Seminars in thrombosis and hemostasis
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Semin. Thromb. Hemost. · Jan 1997
ReviewMonitoring and management of anticoagulation in children requiring extracorporeal circulation.
Pharmacologic manipulation of hemostasis is a prerequisite for cardiac surgery with cardiopulmonary bypass (CPB) to prevent clot formation in the extracorporeal circuit. Children who require surgical correction of congenital heart defects are at increased risk for prolonged and excessive bleeding after separation from CPB. Heparin remains the anticoagulant of choice for surgery requiring CPB. ⋯ This manuscript reviews the pitfalls in the management of anticoagulation for children undergoing surgery that requires CPB. Pertinent literature related to the use of aprotinin, a serine protease inhibitor that has been shown to improve hemostasis during and after CPB, is discussed. It is hoped that this article will provide a practical guideline for the rational management of anticoagulation in children with congenital heart disease undergoing CPB surgery.
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Semin. Thromb. Hemost. · Jan 1996
ReviewManagement of acquired coagulation disorders in emergency and intensive-care medicine.
Coagulation disorders usually confront the emergency physician as bleeding episodes or as abnormalities of laboratory tests. Bleeding has to be treated aggressively, while pathological coagulation tests should be related to a more differentiated diagnosis at first. The most common causes of acquired coagulation disorders are liver disease, vitamin K deficiency, and disseminated intravascular coagulation (DIC). ⋯ Antithrombin III substitution cannot be assumed as established therapy so far. Inhibitors can lead to bleeding, but the most common inhibitor, lupus anticoagulant, rather predisposes to thrombosis. In bleeding patients with inhibitors against single clotting factors, treatment consists of adequate substitution before initiating the diagnostic workup.
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Semin. Thromb. Hemost. · Jan 1996
ReviewCurrent trends in antithrombotic drug and device development.
During the past decade, many significant developments in the clinical management of thrombotic and vascular disorders have occurred. In particular, several newer approaches for the prophylactic and therapeutic management of such disorders as venous thrombosis, acute myocardial infarction, and stroke have been introduced. This has been possible because of the understanding of the molecular mechanisms involved in the thrombogenic process, which plays a key role in the pathophysiology of thrombotic and vascular disorders. ⋯ Thus, an optimal antithrombotic drug approach will include the targeting of all possible sites involved in thrombogenesis. Antithrombotic and anticoagulant drugs will also be useful in the development of such biomedical devices as stents and other vascular support material. Polytherapeutic approaches utilizing combinations of drugs may turn out to be the most effective in the management of thrombotic disorders.
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Semin. Thromb. Hemost. · Jan 1995
Review Comparative StudyThromboelastography and cardiopulmonary bypass.
The TEG tracks postoperative hemorrhage after CPB and is useful in guiding therapy. Its ability to characterize the overall interaction of all procoagulant participants in a final outcome (clot strength) is unique. Much work in the future is needed to establish the particular applications for TEG monitoring in CPB patients