Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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Clin. Appl. Thromb. Hemost. · Oct 2014
Comparative StudyMonitoring of unfractionated heparin using activated partial thromboplastin time: an assessment of the current nomogram and analysis according to age.
We frequently encounter high levels of activated partial thromboplastin time (aPTT) during heparin anticoagulation. The purpose of this study is, first, to investigate the rate of achieving and maintaining therapeutic aPTT in patients treated with heparin anticoagulation and second, to assess the adequacy the current nomogram. ⋯ Our results indicate a high rate of achieving therapeutic aPTT at 24 hous and 48 hours, but a low success rate for maintenance within the TR. Most patients had supratherapeutic aPTT of more than 90 seconds. Therefore, the TR of aPTT that matches heparin levels of 0.3 to 0.7 IU/mL measured by antifactor Xa assay should be determined. If not, we should consider adopting a new heparin dosing nomogram.
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Clin. Appl. Thromb. Hemost. · Jul 2014
Postmarketing Surveillance of Recombinant Human Soluble Thrombomodulin (Thrombomodulin α) in Pediatric Patients With Disseminated Intravascular Coagulation.
Recombinant human soluble thrombomodulin (thrombomodulin α [TM-α]) has been marketed as a novel anticoagulant for disseminated intravascular coagulation (DIC) in Japan since 2008. Postmarketing surveillance (PMS) has been conducted since its approval. As effectiveness and safety were not previously determined in pediatric patients, this study evaluated PMS data and examined the usefulness of TM-α in treating pediatric DIC. ⋯ At 28 days after the last TM-α administration, the survival rate was 71.6%. Nineteen episodes of adverse drug reactions were observed in 11 patients but no significant differences were noted for effectiveness and safety. Although this study was limited by its retrospective design, including selection biases and no limitation on concomitant use of other anticoagulants, TM-α appears to be useful for the treatment of DIC in both pediatric and adult patients.
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Clin. Appl. Thromb. Hemost. · May 2014
Prognostic value of red cell distribution width in patients with pulmonary embolism.
Elevated red blood cell distribution width (RDW) has been associated with adverse outcomes of heart failure and pulmonary hypertension. A total of 702 consecutive patients with acute pulmonary embolism (PE) were evaluated. There was a graded increase in mortality rate with RDW quartiles of 5.8% in quartile I (≤13.6), 9.7% in quartile II (13.7%-14.5%), 13.1% in quartile III (14.6%-16.3%), and 20% in quartile IV (>16.3%; P < .001). ⋯ In multivariable regression analysis, RDW remained associated with an increased odds of death (odds ratio: 1.2, 95% CI: 1.1-1.4). High RDW level was an independent predictor of short-term mortality in PE. The RDW levels may provide a potential marker to predict outcome in patients with PE.
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Clin. Appl. Thromb. Hemost. · Apr 2014
Randomized Controlled TrialProtamine overdose and its impact on coagulation, bleeding, and transfusions after cardiopulmonary bypass: results of a randomized double-blind controlled pilot study.
We assessed the effects of protamine overdosing on thrombelastometry, bleeding, and transfusions in patients after cardiopulmonary bypass (CPB). ⋯ Heparin dose-based protamine management leads to protamine overdosing with inhibition of the coagulation process. Protamine management guided by heparin concentration avoids these complications.
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Clin. Appl. Thromb. Hemost. · Mar 2014
Randomized Controlled Trial Multicenter StudyThrombin generation mediators and markers in sepsis-associated coagulopathy and their modulation by recombinant thrombomodulin.
Severe sepsis remains the most common cause of death in critically ill patients, and thrombin plays a crucial role in the pathogenesis of sepsis-associated disseminated intravascular coagulation (DIC). The purpose of this study was to profile prothrombin fragment (F1.2), thrombin-antithrombin complex (TAT), and d-dimer (DD) throughout the course of hospital stay in patients identified with sepsis. Plasma samples from patients enrolled in the ART-123 study, a phase 2b, international, multicenter, randomized placebo-controlled trial were analyzed for various parameters using enzyme-linked immunosorbent assay methods. ⋯ Although the data were widely scattered, these results show that DIC represents a hypercoagulable state along with other hemostatic abnormalities and the activation of the inflammatory process. Modulation of these activation processes through targets such as DD, F1.2, and TAT may play an important regulatory role in the pathogenesis of sepsis-associated coagulopathy. Moreover, this study validates the hypothesis that thrombomodulin downregulates the thrombin generation mediators/markers in sepsis-associated DIC.