Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Apr 2009
Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases.
Timely reversal of excessive anticoagulation is important in preventing bleeding complications. The use of vitamin K in correcting over-anticoagulation is widely accepted to be superior to discontinuation of therapy but its effectiveness and safety in large scale cohort studies has not been assessed. ⋯ This adopted protocol for the reversal of excessive anticoagulation in asymptomatic or minor symptom presenting patients is easily applied, effective in lowering the INR and preventing complications. Its use in high risk thromboembolic patients warrants caution.
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J. Thromb. Thrombolysis · Jan 2009
Randomized Controlled Trial Multicenter Study Comparative StudyPlatelet and endothelial activity in comorbid major depression and coronary artery disease patients treated with citalopram: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy Trial (CREATE) biomarker sub-study.
Major depression is an independent risk factor for increased morbidity and mortality in patients with coronary artery disease (CAD). Increased platelet activity and vascular endothelial dysfunction are possible pathways through which depression may increase cardiovascular risk. Citalopram exhibits strong selective inhibition of human platelet activation, but little is known about its effects on vascular endothelium. We assessed whether treatment of depressed CAD patients with citalopram alters platelet/endothelial biomarkers. The study was performed within the framework of the CREATE trial. ⋯ Treatment with citalopram for 12 weeks in depressed CAD patients is associated with enhanced production of nitric oxide despite the co-administration of commonly prescribed anti-platelet regimens including aspirin and clopidogrel. Clinical implications of these findings are unclear, but improved endothelial function is implied by the increased NO production, suggesting that citalopram may be of particular benefit for patients with comorbid depression and vascular disease including CAD, stroke, peripheral artery disease, and diabetes.
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J. Thromb. Thrombolysis · Jan 2009
Antithrombin after cardiac surgery: implications on short and mid-term outcome.
Antithrombin (AT) drop during cardiac surgery has been described. The causes and the effects of this phenomenon are not clear. The objective of the study is to evaluate the relationship of AT postoperative values on short and mid-term outcome after cardiac surgery. ⋯ Low AT after cardiac surgery is associated with higher incidences of peri-operative complications and worse survival in the mid-term. Future studies should clarify the pathophysiologic mechanism of this findings and possible therapeutic directions.
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J. Thromb. Thrombolysis · Oct 2008
Underutilization of venous thromboemoblism prophylaxis in medical patients in a tertiary care center.
New recommendations concerning the use of prophylactic anticoagulation for medically ill patients have been in use for some time now. This study aims at assessing how much house-staff in a tertiary care setting are implementing these new recommendations in the hope that through quantitative analysis of the deficiency we would be able to identify areas of weakness. ⋯ VTE prophylaxis is underutilized at AUBMC, a tertiary care teaching hospital in the Middle East. Critical care patients were being acceptably anti-coagulated, whereas cancer patients are doing the worst.
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J. Thromb. Thrombolysis · Aug 2008
Comparative StudyRole of mean platelet volume in triagging acute coronary syndromes.
Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). ⋯ In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.