Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Dec 2013
Three polymorphisms in promoter of protein C gene with endothelial protein c receptor gene and risk of venous thrombosis.
The primary abnormalities that are associated with a risk of venous thrombosis are the deficiencies of protein C. Protein C (PROC), encoded by the PROC gene, acts through its affinity for binding to its transmembrane endothelial cell protein C receptor (EPCR) encoded by the EPCR gene. The objective of the study was to analyze the link between three polymorphisms in the promoter of PROC gene, the polymorphism in the EPCR gene and the occurrence of venous thrombosis. ⋯ The combination of haplotype CAA/CAA of PROC gene and variant genotype AG of EPCR gene was confirmed with a higher frequency in the group of patients (3.9 vs. 1.2%). This analysis showed that the PROC haplotype associated with a high protein C level (TAA) and the EPCR AA genotype was significantly more frequent in the healthy volunteers (P = 0.0066). Haplotypes associated with a low production of protein C (CAA or CGT) were more frequent in patients with venous thrombosis.
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Blood Coagul. Fibrinolysis · Dec 2013
Pulmonary embolism risk stratification: the intermediate-risk group.
Despite all the advances on acute pulmonary embolism risk stratification, a grey area still justifies ongoing debate. Although growing scientific evidence has clarified the extremes of pulmonary embolism risk continuum and has given support to every day's clinical practice decisions, on who may be sent home or needs promptly aggressive measures, the intermediate-risk pulmonary embolism patients are still a challenging group. Moreover, recent studies reported most interesting findings, exposing weaknesses of traditional markers of pulmonary embolism prognosis (e.g. right-ventricular dysfunction), and shed some light on how we can potentially overcome the difficulties of risk assessment in these cases. Our intention is to briefly discuss the recent developments in pulmonary embolism risk stratification, aiming at clarifying their usefulness in current pulmonary embolism management.
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Blood Coagul. Fibrinolysis · Oct 2013
ReviewFactors that influence the bleeding phenotype in severe hemophilic patients.
Hemophilia A and B are rare, X-linked bleeding disorders resulting from a partial or total deficiency of functionally active coagulation factor VIII or factor IX, respectively. Endogenous factor levels have traditionally been used to characterize the severity of the disorder, with severe hemophilia considered as circulating levels of factor less than 1% of normal. ⋯ This article will review potential modifiers of hemophilia-associated bleeding other than endogenous factor activity, which may influence bleeding tendencies and complications in hemophilic patients considered to have severe hemophilia. These potential modifiers include physiologic factors, such as elements of the hemostatic system; pathophysiologic factors, such as hemophilic arthropathy, associated inflammation, and angiogenesis; and others, such as seasonal variation, body weight, and physical activity.
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Acute compartment syndrome (ACS) is characterized by an increase in pressure (intramuscular pressure) within a muscle compartment, which reduces capillary perfusion threatening tissue survival. Persistence of this increased pressure for a few hours will result in necrosis of muscle and nerve tissue, with contracture in the affected limb and permanent loss of function. For that reason, early treatment and diagnosis of ACS is fundamental. ⋯ Overlooked compartment syndrome remains one of most common causes of malpractice lawsuits. In haemophilia, adequate substitution of coagulation factor must be the first step. The main principle of surgical treatment is an extensive fasciotomy.
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Blood Coagul. Fibrinolysis · Sep 2013
Randomized Controlled TrialCorrelation between D-dimer levels and coronary artery reperfusion in acute myocardial infarction patients after thrombolytic treatment.
The correlation between plasma D-dimer level and reperfusion has not been clarified yet in thrombolytic therapy applied for acute myocardial infarction patients. The aim of this study was to investigate whether there is a relationship between reperfusion and fibrinolytic activity in acute myocardial infarction patients treated with thrombolytic therapy. Fibrinolytic activity was reflected by plasma D-dimer levels. ⋯ D-dimer levels were markedly high after thrombolytic therapy versus before (155 mg/dl, 362 mg/dl, P<0.005). We compared the D-dimer values before and after thrombolytic therapy between reperfused group and the nonreperfused group (189-409 mg/l in reperfused group, P=0.086; 82-258 mg/l in the nonreperfused group, P=0.173). In conclusion, in this study, D-dimer levels were elevated markedly in patients with ST elevation myocardial infarction after thrombolytic therapy, but no significant difference was seen in D-dimer levels between the reperfused and nonreperfused groups.