Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Jun 2008
ReviewVascular endothelial growth factors in pulmonary edema: an update.
Pulmonary edema is a life-threatening complication of critical illness. Identification of the underlying mechanisms of pulmonary edema is a prerequisite for the development of adequate treatment. The initial description of fluid transportation across capillaries (Starling's law) while of critical importance, did not provide full insight into the underlying pathophysiology of vascular leakage. ⋯ However, it has long been recognized that there is significant overlap between the various types of pulmonary edema, raising important questions regarding the role of novel mechanisms that may contribute to the development of interstitial and alveolar leakage. Recently, several studies on VEGF, an angiogenic growth factor which affects endothelial permeability, have identified this molecule as a potential regulator of vascular leakage and repair in pulmonary edema. We review here the underlying the mechanisms by which VEGF may do this and will discuss the still unanswered questions regarding vascular pharmacology in the setting of pulmonary edema.
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J. Thromb. Thrombolysis · Jun 2008
Case ReportsEchocardiographic diagnosis of a giant thrombus passing through a patent foramen ovale from right atrium to the left atrium.
Pulmonary embolus sourced by right atrial thrombus trapped in a patent foramen ovale is an unusual, rare condition. Thus in suspicion of massive pulmonary thromboembolus, echocardiographic examination carries great importance evaluate right ventricular functions and diagnose right sided intracardiac thrombus. We report a 76-year-old female with massive pulmonary embolism caused by a gigantic thrombus trapped in a patent foramen ovale. The echocardiography was the diagnostic procedure to display the source of the thromboembolism and urgent cardiac surgery was successful and life-saving treatment in this case.
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J. Thromb. Thrombolysis · Jun 2008
Effect of body mass index on Argatroban therapy during percutaneous coronary intervention.
Obesity is common in patients undergoing percutaneous coronary intervention (PCI). Argatroban, a direct thrombin inhibitor, is used during PCI in patients with or at risk of heparin-induced thrombocytopenia (HIT) and also has been evaluated in conjunction with glycoprotein IIb/IIIa inhibition in nonHIT patients. We investigated the effect of body mass index (BMI), and specifically obesity (BMI>30 kg/m2), on argatroban therapy during PCI. ⋯ These findings support the use of actual body weight-adjusted (and ACT-targeted) argatroban therapy during PCI and suggest that dose adjustment for obesity (BMI up to 50.9 kg/m2) is unnecessary.
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J. Thromb. Thrombolysis · Jun 2008
Diagnostic value of D-dimer measurement in patients referred to the emergency department with suspected myocardial ischemia.
The accurate identification of patients with acute myocardial infarction (AMI) remains one of the most difficult challenges facing emergency physicians. The introduction of early and reliable biomarkers of AMI should hence be acknowledged, since they would increase the efficiency of the diagnostic process. ⋯ Results of the present investigation on patients with AMI established by accepted diagnostic criteria (cTnT values above the decisional threshold of the assay associated with suggestive clinical symptoms), testify that D-dimer testing would not add clinically meaningful information to the sole determination of the cardiospecific troponins 12-24 h after patient's admission at the emergency department, when the cumulative data indicate that the diagnostic efficiency of cTnT is the highest.
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J. Thromb. Thrombolysis · Apr 2008
Frequency of thromboprophylaxis and incidence of in-hospital venous thromboembolism in a cohort of emergency department patients.
Prior work suggests that in-hospital pulmonary and venous thromboembolism (VTE) could be decreased if the rate of prophylaxis for VTE in high-risk patients were increased at the time of admission. Our objective was to quantify the rate of thromboprophylaxis and incidence of in-hospital VTE, based upon risk of VTE, in a cohort of patients admitted through the emergency department (ED). ⋯ These data suggest only a modest opportunity for ED-based policy for thromboprophylaxis in admitted medical patients.