Seminars in hematology
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Seminars in hematology · Jul 2013
ReviewThrombocytopenia in the intensive care unit-diagnostic approach and management.
Thrombocytopenia often complicates critical illness and is associated with increased morbidity and mortality. Approaching thrombocytopenia is challenging in the intensive care unit (ICU) because of the multifactorial pathogenesis of this disorder. Interpretation of the platelet count course after ICU admission is helpful to narrow down the cause of thrombocytopenia. ⋯ A rapid decrease in platelet counts of more than 50% within 1-2 days, especially if occurring after an intermittent rise, requires immediate attention as it may be a symptom of immune-mediated mechanisms, eg, heparin-induced thrombocytopenia. Treatment should target the underlying disease. Platelet transfusions are indicated in bleeding patients, while there is no strong evidence supporting the usefulness of prophylactic transfusions in ICU patients.
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Trauma is a leading cause of death and disability. Hemorrhage is the major mechanism responsible for death during the first 24 hours following trauma. One quarter of severely injured patients present in the emergency room with acute coagulopathy of trauma and shock (ACOT). ⋯ The resuscitation-associated coagulopathy (RAC) is secondary to a combination of acidosis, hypothermia and dilution from intravenous blood and fluid therapy. RAC may further aggravate acidosis and hypoxia resulting in a vicious cycle. This review focuses on the biology of the trauma-associated coagulopathy, and reviews current therapeutic strategies.
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Seminars in hematology · Jul 2013
ReviewReview of the American College of Chest Physicians 2012 Guidelines for Anticoagulation Therapy and Prevention of Thrombosis.
The eighth edition (AT8) of the American College of Chest Physicians (ACCP) Antithrombotic Therapy and Prevention of Thrombosis Guideline, published in June 2008, was a comprehensive presentation of primary studies and detailed discussions of rationale for recommendations. This resulted in an approximately 900-page Chest Supplement publication. Updating the guidelines in a succinct fashion posed a formidable challenge for the ninth edition (AT9), published in February 2012. ⋯ Major innovative changes include a recognition of the value of estimating the risk reductions in symptomatic, as opposed to asymptomatic (venographically), detected venous thrombosis, using nonconflicted methodologists as topic editors, new insights into evidence, and increasing emphasis on what is known about patients' values and preferences that have served to improve this edition of the guidelines. This review provides a summary of the updates of the guidelines for anticoagulation therapy and prevention of thrombosis. The AT9 recommendations are presented with, if included, the AT8 recommendations in parenthesis for comparison purposes.