Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jan 2010
Case ReportsAlgorithm-based coagulation management of catastrophic amniotic fluid embolism.
Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. ⋯ Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.
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Blood Coagul. Fibrinolysis · Jan 2010
Case ReportsUnusual onset of venous thromboembolism and heparin-induced thrombocytopenia in a patient with essential thrombocythemia.
Essential thrombocythemia is a hematological disorder characterized by clonal hemopoiesis in the bone marrow and increased number of circulating platelets. It is usually discovered accidentally at the time of routine blood examinations or can become clinically evident with either thrombotic or hemorrhagic complications. In the present article, we describe the case of a 66-year-old woman with pneumonia due to Pneumocystis carinii, who experienced deep vein thrombosis and pulmonary embolism during hospitalization with a subsequent heparin-induced thrombocytopenia. Bone marrow examination performed after clinical improvement revealed the patient to be affected by essential thrombocythemia.
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Blood Coagul. Fibrinolysis · Jan 2010
Randomized Controlled TrialLow-molecular-weight heparin and unfractionated heparin in prophylaxis against deep vein thrombosis in critically ill patients undergoing major surgery.
The objective of the present study was to compare the efficacy and safety of low-dose unfractionated heparin (UFH) and a low-molecular-weight heparin (LMWH) as prophylaxis against venous thromboembolism in critically ill surgical patients undergoing major surgery. This was a randomized prospective study in which critically ill patients scheduled to undergo major elective surgery were allocated to receive subcutaneously either LMWH once daily and a placebo injection containing sterile 0.9% normal saline or 5000 IU UFH twice daily subcutaneously. Each patient was evaluated postoperatively clinically and confirmed by Doppler study for development of deep vein thrombosis (DVT). ⋯ However, minor hemorrhagic complications such as wound hematoma and surgical site bleeding were significantly more in the heparin group as compared with the LMWH group. Both UFH 5000 units subcutaneously twice daily and LMWH 40 mg once daily provide highly effective and well tolerated prophylaxis for critically ill surgical patients. Considering the advantage of once-daily dosing, a wider adoption of prophylaxis with LMWH may be justified on the basis of patient acceptability and saving of nursing time.
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Blood Coagul. Fibrinolysis · Jan 2010
Comparative StudyCarbon monoxide releasing molecule-2 increases the velocity of thrombus growth and strength in hemophilia A, hemophilia B and factor VII-deficient plasmas.
Carbon monoxide derived from carbon monoxide releasing molecules (CORMs) has been demonstrated to enhance normal plasma thrombus speed of growth and strength in vitro. We tested the hypothesis that tricarbonyldichlororuthenium (II) dimer (CORM-2) improves the velocity of formation and strength of hemophiliac plasma thrombi as determined by thrombelastography. Plasma deficient (<1% normal activity) in factor VIII (FVIII; n = 11 individuals), factor IX (FIX; n = 5 individuals) or factor VII (FVII; n = 4 individuals) was exposed to 0 or 100 micromol CORM-2, with coagulation initiated with tissue factor. ⋯ Lastly, CORM-2 exposure increased FVII-deficient plasma velocity of formation (45%) and strength (63%). CORM-2 markedly enhanced the velocity of clot growth and strength in hemophiliac plasma. These findings serve as the rationale to determine whether CORMs could be utilized as hemostatic agents.