Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Jan 2011
ReviewProphylaxis for venous thromboembolism: guidelines translated for the clinician.
Venous thromboembolism is a major cause of morbidity and mortality worldwide and most often affects hospitalized postoperative surgical and medical patients. Venous thromboembolism prophylaxis undoubtedly improves the care of these patients, as demonstrated by the current literature and guidelines. Failure to prescribe prophylaxis when indicated, however, remains a vital health care concern. ⋯ We will briefly review the grading system used in the guidelines for the level of evidence and the strength of the recommendation. We will then discuss the recommendations for prophylaxis in the various patient populations described in these guidelines including general and orthopedic surgery, gynecologic surgery, urologic surgery, thoracic surgery, neurosurgery, trauma, medical conditions, cancer patients, and critical care. In addition, we will discuss recent clinical trials regarding novel anticoagulants for venous thromboembolism prophylaxis and share some conclusions.
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J. Thromb. Thrombolysis · Jan 2011
Multicenter StudyImprovement of hemodialysis catheter function with tenecteplase: a phase III, open-label study: TROPICS 4.
Hemodialysis (HD) catheters are prone to thrombotic occlusion. We evaluated tenecteplase, a thrombolytic, for the treatment of dysfunctional HD catheters. Patients with tunneled HD catheters and blood flow rate (BFR) <300 mL/min received open-label tenecteplase (2 mg/lumen) for a 1 h intracatheter dwell. ⋯ Reported targeted adverse events included five catheter-related bloodstream infections and one thrombosis. No intracranial hemorrhage, major bleeding, embolic events, or catheter-related complications were reported. Tenecteplase administered as a 1 h or 1 h plus extended dwell was associated with improved HD catheter function in the TROPICS 4 trial.
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J. Thromb. Thrombolysis · Jan 2011
The diagnostic yield of D-Dimer in relation to time from symptom onset in patients evaluated for venous thromboembolism in the emergency medicine department.
D-Dimer concentrations increase following the thrombotic event and decrease thereafter. Timing of D-Dimer evaluation in relation to the onset of the disease might have a diagnostic impact. We have presently performed a retrospective analysis of diagnostic procedures performed in individuals who presented to the Emergency department and evaluated for acute venous thromboembolism (VTE) following a single quantitative D-Dimer testing. ⋯ Highly significant differences between patients and controls regarding D-Dimer concentrations were noted mainly during the early days from symptom onset and turned less significant thereafter. Taking into consideration the time from symptoms onset in patients with acute VTE might have an effect on the diagnostic yield of quantitative D-Dimer in the Emergency department. We suggest not to exclude the eventual presence of acute VTE if quantitative D-Dimer is obtained later than 1 week following the onset of symptoms.