Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · May 2010
Clinical TrialMonitoring unfractionated heparin in pediatric patients with congenital heart disease having cardiac catheterization or cardiac surgery.
Determine the effect of age and congenital heart disease (CHD) on whole blood tests for monitoring unfractionated heparin (UFH) in children. Determine correlation with anti-Xa levels in children undergoing cardiac catheterization or cardiac surgery. A prospective cross-sectional study of 211 healthy children about to have minor surgery (median age 3.5 years) and 110 CHD patients (median age 2.1 years) undergoing cardiac catheterization or cardiac surgery. ⋯ Some whole blood coagulation tests are affected by age in healthy children similar to laboratory tests and are variably influenced by the presence of CHD. ACT+ is the most reliable predictor of anti-Xa levels in both catheterization and surgery for pediatric patients. The APTT exhibited stronger correlation with anti-Xa than previous reports of laboratory APTT and warrants further evaluation for monitoring heparin thromboembolism therapy.
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J. Thromb. Thrombolysis · May 2010
Comparative StudyComparative effects of cilostazol and aspirin on the impairment of endothelium-dependent cerebral vasodilation caused by acute cigarette smoking in rats.
We previously reported that acute cigarette smoking can cause a dysfunction of endothelium-dependent vasodilation in cerebral vessels, and that a reduction of oxidative stress by agents such as valsartan, fasudil, or apocynin prevented this impairment. Here, our aim was to investigate the comparative effects of two antiplatelet drugs used for stroke-prevention [a phosphodiesterase-3 inhibitor (cilostazol) and a cyclooxygenase inhibitor (aspirin)] on smoking-induced endothelial dysfunction in cerebral arterioles. In Sprague-Dawley rats, we used a closed cranial window preparation to measure the changes in pial vessel diameters induced by topical application of acetylcholine (ACh) following intraperitoneal injection of 0.5% carboxymethyl cellulose sodium salt (CMC; vehicle control for the antiplatelet drugs). ⋯ Under control conditions, cerebral arterioles were dose-relatedly dilated by topical ACh (10(-6) and 10(-5 )M). One hour after 1-min smoking, 10(-5 )M ACh (a) constricted cerebral pial arterioles in the control group and in the aspirin-pretreatment group (responses not significantly different from each other), but (b) dilated cerebral pial arteries in the cilostazol pretreatment groups (responses significantly different from those obtained without cilostazol pretreatment). Thus, cilostazol (but not aspirin) may prevent the smoking-induced impairment of endothelium-dependent vasodilation in cerebral pial arterioles.
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J. Thromb. Thrombolysis · Feb 2010
ReviewWarfarin anticoagulation reversal: management of the asymptomatic and bleeding patient.
The management of patients with supra-therapeutic INR in a common clinical problem. The risk of bleeding is influenced by the intensity, variability and duration of anticoagulation, patient age, presence of co-morbidities and concomitant drug therapy. For the asymptomatic patient, warfarin discontinuation is all that is usually required but for individuals at high risk of bleeding and those with INR > 10, oral vitamin K administration is recommended. In the presence of major bleeding, treatment with intravenous vitamin K and prothrombin complex concentrate is the most effective therapy.
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J. Thromb. Thrombolysis · Feb 2010
Review Case ReportsImpact on patient care: patient case through the continuum of care.
Hospitalized patients are at increased risk of venous thromboembolism and the Joint Commission has initiated practice measures to improve the rates of preventable events. The Joint Commission also initiated the National Patient Safety Goals for medication prescribing and administration, of which, goal 03.05.01 is specifically aimed at anticoagulation therapy. These measures and goals are consistent with the American College of Chest Physicians' Consensus Guidelines on Antithrombotic and Thrombolytic Therapy. This narrative review uses a case-based approach that brings up practical clinical questions regarding these measures, goals and guidelines as they apply to a patient going through the continuum of care from the hospital to their home.
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J. Thromb. Thrombolysis · Feb 2010
ReviewWhat you should know about the 2008 American College of Chest Physicians evidence-based clinical practice guidelines (8th) on antithrombotic and thrombolytic therapy.
The American College of Chest Physicians published their first consensus conference guidelines on antithrombotic therapy in 1986 and has updated these guidelines approximately every 3 years as a supplement to the journal Chest. These guidelines are widely accepted as an authoritative source of information and considered by many to be the textbook for antithrombotic therapy. ⋯ Examples from the literature that support the evolution these guidelines will focus on changes that are most germane to the majority of attendees at the 10th National Conference on Anticoagulant Therapy and members of the AC Forum. The objective of this article is to help answer ten common clinical questions frequently faced by anticoagulation management services.