Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Jan 2013
Clinical TrialThree-month cumulative incidence of thromboembolism and bleeding after periprocedural anticoagulation management of arterial vascular bypass patients.
The objective of this study was to determine 3-month cumulative incidence of peri-procedural thromboembolism (TE) including graft occlusion, and peri-procedural bleeding for chronically anticoagulated vascular bypass graft (BG) patients requiring temporary warfarin interruption for an invasive procedure. Appropriate peri-procedural management of patients receiving chronic warfarin therapy to preserve lower extremity arterial BG patency is unknown. In a protocol driven, cohort study design, all BG patients referred to the Mayo Clinic Thrombophilia Center for peri-procedural anticoagulation (1997-2007) were followed forward in time to estimate the 3-month cumulative incidence of TE and bleeding. ⋯ TE and bleeding did not differ by bridging status. The 3-month cumulative incidence of TE among BG patients in whom warfarin is temporarily interrupted for an invasive procedure may be higher than in other "bridging" populations (atrial fibrillation, prosthetic heart valve, venous thromboembolism). This finding underscores the often tenuous nature of distal bypass grafts necessitating an aggressive approach to peri-procedural anticoagulation management.
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J. Thromb. Thrombolysis · Jan 2013
Clinical TrialUsing fibrin degradation products level to facilitate diagnostic evaluation of potential acute aortic dissection.
This study evaluated whether degradation products of plasma fibrin and fibrinogen (FDP) level can be used to differentiate acute aortic dissection (AAD) from acute myocardial infarction (AMI), angina pectoris, acute cerebral infarction, or transient cerebral ischemic attack (TIA). Ninety-six consecutive patients with definitive diagnosis of AAD by contrast-enhanced computed tomography scan underwent measurement of FDP on admission. Of these patients, 45 had a patent false lumen (patent-type), and 51 had complete thrombosis of the false lumen (thrombosed-type). ⋯ A simple liner regression, calculated using FDP and D-dimer values from a total of 71 patients, yielded a correlation coefficient (R2) of 0.95, indicating a strong correlation. In symptomatic patients with suspected AAD, a diagnosis of patent-type AAD should be considered if FDP ≥ 12.6 μg/mL. Patients with FDP ≥ 5.6 μg/mL have the possibility of thrombosed-type AAD.
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J. Thromb. Thrombolysis · Jan 2013
Clinical TrialBleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery.
Individual variability in the response to antiplatelet therapy (APT), frequently administered preoperatively, has been established by various platelet function assays and could reflect bleeding tendency after coronary artery bypass surgery (CABG). Our hypothesis is that multiple electrode whole-blood aggregometry (MEA) can identify patients at risk for excessive bleeding. We enrolled 211 patients (155 male and 56 female) undergoing isolated CABG in a prospective observational study. ⋯ The proportion of patients transfused with PRBC did not significantly differ among the groups in regard to preoperative APT (p = 0.636). Comparison of the ASPI test values between patients with respect to PRBC administration revealed lower values in the ASPI test in a group of patients transfused with PRBC (mean, 27.88 vs. 40.32 AUC, p = 0.002). Our study showed that MEA is a useful method of predicting CABG patients with excessive postoperative bleeding.
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J. Thromb. Thrombolysis · Jan 2013
Case ReportsThe untold story of Dabigatran etexilate: alveolar hemorrhage in an elderly patient with interstitial pulmonary fibrosis.
We report an 85-year-old male, with history of interstitial pulmonary fibrosis (IPF), who was presented with progressive dyspnea, hypoxia, and anemia of 2 months duration. Six months before presentation, the patient was placed on Dabigatran etexilate (Dabigatran) (110 mg BID) for atrial fibrillation. His prior anemia workup included a negative upper endoscopy and colonoscopy. ⋯ The bronchial tree was washed and Dabigatran was discontinued. The patient's medical condition improved and was subsequently discharged home. Our case illustrates the failure of current literature to predict the isolated bronchoalveolar bleed secondary to Dabigatran therapy.
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J. Thromb. Thrombolysis · Jan 2013
Clinical TrialPerioperative assessment of platelet function by Thromboelastograph Platelet Mapping in cardiovascular patients undergoing non-cardiac surgery.
Five percent of patients on dual antiplatelet therapy after coronary artery stent implantation will need non-cardiac surgery within the first year of therapy, and many more will need surgery later on. A function assay that evaluates platelet reactivity and inhibition by drug therapy is beneficial for such patients. Platelet Mapping assay (PM) using the TEG analyzer was tested in surgical patients. After IRB approval, 60 patients on combined aspirin and clopidogrel therapy were consented and enrolled. The TEG maximal amplitude (MA) and the percentage (%) platelet inhibition were recorded and analyzed. Fifty-seven patients (mean age 65.7 ± 10.9 years) had preoperative data only. Distribution of preoperative ADP (43.6 ± 24.4%) and AA inhibition (52.8 ± 30.2%) was determined, as well as for the preoperative MA ADP (43.1 ± 15.9 mm) and MA AA (37.2 ± 19.6 mm), showing an offset of the effect of both medications starting from day 3. Patients with complete pre- and postoperative data were stratified depending on duration off antiplatelet therapy (≤3 days, 3-7 days and >7 days): n = 27, ADP % preop inhibition (43.2 ± 21.6%), ADP % postop inhibition (32.3 ± 18.3%), p = 0.048. Distribution of immediate pre- and post- ADP and AA % inhibitions, showing a possible reduction in Δ of inhibition for clopidogrel at 3 days, were also assessed. ⋯ According to the findings, the TEG PM assay might be a feasible approach to objectively evaluate the effects of aspirin and clopidogrel during the perioperative period and potentially guide drug management.