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https://www.readbyqxmd.com/read/27913550/prevention-of-thrombosis-in-antiphospholipid-syndrome
#1
Wendy Lim
Antiphospholipid syndrome (APS) is an acquired autoimmune condition characterized by thrombotic events, pregnancy morbidity, and laboratory evidence of antiphospholipid antibodies (aPL). Management of these patients includes the prevention of a first thrombotic episode in at-risk patients (primary prevention) and preventing recurrent thrombotic complications in patients with a history of thrombosis (secondary prevention). Assessment of thrombotic risk in these patients, balanced against estimated bleeding risks associated with antithrombotic therapy could assist clinicians in determining whether antithrombotic therapy is warranted...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913536/reversal-of-direct-oral-anticoagulants-a-practical-approach
#2
Andrew W Shih, Mark A Crowther
Direct oral anticoagulants (DOACs) have at least noninferior efficacy compared with other oral anticoagulants and have ancillary benefits, including overall better safety profiles, lack of the need for routine monitoring, rapid onset of action, and ease of administration. Reversal of these agents may be indicated in certain situations such as severe bleeding and for perioperative management. DOAC-associated bleeding should be risk stratified: patients with moderate or severe bleeding should have the DOAC discontinued and reversal strategies should be considered...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913509/the-post-thrombotic-syndrome
#3
Susan R Kahn
The post-thrombotic syndrome (PTS) is a frequent, sometimes disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. This article discusses risk factors for PTS after DVT and available means to prevent and treat PTS, with a focus on new information in the field. After DVT, PTS will develop in 20% to 50% of patients, and severe PTS, including venous ulcers, will develop in 5% to 10%. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, persistent leg symptoms 1 month after acute DVT, obesity, and older age...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913479/thrombosis-and-anticoagulation-in-the-setting-of-renal-or-liver-disease
#4
Christine Ribic, Mark Crowther
Thrombosis and bleeding are among the most common causes of morbidity and mortality in patients with renal disease or liver disease. The pathophysiology underlying the increased risk for venous thromboembolism and bleeding in these 2 populations is distinct, as are considerations for anticoagulation. Anticoagulation in patients with kidney or liver disease increases the risk of bleeding; this risk is correlated with the degree of impairment of anticoagulant elimination by the kidneys and/or liver. Despite being in the same pharmacologic category, anticoagulant agents may have varied degrees of renal and liver metabolism...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913478/thrombosis-in-the-setting-of-obesity-or-inflammatory-bowel-disease
#5
Steven R Lentz
Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27910125/bioprosthetic-tricuspid-valve-replacement-for-tricuspid-valve-endocarditis-secondary-to-infected-endocardial-pacemaker-leads
#6
Zhiwei Xu, Qiuxia Shi, Ju Mei, Yan Tan
BACKGROUND: The purpose of this study was to present outcomes of bioprosthetic tricuspid valve replacement (TVR) in patients with tricuspid valve infective endocarditis (TVIE). METHODS: From October 2001 to December 2015, 26 patients underwent a bioprosthetic TVR due to severe TVIE after endocardial pacemaker implantation. RESULTS: Staphylococcus species and Streptococcus species were the predominant microorganisms. Early 30-day hospital mortality was 0 (0%)...
December 1, 2016: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/27909544/reducing-the-risk-of-stroke-in-patients-with-nonvalvular-atrial-fibrillation-with-direct-oral-anticoagulants-is-one-of-these-not-like-the-others
#7
REVIEW
Paul P Dobesh Pharm D, John Fanikos Mba R Ph
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and increases risk of stroke by nearly 5-fold. While warfarin has been employed successfully to reduce the risk of stroke in these patients, there are a number of challenges with therapy. These include the need for therapeutic monitoring due to variability in patient response, frequent dose adjustments, numerous drug-drug, drug-food, and drug-disease interactions, and a heightened risk of thrombosis and bleeding due to these issues. Current guidelines recommend that the vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27905013/impact-of-stent-type-and-prolonged-dual-antiplatelet-therapy-on-long-term-clinical-outcomes-in-hemodialysis-patients-with-coronary-artery-disease
#8
Masahiko Asami, Jiro Aoki, Tatsuyuki Sato, Shuzou Tanimoto, Mika Watanabe, Yu Horiuchi, Koichi Furui, Kentaro Yasuhara, Yu Sato, Takuya Hashimoto, Sen Yachi, Kazuhiro Hara, Kengo Tanabe
The aim of this study was to address 7-year clinical outcomes and impact of prolonged dual antiplatelet therapy (DAPT) after coronary stenting in hemodialysis patients. Our study included 123 consecutive hemodialysis patients who had undergone percutaneous coronary intervention with a drug-eluting stent (DES) or bare-metal stent (BMS) (DES: 64, BMS: 59) in our institution. We compared long-term clinical outcomes following DES with BMS implantation as well as clinical outcomes in patients on DAPT for ≥1 year (DAPT on group, 89) with those on DAPT for <1 year (DAPT off group, 34)...
November 30, 2016: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/27904902/a-novel-hirudin-derivative-inhibiting-thrombin-without-bleeding-for-subcutaneous-injection
#9
Bing Zhao, Yanling Zhang, Yinong Huang, Jinchao Yu, Yaran Li, Qi Wang, Yixin Ma, Hou-Yan Song, Min Yu, Wei Mo
Currently, anticoagulants would be used to prevent thrombosis. Thrombin is an effector enzyme for haemostasis and thrombosis. We designed a direct thrombin inhibitor peptide (DTIP) using molecular simulation and homology modelling and demonstrated that the C-terminus of DTIP interacts with exosite I, and N-terminus with the activity site of thrombin, respectively. DTIP interfered with thrombin-mediated coagulation in human, rat and mouse plasma (n=10 per group) and blocked clotting in human whole blood in vitro...
December 1, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27904757/brain-hemorrhage-after-electrical-burn-injury-case-report-and-probable-mechanism
#10
Gutierrez Aceves Guillermo Axayacalt, Ceja Espinosa Alejandro, Rios Alanis Marcos, Ruiz Flores Milton Inocencio, Herrera Gonzalez Jose Alfredo
BACKGROUND: High-voltage electric injury may induce lesion in different organs. In addition to the local tissue damage, electrical injuries may lead to neurological deficits, musculoskeletal damage, and cardiovascular injury. Severe vascular damage may occur making the blood vessels involved prone to thrombosis and spontaneous rupture. CASE DESCRIPTION: Here, we present the case of a 39-year-old male who suffered an electrical burn with high tension wire causing intracranial bleeding...
2016: Surgical Neurology International
https://www.readbyqxmd.com/read/27903531/dream-plays-an-important-role-in-platelet-activation-and-thrombogenesis
#11
Kyungho Kim, Alan Tseng, Andrew Barazia, Joseph E Italiano, Jaehyung Cho
Downstream regulatory element antagonist modulator (DREAM), a transcriptional repressor, is known to modulate pain responses. However, it is unknown whether DREAM is expressed in anucleate platelets and plays a role in thrombogenesis. By using intravital microscopy with DREAM-null mice and their bone marrow chimeras, we demonstrated that both hematopoietic and non-hematopoietic cell DREAM are required for platelet thrombus formation following laser-induced arteriolar injury. In a FeCl3-induced thrombosis model, we found that compared to WT control and non-hematopoietic DREAM knockout (KO) mice, DREAM KO control and hematopoietic DREAM KO mice showed a significant delay in time to occlusion...
November 30, 2016: Blood
https://www.readbyqxmd.com/read/27902833/evaluation-of-ischemic-and-bleeding-risks-associated-with-2-parenteral-antiplatelet-strategies-comparing-cangrelor-with-glycoprotein-iib-iiia-inhibitors-an-exploratory-analysis-from-the-champion-trials
#12
Muthiah Vaduganathan, Robert A Harrington, Gregg W Stone, Efthymios N Deliargyris, Ph Gabriel Steg, C Michael Gibson, Christian W Hamm, Matthew J Price, Alberto Menozzi, Jayne Prats, Steven Elkin, Kenneth W Mahaffey, Harvey D White, Deepak L Bhatt
Importance: In the context of contemporary pharmacotherapy, optimal antiplatelet management with percutaneous coronary intervention (PCI) has not been well established. Objective: To compare the ischemic and bleeding risks associated with glycoprotein IIb/IIIa inhibitors (GPIs) and a potent P2Y12 antagonist, cangrelor, in patients undergoing PCI. Design, Setting, and Participants: An exploratory analysis of pooled patient-level data from the 3 phase 3 Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) trials of patients undergoing elective or nonelective PCI...
November 30, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27901002/shorter-versus-longer-duration-dual-antiplatelet-therapy-in-patients-with-diabetes-mellitus-undergoing-drug-eluting-stents-implantation-a-meta-analysis-of-randomized-controlled-trials
#13
He Huang, Ya Li, Yu Chen, Guo-Sheng Fu
BACKGROUND: Patients with diabetes mellitus (DM) have a higher risk of thromboembolic events; however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to assess the efficacy and safety of various DAPT durations in patients with DM undergoing drug-eluting stent implantation. METHODS: We conducted a literature search for randomized controlled trials (RCTs). We searched databases including EMBASE, PubMed, Cochrane Library, and Scopus up to June 2016...
2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27900627/extended-duration-versus-short-duration-pharmacological-thromboprophylaxis-in-acutely-ill-hospitalized-medical-patients-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#14
Aaron Y L Liew, Siavash Piran, John W Eikelboom, James D Douketis
Extended-duration pharmacological thromboprophylaxis, for at least 28 days, is effective for the prevention of symptomatic venous thromboembolism (VTE) in high-risk surgical patients but is of uncertain benefit in hospitalized medical patients. We aimed to evaluate the efficacy and safety of extended-duration thromboprophylaxis in hospitalized medical patients. We conducted a systematic PubMed, Medline and EMBASE literature search until June 2016 and a meta-analysis of randomized controlled trials which compared extended-duration with short-duration thromboprophylaxis in hospitalized medical patients...
November 30, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27899520/is-adherence-to-the-american-college-of-chest-physicians-recommended-anticoagulation-treatment-duration-associated-with-different-outcomes-among-patients-with-venous-thromboembolism
#15
Alex C Spyropoulos, Ron Preblick, Winghan J Kwong, Melissa Lingohr-Smith, Jay Lin
Clinical and economic outcomes associated with venous thromboembolism (VTE) patient adherence to the American College of Chest Physicians (ACCP) anticoagulant (AC) treatment guidelines are incompletely understood. Patients with ≥1 inpatient or ≥2 separate outpatient claims for deep vein thrombosis and/or pulmonary embolism, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified from the IMS PharMetrics Plus database. Patients had continuous insurance coverage for 12 months before (baseline) and after (follow-up) the index event (first VTE claim) but no baseline VTE claims...
November 28, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27899203/bioresorbable-scaffold-implantation-in-patients-with-indication-for-oral-anticoagulation-a-propensity-matched-analysis
#16
Niklas F Boeder, Victoria Johnson, Oliver Dörr, Jens Wiebe, Albrecht Elsässer, Helge Möllmann, Christian W Hamm, Holger M Nef, Timm Bauer
OBJECTIVES: To examine ischemic and bleeding outcomes in patients on triple antithrombotic therapy (TAT) compared with dual antiplatelet therapy (DAPT) after the implantation of bioresorbable scaffolds (BRS). BACKGROUND: The optimal antithrombotic regimen in patients undergoing percutaneous coronary intervention that have an indication for oral anticoagulation is unclear, in particular among those undergoing BRS implantation. METHODS: Consecutive patients of a single-center, all-comers BRS registry were included...
November 24, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27894260/high-platelet-reactivity-affects-the-clinical-outcomes-of-patients-undergoing-percutaneous-coronary-intervention
#17
Jun-Jie Zhang, Xiao-Fei Gao, Zhen Ge, Nai-Liang Tian, Zhi-Zhong Liu, Song Lin, Fei Ye, Shao-Liang Chen
BACKGROUND: The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation. METHODS: All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years...
November 29, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27892890/trial-design-rivaroxaban-for-the-prevention-of-major-cardiovascular-events-after-transcatheter-aortic-valve-replacement-rationale-and-design-of-the-galileo-study
#18
Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
October 31, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27891150/splenic-artery-embolization-for-the-treatment-of-gastric-variceal-bleeding-secondary-to-splenic-vein-thrombosis-complicated-by-necrotizing-pancreatitis-report-of-a-case
#19
Hee Joon Kim, Eun Kyu Park, Young Hoe Hur, Yang Seok Koh, Chol Kyoon Cho
Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically...
2016: Case Reports in Medicine
https://www.readbyqxmd.com/read/27889688/management-of-distal-deep-vein-thrombosis
#20
REVIEW
Helia Robert-Ebadi, Marc Righini
Isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower limb DVT in ultrasound series and is therefore a frequent medical condition. Unlike proximal DVT and pulmonary embolism (PE), which have been extensively studied and for which management is well standardized, much less is known on the optimal management of isolated calf DVT. Recent data arising from registries and non-randomized studies suggest that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated...
November 10, 2016: Thrombosis Research
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