Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Mar 2013
Higher prognostic value of soluble fibrin complexes than D-dimer and fibrin degradation product for disseminated intravascular coagulation in patients with liver cirrhosis.
Fibrin-related markers may help differentiate disseminated intravascular coagulation (DIC) from liver cirrhosis-associated dysfunctional coagulation. We investigated the significance of three fibrin-related markers [D-dimer, fibrin degradation product (FDP), and soluble fibrin complexes (sFC)] for the assessment of DIC status and prognosis. We classified 235 patients with suspected DIC into two groups according to their condition: the liver cirrhosis group (n = 47) and the no liver cirrhosis group (n = 188). ⋯ For the diagnosis of overt DIC in patients with liver cirrhosis, the area under the concentration curve (AUC) was larger for sFC (0.746) than for D-dimer (0.733) and FDP (0.687). Cox analysis also indicated that an elevated sFC concentration is a more significant prognostic factor of DIC than D-dimer or FDP (hazard ratio: 10.78; P = 0.036) in liver cirrhosis group; however, it was not a prognostic factor in the no liver cirrhosis group. sFC is a powerful diagnostic and prognostic marker of DIC in patient with liver cirrhosis. The use of sFC is expected to enhance the diagnosis and prognosis of DIC, particularly in patients with liver cirrhosis.
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Blood Coagul. Fibrinolysis · Mar 2013
Dosing and monitoring of enoxaparin therapy in children: experience in a tertiary care hospital.
Pediatric deep vein thrombosis (DVT) is an emerging problem in tertiary care hospitals, recent reviews shows a rate of 40.2/10,000 admissions. Experts affirm that enoxaparin has become in the drug of choice for DVT therapy. Despite this, there is a little information regarding the optimal dose schedule for enoxaparin therapy in children and the therapeutic guidelines for enoxaparin use in children are extrapolated from adult guidelines. ⋯ Complete resolutions of DVT were registered in all cases. The mean number of dose increases was three and a median of 11 days to achieve target anti-Xa concentration. This study indicates that an initial higher enoxaparin dose may be necessary in neonates and infants, but other factors must be considered to improve management.
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Blood Coagul. Fibrinolysis · Jan 2013
Comparative Study Clinical TrialComparison of empirical estimate of clinical pretest probability with the Wells score for diagnosis of deep vein thrombosis.
Wells score has been validated for estimation of pretest probability in patients with suspected deep vein thrombosis (DVT). In clinical practice, many clinicians prefer to use empirical estimation rather than Wells score. However, which method is better to increase the accuracy of clinical evaluation is not well understood. ⋯ In addition, the appropriate D-dimer cutoff value based on Wells score was 175 μg/l and 108 patients were excluded. Empirical assessment increased the appropriate D-dimer cutoff point to 225 μg/l and 162 patients were ruled out. Our findings indicated that empirical estimation not only improves D-dimer assay efficiency for exclusion of DVT but also increases clinical judgement accuracy in the diagnosis of DVT.
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Blood Coagul. Fibrinolysis · Jan 2013
Clinical TrialEvaluation of the Q analyzer, a new cap-piercing fully automated coagulometer with clotting, chromogenic, and immunoturbidometric capability.
The Q analyzer is a recently launched fully automated photo-optical analyzer equipped with primary tube cap-piercing and capable of clotting, chromogenic, and immunoturbidometric tests. The purpose of the present study was to evaluate the performance characteristics of the Q analyzer with reagents from the instrument manufacturer. We assessed precision and throughput when performing coagulation screening tests, prothrombin time (PT)/international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen assay by Clauss assay. ⋯ When used in combination with DG-PT reagent and manufacturer's instrument-specific international sensitivity index, the INRs obtained were accurate. The Q analyzer with DG-APTT Synth reagent demonstrated good sensitivity to isolated mild deficiency of FVIII, IX, and XI and had the advantage of relative insensitivity to mild FXII deficiency. Taken together, our data indicate that the Q hemostasis analyzer was suitable for routine use in combination with the reagents evaluated.
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Blood Coagul. Fibrinolysis · Jan 2013
Case ReportsEffectiveness of low-dose prolonged infusion of tissue plasminogen activator in a nonagenarian patient with acute pulmonary embolism and main pulmonary artery thrombus.
Acute pulmonary embolism is an important emergency disease which frequently results in life-threatening complication. Systemic fibrinolysis is recommended as standard, first-line therapy in patients with massive pulmonary embolism. In the case described in this report, a 95-year-old woman was treated with low-dose prolonged infusion of tissue plasminogen activator for acute pulmonary embolism and mobile thrombus in the main pulmonary artery and right pulmonary artery. On the basis of echocardiographic findings, acute thrombolysis with low-dose prolonged infusion of tissue plasminogen activator was performed resulting in hemodynamic stabilization of the patient and complete resolution of the pulmonary artery thrombus.