Seminars in thrombosis and hemostasis
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Semin. Thromb. Hemost. · Nov 2007
ReviewClinical relevance of the effects of plasma expanders on coagulation.
Patients with severe bleeding are often treated with colloids as plasma replacement fluids, including dextrans, gelatin-based solutions, or starches. Many of these agents will affect the hemostatic system beyond their effect on hemodilution. ⋯ In this overview, we discuss the effects of various plasma replacement solutions on the coagulation system and review the controlled clinical studies with different plasma expanders on clinically significant end points. We conclude that most plasma expanders have indeed marked effects at various points in the hemostatic system and that there are significant differences between various plasma replacement fluids but that clinically relevant effects on bleeding are mostly present if large volumes (i.e., > 1.5 L) are infused or if the patient has a concomitant or preexistent hemostatic impairment.
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Semin. Thromb. Hemost. · Nov 2007
ReviewThrombolysis for pulmonary embolism and venous thrombosis: is it worthwhile?
Venous thromboembolism is a frequently occurring and potentially fatal disease characterized by short-term and long-term sequelae. Conventional treatment consists of heparin and vitamin K antagonists, but there is an ongoing controversy if more aggressive therapy, such as thrombolytic drugs, should be used in selected patients to achieve faster clot lysis in pursuit of better clinical outcome. A review of the literature shows that thrombolytic therapy is not recommended in the treatment of venous thrombosis. ⋯ In pulmonary embolism (PE), thrombolytic therapy is generally recommended for patients with massive PE and hemodynamic instability, despite scarce and inconclusive evidence. There is no evidence that thrombolysis has a benefit over standard anticoagulant treatment in normotensive patients with acute PE, but more research is needed to better identify the subgroup of patients with nonmassive PE in whom the risk-benefit ratio is most favorable. Until this group is defined and the benefit of thrombolytic therapy is demonstrated, thrombolytic therapy should only be considered in patients with signs of massive PE and hemodynamic shock.