Haematologica
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Comparative Study Clinical Trial
The VAD-DCEP sequence is an effective pre-transplant therapy in untreated multiple myeloma.
Standard treatment for patients with multiple myeloma is debulking chemotherapy with non-alkylating agents followed by a regimen to mobilize peripheral blood stem cells (PBSC) and the transplantation of the mobilized, autologous PBSC. The aim of this study was to evaluate the efficacy of a new regimen and compare it with that of a previous regimen. ⋯ the VAD-DCEP sequence has an adequate mobilizing capacity, without significant toxicity, and a good anti-myeloma activity, and therefore represents a safe and effective therapeutic approach for multiple myeloma patients at the onset of their disease.
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Anticoagulation of patients with heparin-induced thrombocytopenia (HIT) may be limited by cross-reaction of HIT antibodies with danaparoid and generation of antibodies during therapy with lepirudin. We used fondaparinux to treat 6 patients with a history of HIT with thromboembolism and 2 patients with thrombocytopenia during low-molecular-weight heparin administration.
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Review
Management of coumarin-associated coagulopathy in the non-bleeding patient: a systematic review.
Excessive anticoagulation is a frequent complication of anticoagulant therapy. The risk of hemorrhage approximately doubles for each one point increase in the International Normalized Ratio (INR) above 3.0. Reducing a prolonged INR to within the desired therapeutic range requires that oral anticoagulants be withheld. In addition, vitamin K may be administered. Since this latter treatment can produce rapid reductions in the INR, it must be carefully tailored to meet individual needs, balancing the risk of bleeding against the potential risk of causing thromboembolism. ⋯ Large randomized trials using clinical end-points are now required to provide evidence-based treatment recommendations for patients with coumarin-associated coagulopathy.
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Letter Clinical Trial
Efficacy of a modified Stanford V regimen in patients with advanced Hodgkin's lymphoma.
We report treatment results obtained with a modified Stanford V regimen in 32 patients with advanced Hodgkin's lymphoma (stage II bulky disease, III, IV). Treatment results were not superior to those achieved with conventional treatment (ABVD) in terms of complete remission and survival rates (progression-free survival and overall survival at 3 years: 66% and 91%, respectively).
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Practice Guideline
Thromboprophylaxis practice patterns in two Western Australian teaching hospitals.
Evidence-based international guidelines recommend that all patients undergoing elective hip or knee arthroplasty receive thromboprophylaxis with low-molecular-weight heparin or adjusted-dose warfarin. Our objective was to determine what proportion of patients undergoing elective hip or knee arthroplasty actually receive recommended thromboprophylaxis according to international guidelines. ⋯ Current thromboprophylaxis practice at our institutions falls substantially short of national and international guidelines. The reasons for low thromboprophylaxis use should be further explored and strategies for change implemented in order to optimize clinical practice.