Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Aug 2009
Comparative StudyA comparison of direct thrombin inhibitors in the treatment of Heparin-Induced Thrombocytopenia: a single institution experience.
Heparin-Induced Thrombocytopenia (HIT), if left untreated, can lead to thrombocytopenia, thromboembolic complications and even death. Two thrombin inhibitors, lepirudin and argatroban, have been shown to improve clinical outcomes compared to historical controls in the management of HIT. The purpose of this retrospective study was to compare the effects of lepirudin and argatroban in the management of HIT. ⋯ Our findings suggest that thrombin inhibitors can improve the outcomes of patients with HIT by decreasing the incidence of morbidity and mortality relating to HIT. No significant difference could be determined in outcomes between argatroban and lepirudin therapy.
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J. Thromb. Thrombolysis · Aug 2009
Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia.
Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient at increased risk of thrombotic events. ⋯ Implementation of a CDSS did not appear to improve the ability to detect and respond to potential HIT, but resulted in increased laboratory testing and changes in clinician reactions to decreasing platelet counts that deserve further study.
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J. Thromb. Thrombolysis · Jul 2009
ReviewPlatelet reactivity and the identification of acute coronary syndromes in the emergency department.
Risk stratifying patients with potential acute coronary syndromes (ACS) in the Emergency Department is an imprecise and resource-consuming process. ACS cannot be ruled in or out efficiently in a majority of patients after initial history, physical exam, and ECG are analyzed. This has led to a reliance on cardiac markers of myocardial necrosis as a key means of making the diagnosis. ⋯ This has led to an ongoing search for one or more marker(s) that would be more sensitive in early ACS. With the central role that platelets play in the pathophysiology of coronary thrombosis, measures of platelet function represent one potential area where an early ACS marker might be identified. This review will focus on selected tests/markers of platelet function that have shown some promise with respect to the risk stratification of patients with potential ACS.
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J. Thromb. Thrombolysis · May 2009
Comparative StudyAspirin is insufficient in inhibition of platelet aggregation and thromboxane formation early after coronary artery bypass surgery.
Aspirin administered early after coronary artery bypass grafting surgery (CABG) improves graft patency and patients survival. However, the antiplatelet effect of aspirin seems to be variable and aspirin resistance is currently still being discussed. The aim of the study was to assess aspirin efficacy in the early postoperative period. ⋯ Aspirin did not sufficiently inhibit platelet aggregation and thromboxane formation in the early postoperative period. Thus, antiplatelet treatment strategy should be intensified or modified in patients early after bypass surgery.