clotting time levels. ⋯ When divided into three groups on the basis of the activated clotting time (<300, 300-450, >450 s), no significant difference was observed between the groups in the efficacy endpoint, which occurred in 9.8% (6/61) of patients in the group with activated clotting time less than 300 s, 19.6% (9/46) of patients in the group with activated clotting time 300-450 s, and 7.7% (1/13) of patients in the group with activated clotting time more than 450 s (P = 0.58). The rate of major bleeding was higher in the group of patients with activated clotting time more than 450 s (1.6, 0, and 15.4% patients, respectively; P = 0.006). These results suggest that in patients undergoing percutaneous coronary intervention, argatroban provides adequate anticoagulation with a low bleeding rate, when activated clotting time is maintained below 450 s.
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Blood Coagul. Fibrinolysis · Jul 2008
Activity of recombinant factor VIIa under different conditions in vitro: effect of temperature, pH, and haemodilution.
Recombinant activated factor VII (NovoSeven; Novo Nordisk A/S, Måløv, Denmark) is an effective drug for treatment of bleeding in patients with haemophilia A or B and inhibitors. Little is known about physiological conditions influencing the efficacy of recombinant activated factor VII. We investigated the in-vitro effects of pH, temperature, and haemodilution on the activity of recombinant activated factor VII. ⋯ Haemodilution had significant effects on clot formation time, maximum clot firmness, and factor VII coagulant activity, but no effects on clotting time indicating that haemodilution does not affect clot formation, but the clot formed at high haemodilution may not be so firm. In conclusion, the activity of recombinant activated factor VII was affected in vitro by pH, temperature, and haemodilution. Additional studies are necessary to demonstrate that these conditions also affect the efficacy of recombinant activated factor VII therapy in vivo.
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Recombinant activated factor VII, a bypassing hemostatic agent originally developed for the treatment of hemorrhages in hemophilic patients with inhibitors, is increasingly being employed on a compassionate use basis for the treatment of uncontrolled massive bleeding from various causes. In this review, we present the current knowledge on the use of this agent in patients with severe coagulopathy due to end-stage liver disease. ⋯ Given the paucity of the published data and the lack of randomized trials, there is not enough evidence to support the extensive use of recombinant activated factor VII in any of the clinical indications analyzed. In conclusion, further large randomized, controlled clinical trials are needed to better define the role of recombinant activated factor VII in the treatment of bleeding complications of liver disorders.
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Blood Coagul. Fibrinolysis · Jul 2008
Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis.
Common tests for the assessment of blood coagulation in the acute phase of deep vein thrombosis are of limited value for the evaluation of the associated hypercoagulability. The new rotation thromboelastometry by rotation thrombelastogram has the potential to provide information on whole blood clot formation and prothrombotic state in patients with acute deep vein thrombosis. Rotation thrombelastogram parameters were evaluated in whole blood of 30 patients with a first episode of acute deep vein thrombosis and 40 healthy controls. ⋯ In a small subset of acute deep vein thrombosis patients, inherited thrombophilia had no influence on rotation thrombelastogram parameters. The new rotation thrombelastogram thromboelastometry is a useful tool to detect acute deep vein thrombosis-related hypercoagulability. Prospective studies are needed to define the potential applications of rotation thrombelastogram in the management of deep vein thrombosis patients.