Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Nov 2010
Comparative StudySafety of immediate reversal of anticoagulation by protamine to reduce bleeding complications after infarct artery stenting for acute myocardial infarction and adjunctive abciximab therapy.
Infarct artery stenting with adjunctive abciximab therapy is widely used treatment for patients with acute myocardial infarction (AMI). However, bleeding complications have been associated with a worse clinical outcome. Randomized trials in elective patients have shown that postprocedural protamine administration is safe and associated with a significant reduction in bleeding complications. ⋯ The two groups were similar in all baseline characteristics. There were no differences in in-hospital mortality, reinfarction, urgent target vessel revascularization, stroke or acute or subacute stent thrombosis, while Group 1 patients showed a lower incidence of major bleeding complications (ACUITY scale: 1.1 vs. 4.0%, P = 0.035) and a shorter length of hospital stay (3.5 ± 1.7 vs. 4.0 ± 1.6 days, P = 0.002) as compared with heparin treated patients. Among patients undergoing primary stenting with abciximab administration, immediate post-PCI reversal anticoagulation by protamine without associated heparin infusion is safe and associated with a significant reduction in major bleeding complications.
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J. Thromb. Thrombolysis · Aug 2010
Plasma fibrin clot properties in atopic dermatitis: links between thrombosis and atopy.
Myocardial infarction and ischemic stroke are associated with formation of dense fibrin clots resistant to lysis. Although pro- and antithrombotic alterations have been reported in atopy, fibrin clot function has not been studied in atopic patients. The aim of the current study was to investigate fibrin clot properties in patients with atopic dermatitis (AD). ⋯ Patients with AD had lower clot permeability (7.12 +/- 1.87 vs. 9.32 +/- 0.86 x 10(-9) cm(2); P < 0.0001), increased fiber thickness (maximum clot absorbancy at 405 nm, 4.03 +/- 0.54 vs. 3.47 +/- 0.25), faster clot formation (the lag phase, 39.16 +/- 4.61 vs. 43.05 +/- 4.56 s), higher maximum D-dimer levels released from clots, reflecting increased clot mass (4.05 +/- 0.57 vs. 3.47 +/- 0.25 mg/l; P < 0.0001), lower rate of D-dimer release (0.073 +/- 0.01 vs. 0.078 +/- 0.01 mg/l/min; P < 0.0001), and prolonged fibrinolysis time (9.26 +/- 1.47 vs. 7.81 +/- 1.17 min; P < 0.0001) compared with controls. Concomitant asthma (n = 36; 27.7%) was related to a higher rate of D-dimer release from clots than the remainder (0.075 +/- 0.01 vs. 0.072 +/- 0.01 mg/l/min, respectively; P = 0.03). Altered plasma fibrin clot properties associated with reduced efficiency of fibrinolysis can be detected in AD patients, which might represent a novel mechanism that modulates a hemostatic balance in atopy.
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J. Thromb. Thrombolysis · Jul 2010
Are surgical patients at risk of venous thromboembolism currently meeting the Surgical Care Improvement Project performance measure for appropriate and timely prophylaxis?
The US Surgical Care Improvement Project (SCIP) has approved two performance measures to improve venous thromboembolism (VTE) prevention. SCIP-VTE-2 measures the proportion of surgery patients who received appropriate VTE prophylaxis within 24 h prior to surgery to 24 h after surgery. This study assesses the current rate of achievement of SCIP-VTE-2 criteria using a retrospective data set of real-world surgical patients. ⋯ Of the 149,785 patients included, 56.2% received appropriate prophylaxis and 52.7% achieved the SCIP-VTE-2 performance measure for both appropriate and timely prophylaxis. To conclude, this study highlights that VTE prophylaxis currently only meets SCIP-VTE-2 requirements in approximately half of real-world surgical patients. The use of retrospective analyses such as this hospital billing data analysis may assist hospitals in measuring their current and future performance in VTE prevention.
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Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but usually preventable complication of hospitalization associated with substantial mortality, morbidity, and health care costs. Despite published guidelines for the prevention of VTE among hospitalized patients, underutilization of prophylaxis continues to be a problem in the United States, Canada, and worldwide. ⋯ While extended out-of-hospital prophylaxis has been validated in the orthopedic and surgical oncology literature, data regarding the prevention of VTE in other hospitalized patient populations after discharge have been limited. In this review article, we discuss decision support strategies for improving VTE prevention during hospitalization and at the time of discharge.
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J. Thromb. Thrombolysis · Jul 2010
Thrombolytic efficacy of recombinant human microplasmin in a canine model of copper coil-induced coronary artery thrombosis.
We investigated the in vitro fibrinolytic properties of microplasmin, the isolated proteinase domain of plasmin, and its thrombolytic efficacy in a coronary artery thrombosis model in dogs. The amidolytic and fibrinolytic activity of recombinant microplasmin was compared with natural human plasmin. The thrombolytic efficacy of microplasmin was studied in a canine model of copper coil induced coronary artery thrombosis. ⋯ TIMI 3 coronary flow was obtained in 0/5, 2/5, 2/5 and 3/5, respectively, during subsequent intravenous administration and in 5/5 and 4/5 in case of intracoronary administration (ANOVA P < 0.05). When compared to natural plasmin, the catalytic efficiency of microplasmin towards chromogenic substrates was similar, but the fibrinolytic potency of microplasmin towards fibrin clots was lower. Intracoronay administration of microplasmin effectively lysed coronary thrombosis.