Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Jul 2014
Clinical TrialDecreased circulating microRNA-223 level predicts high on-treatment platelet reactivity in patients with troponin-negative non-ST elevation acute coronary syndrome.
To investigate the relationship between circulating microRNA 223 (miR-223) levels and clopidogrel responsiveness in patients with coronary heart disease. A total of 62 consecutive patients with troponin-negative non-ST elevation acute coronary syndrome (NSTE-ACS) scheduled for elective percutaneous coronary intervention were enrolled. The plasma circulating miR-223 levels were quantified by real-time PCR, and platelet reactivity was determined by platelet reactivity index (PRI), measured by vasodilator-stimulated phosphoprotein (VASP) phosphorylation flow cytometry after 300 mg (for at least 24 h) or 75 mg clopidogel (for at least 5 days) plus aspirin treatment. ⋯ In addition, miR-223 level was statistically correlated with PRI (Spearman r = -0.379, P = 0.002). Stepwise binary logistic regression analysis revealed that among factors that potentially influence platelet reactivity (CYP2C19*2/*3 loss-of-function genotypes, use of calcium channel blockers/proton-pump inhibitors, age, diabetes and smoking), decreased circulating miR-223 level was the only independent predictor for the presence of PRI-determined lower responders (OR 0.111, 95% CI 0.018-0.692, P = 0.019). Our data suggest that circulating miR-223 may serve as a novel biomarker for assessment of clopidogrel responsiveness in troponin-negative NSTE-ACS patients.
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J. Thromb. Thrombolysis · May 2014
Randomized Controlled Trial Multicenter Study Comparative StudyCluster randomized controlled trial of a simple warfarin maintenance dosing algorithm versus usual care among primary care practices.
Many patients using warfarin are being managed in primary care and typically achieve a lower time in therapeutic range (TTR) for the international normalized ratio (INR) than patients in specialized care. A simple warfarin maintenance dosing tool could assist primary care physicians with improving TTR. We tested whether a simple warfarin maintenance dosing algorithm can improve TTR compared with usual care among Canadian primary care physicians. ⋯ Dosing decisions during the study in the algorithm group were more often in agreement with the algorithm's recommendations than with usual care (81 vs. 91 %; p < 0.0001). Mean study TTR of the algorithm group was not superior to usual care: [72.1 (SE 1.7) vs. 71.4 % (SE 1.5) respectively; p = 0.73]. The simple warfarin maintenance dosing algorithm did not improve TTR compared with usual care among Canadian primary care practices.
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J. Thromb. Thrombolysis · May 2014
Clinical TrialEvaluation of initial heparin infusion rates for a high-dose protocol.
Unfractionated heparin is widely used as anticoagulant therapy for thrombotic disease. However, determining appropriate dosing by intravenous infusion is highly variable in practice. Multiple standardized protocols have been adopted, including a weight-based nomogram entailing a loading dose of 80 U/kg, followed by an initial infusion rate of 18 U/kg/h. ⋯ Larger body mass index led to increased time to reach therapeutic anticoagulation. This study's results suggest that patients may benefit from receiving an initial heparin infusion rate of 14 U/kg/h over 18 U/kg/h. Decreasing the time to therapeutic aPTT may further help reduce workload from monitoring and dose titrations.
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J. Thromb. Thrombolysis · Apr 2014
Comparative StudyDiscrepant ratios of arterial versus venous thrombosis in hemophilia A as compared with hemophilia B.
The occurrence of thrombosis in patients with congenital bleeding disorders represents an exceptional event. Hemophilia A and hemophilia B patients have been showed to present both arterial and venous thrombosis (85 cases of arterial thrombosis and 34 cases of venous thrombosis). The great majority of arterial thrombosis are myocardial infarction or other acute coronary syndromes, whereas the majority of venous thrombosis are deep vein thrombosis and/or pulmonary embolisms. ⋯ The ratio of arterial versus venous thrombosis in hemophilia A is 3.72 whereas that for hemophilia B is 1.12. This indicates that arterial thrombosis is more frequent in hemophilia A as compared to hemophilia B and the opposite is true for venous thrombosis. The potential significance of this discrepancy is discussed.
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J. Thromb. Thrombolysis · Apr 2014
Clinical TrialResident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III.
Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis (DVT) but is often delayed. Clinician-performed focused vascular sonography (FVS) has proven to accurately diagnose DVT in the ambulatory and emergency room settings. Whether trained medical residents can perform quality FVS in the critically ill is unknown. ⋯ The two-point compression ultrasound method demonstrated insufficient sensitivity in a cohort of critically ill medical patients due to a high-incidence of superficial femoral DVT. However, residents demonstrated substantial agreement with radiologists for the diagnosis of clinically relevant DVT after a 2-hour course. FVS should include the superficial femoral vein and is associated with a significant time savings.