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Po-Hao Chen, Hsien-Yuan Lane, Chieh-Hsin Lin
Neuroleptic malignant syndrome (NMS) is one of the most severe iatrogenic emergencies in clinical service. The symptoms including sudden consciousness change, critical temperature elevation and electrolytes imbalance followed by mutli-organ system failure were common in NMS. In addition to aggressive interventions with intravenous fluid resuscitation and antipyretics, several antidotes have been suggested to prevent further progression of the muscle damage. Dantrolene has been reported to be one of the most effective treatments for NMS...
November 30, 2016: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
J Stevanović, L A de Jong, B S Kappelhoff, E P Dvortsin, M Voorhaar, M J Postma
BACKGROUND: Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. METHODS: Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis...
2016: PloS One
Jedrzej Kosiuk, Romina Milani, Laura Ueberham, Tobias Uhe, Clara Stegmann, Gerhard Hindricks, Andreas Bollmann
Remote ischemic preconditioning (RIPC) has been studied in models of different cardiovascular entities. Recently, a beneficial effect of RIPC on incidence of atrial fibrillation (AF) in postsurgical patients has been suggested. However, the potential impact of RIPC on electrophysiological- and thrombogenesis-related parameters in the setting of paroxysmal nonvalvular AF has not been investigated. The aim of the study is to answer the following questions: (1) Does RIPC have impact on inducibility of AF in patients with known paroxysmal AF? If yes, what are the direct electrophysiological mechanisms of this phenomenon, and could RIPC be implemented to reduce AF burden? (2) Does RIPC have the potential to minimize thrombogenic effects of simulated episodes of AF? If so, what are inhibited components of thrombogenesis and can this be used to reduce thromboembolic risk related to paroxysmal AF? The presented study is a 2-arm, randomized, placebo-controlled, double-blinded, single-center trial in a cohort of 146 patients with paroxysmal AF referred for AF ablation in sinus rhythm...
October 24, 2016: Clinical Cardiology
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
Samer G Zammar, Barbara A Pockaj, Chee Chee Stucky, Nabil Wasif, Richard J Gray
BACKGROUND: Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis...
October 3, 2016: American Journal of Surgery
Anene Ukaigwe, Pragya Shrestha, Paras Karmacharya, Sarah K Hussain, Soraya Samii, Mario D Gonzalez, Deborah Wolbrette, Gerald V Naccarrelli
BACKGROUND: Apixaban is a Factor Xa inhibitor increasingly being used for stroke prevention in atrial fibrillation (AF). Although several studies have been done, the efficacy and safety of apixaban during the peri-procedural period of AF ablation remains unclear. We sought to systematically review pooled data from these various studies to evaluate thromboembolic and bleeding risks in patients undergoing catheter ablation for AF who are treated with apixaban (interrupted and uninterrupted)...
October 22, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Joachim Mikkelsen, Steen Henrik Matzen
INTRODUCTION: Cancer is a recognized risk factor of venous thromboembolism (VTE) as it induces a prothrombotic state through various mechanisms of activation of coagulation. Recognizing occult cancer as a risk factor is equally important. In patients with no known thromboembolic risk factors, utilizing PET/CT as a screening tool may be considered in order to reveal occult malignancy associated with otherwise unexplainable VTE. METHODS: This case report has been reported in line with the SCARE criteria...
October 14, 2016: International Journal of Surgery Case Reports
Yoshinari Enomoto, Varuna K Gadiyaram, Carola Gianni, Rodney P Horton, Chintan Trivedi, Sanghamitra Mohanty, Luigi Di Biase, Amin Al-Ahmad, J David Burkhardt, Arvin Narula, Gwen Janczyk, Matthew J Price, Rizwan Afzal, Moustapha Atoui, Matthew Earnest, Vijay Swarup, Shephal K Doshi, Sarina van der Zee, Rebecca Fisher, Dhanunjaya R Lakkireddy, Douglas N Gibson, Andrea Natale, Vivek Reddy
BACKGROUND: In the stroke prevention trials of left atrial appendage closure (LAAC) with the Watchman device, a post-implantation anti-thrombotic regimen of 6 weeks of warfarin was employed. OBJECTIVE: Because of the clinical complexity of warfarin use, we studied the relative feasibility and safety of instead employing non-warfarin oral anticoagulants (NOACs) during the peri- and initial post-implantation period after Watchman implantation. METHODS: This is a retrospective multicenter study of consecutive patients undergoing Watchman implantation and receiving peri- and post-procedural NOACs or warfarin...
October 19, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Naomi K Tepper, Monica V Dragoman, Mary E Gaffield, Kathryn M Curtis
BACKGROUND: Combined hormonal contraceptives (CHCs), containing estrogen and progestin, are associated with an increased risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE), compared with non-use. Few studies have examined whether non-oral formulations (including the combined hormonal patch, combined vaginal ring, and combined injectable contraceptives) increase the risk of thrombosis compared with combined oral contraceptives (COCs). OBJECTIVES: To examine the risk of VTE and ATE among women using non-oral CHCs compared to women using COCs...
October 19, 2016: Contraception
Craig I Coleman, W Frank Peacock, Gregory J Fermann, Concetta Crivera, Erin R Weeda, Michael Hull, Mary DuCharme, Laura Becker, Jeff R Schein
BACKGROUND: Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. METHODS: We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415...
October 22, 2016: BMC Health Services Research
Toshiyuki Amano, Kenta Takahara, Naoki Maehara, Takafumi Shimogawa, Nobutaka Mukae, Tetsuro Sayama, Shoji Arihiro, Shuji Arakawa, Takato Morioka, Sei Haga
OBJECTIVE: The use of antithrombotic agents such as anticoagulants and antiplatelet agents is widespread, and the opportunities to treat patients with chronic subdural hematoma (CSDH) under antithrombotic therapy are growing. However, whether antithrombotic therapy contributes to postoperative complications and recurrences of CSDH and how these agents should be managed in the surgical treatment of CSDH remains unclear. METHODS: We retrospectively analyzed 150 consecutive patients with CSDH who underwent neurosurgical interventions at Kyushu Rosai Hospital from 2011 to 2015 and followed them for more than 3 months...
October 7, 2016: Clinical Neurology and Neurosurgery
Kara J Walters, Anna Meador, John A Galdo, Katharine Ciarrocca
Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications...
October 22, 2016: Special Care in Dentistry
Akil Patel, Timothy R Miller, Ravi Shivashankar, Gaurav Jindal, Dheeraj Gandhi
BACKGROUND AND OBJECTIVE: Acute thrombus formation following aneurysm treatment with the Pipeline embolization device (PED) is a potentially devastating complication that may result in significant thromboembolic sequelae if not promptly treated. We therefore evaluated PED cases complicated by acute thrombus formation at our institution, with an emphasis on identifying early angiographic signs that may portend this event. MATERIALS AND METHODS: We retrospectively identified cases of acute thrombosis following PED placement in 100 consecutive procedures performed at our institution from a prospectively maintained clinical database...
October 21, 2016: Journal of Neurointerventional Surgery
Shigeaki Aoyagi, Eiki Tayama, Takeshi Oda, Tomokazu Kosuga, Hiroshi Yasunaga
In patients with atrial fibrillation, closure of the left atrial appendage (LAA) is recommended to prevent thromboembolic events, however, conventional exclusion or excision techniques have potential drawbacks such as persistent blood flow into the appendage and a residual stump. We propose a simple and easy technique for LAA closure consisting of intra-atrial excision of the LAA, which is invaginated into the left atrium (LA), and direct suture closure of the orifice from inside the LA. In this technique, complete elimination of the LAA was achieved without leaving a residual stump because the LAA was excised at the orifice and was closed at the base of the LAA...
September 9, 2016: Heart, Lung & Circulation
Elizabeth Bilotti, David H Vesole, Laura McBride, Linda Schmidt, Zhijie Gao, Madiha Gilani, Ann McNeill, Urszula Bednarz, Joshua Richter, Anthony Mato, Thorsten Graef, David S Siegel
BACKGROUND: This is a retrospective chart review to evaluate the efficacy of the addition of vorinostat to lenalidomide and dexamethasone in patients with multiple myeloma relapsed/refractory to lenalidomide and dexamethasone. METHODS: Charts from 26 consecutive patients able to obtain commercial vorinostat were analyzed for response and safety data. RESULTS: The overall response rate was 31%, and the clinical beneficial rate was 50%. The median duration of response was 3 months, and the median overall survival was 28...
October 2016: Clinical Lymphoma, Myeloma & Leukemia
Dong-Eog Kim, Jeong-Yeon Kim, Su-Kyoung Lee, Ju Hee Ryu, Ick Chan Kwon, Cheol-Hee Ahn, Kwangmeyung Kim, Dawid Schellingerhout
Direct thrombus imaging visualizes the root cause of thromboembolic infarction. Being able to image thrombus directly allows far better investigation of stroke than relying on indirect measurements, and will be a potent and robust vascular research tool. We use an optical imaging approach that labels thrombi with a molecular imaging thrombus marker - a Cy5.5 near-infrared fluorescent (NIRF) probe that is covalently linked to the fibrin strands of the thrombus by the fibrin-crosslinking enzymatic action of activated coagulation factor XIIIa during the process of clot maturation...
September 25, 2016: Journal of Visualized Experiments: JoVE
K-W Nam, C K Kim, T J Kim, S J An, A M Demchuk, Y Kim, S Jung, M-K Han, S-B Ko, B-W Yoon
BACKGROUND AND PURPOSE: The occurrence of stroke in cancer patients is caused by conventional vascular risk factors and cancer-specific mechanisms. However, cryptogenic stroke in patients with cancer was considered to be more related to cancer-specific hypercoagulability. In this study, we investigated the potential of the D-dimer level to serve as a predictor of early neurologic deterioration (END) in cryptogenic stroke patients with active cancer. METHODS: We recruited 109 cryptogenic stroke patients with active cancer within 72 h of symptom onset...
October 20, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Marina Pieri, Anna Mara Scandroglio, Marcus Müller, Panagiotis Pergantis, Alexandra Kretzschmar, Friedrich Kaufmann, Volkmar Falk, Thomas Krabatsch, Georg Arlt, Evgenij Potapov, Marian Kukucka
BACKGROUND AND AIM OF THE STUDY: Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue. METHODS: We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection...
October 20, 2016: Journal of Cardiac Surgery
James Demetrios Douketis
The American College of Chest Physicians recently updated their practice guidelines for the treatment of patients with venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism. The 2016 guidelines represent the tenth iteration of these guidelines, which are widely used, and are considered as the reference standard for practice guidelines related to venous thromboembolism. The objectives of this review are to highlight the key recommendations that are new in these guidelines, to address recommendations that may be considered controversial, and to touch on areas of ongoing research that may better inform some of these recommendations...
October 20, 2016: Internal and Emergency Medicine
Makoto Ikejiri, Hideo Wada, Norikazu Yamada, Maki Nakamura, Naoki Fujimoto, Kaname Nakatani, Akimasa Matsuda, Yosihito Ogihara, Takeshi Matsumoto, Yuki Kamimoto, Tomoaki Ikeda, Naoyuki Katayama, Masaaki Ito
Congenital thrombophilia which is characterized by deficiencies in proteins such as antithrombin (AT), protein C (PC) and protein S (PS), is a major cause of venous thromboembolism (VTE). A total of 130 patients with VTE were evaluated for congenital thrombophilia based on the activity of AT, PC, or PS. Fifteen VTE patients with congenital AT deficiency (11.5 %), 16 with congenital PC deficiency (12.3 %) and eight with congenital PS deficiency (6.2 %) were diagnosed using DNA analysis. The frequency of congenital AT deficiency was significantly higher in subjects with pregnancy-related and idiopathic VTE than in those with VTE due to other causes, and congenital PC and PS deficiency were frequently associated with idiopathic VTE...
October 20, 2016: International Journal of Hematology
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