Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Feb 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.
Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities. ⋯ While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial, its use suggested a possible benefit for patients with the most severe heart failure or hypotension. ABBREVIATED ABSTRACT: We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infarction complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure. The primary end point, mortality at 6 months, did not differ between groups (34% for combined treatment versus 43% for fibrinolysis alone [n = 27]; adjusted P = 0.23), although patients with Killip class III or IV did show a trend toward greater benefit from IABP (39% for combined therapy versus 80% for fibrinolysis; P = 0.05).
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J. Thromb. Thrombolysis · Feb 2005
Case Reports Comparative StudyTreatment of patients with a history of heparin-induced thrombocytopenia and anti-lepirudin antibodies with argatroban.
Patients with heparin-induced thrombocytopenia (HIT) type II require anticoagulation with non-heparin immediate acting anticoagulants. Danaparoid may cross react with HIT-antibodies and lepirudin may generate anti-lepirudin antibodies influencing anticoagulation. We hypothesised, that the synthetic small molecular thrombin inhibitor argatroban does not induce immunoglobulins reacting towards lepirudin in patients with anti-lepirudin antibodies in the history and that titration of the anticoagulation may be easier with argatroban. ⋯ Patients on argatroban did not generate immunoglobulin IgG reacting towards lepirudin in contrast to both patients on lepirudin who developed anti-lepirudin antibodies. Both treatments were well tolerated. Despite the low number of patients argatroban seems to lead to a more stable anticoagulant response than lepirudin resulting in a lower variability of the dosage for prophylaxis or treatment of thromboembolism of patients with a history of HIT and lepirudin antibodies.
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J. Thromb. Thrombolysis · Feb 2005
Predictors of revascularization among emergency department patients who are evaluated for acute coronary syndrome.
To determine, among patients who present to the emergency department with symptoms suggestive of acute coronary syndrome (ACS), predictors of short-term revascularization. ⋯ In a single site study, among emergency department patients with symptoms suggestive of ACS, ST elevation on initial ECG and an elevation in troponin I, CK-MB, and myoglobin upon presentation all predicted short -term revascularization. Among the three biomarkers, elevation in troponin I was the strongest predictor. ABBREVIATED ABSTRACT: We conducted a prospective descriptive trial to identify predictors of short-term revascularization among 341 emergency department patients who presented with symptoms suggestive of ACS. Fourteen percent of the study population received revascularization. Predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0.), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization.