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https://www.readbyqxmd.com/read/29683037/pharmacological-differentiation-of-thrombomodulin-alfa-and-activated-protein-c-on-coagulation-and-fibrinolysis-in-vitro
#1
Kosuke Tanaka, Shunsuke Tawara, Kazuhisa Tsuruta, Debra Hoppensteadt, Jawed Fareed
Although thrombomodulin alfa (TM alfa), recombinant human soluble thrombomodulin, exerts antithrombogenic effects through activated protein C (APC), clinical trials suggested that TM alfa has a lower bleeding risk than does recombinant human APC. To address the mechanism explaining this difference, effects of TM alfa and APC on thrombogenic, coagulation, and fibrinolytic processes were compared in vitro. TM alfa and APC inhibited generation of thrombogenic markers, thrombin, and prothrombin fragment F1+2 and prolonged coagulation parameters, activated clotting time (ACT), and activated partial thromboplastin time (APTT)...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29664991/haemostatic-therapies-for-acute-spontaneous-intracerebral-haemorrhage
#2
REVIEW
Rustam Al-Shahi Salman, Zhe Kang Law, Philip M Bath, Thorsten Steiner, Nikola Sprigg
BACKGROUND: Outcome after spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume; up to one-third of ICHs enlarge within 24 hours of onset. Early haemostatic therapy might improve outcome by limiting haematoma growth. This is an update of a Cochrane Review first published in 2006, and last updated in 2009. OBJECTIVES: To examine 1) the effectiveness and safety of individual classes of haemostatic therapies, compared against placebo or open control, in adults with acute spontaneous intracerebral haemorrhage, and 2) the effects of each class of haemostatic therapy according to the type of antithrombotic drug taken immediately before ICH onset (i...
April 17, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29661416/anaemia-and-red-blood-cell-transfusion-in-intracranial-neurosurgery-a-comprehensive-review
#3
REVIEW
A Kisilevsky, A W Gelb, M Bustillo, A M Flexman
Both anaemia and blood transfusion are associated with poor outcomes in the neurosurgical population. Based on the available literature, the optimal haemoglobin concentration for neurologically injured patients appears to be in the range of 9.0-10.0 g dl-1 , although the individual risks and benefits should be weighed. Several perioperative blood conservation strategies have been used successfully in neurosurgery, including correction of anaemia and coagulopathy, use of antifibrinolytics, and intraoperative cell salvage...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29656433/antifibrinolytics-for-heavy-menstrual-bleeding
#4
REVIEW
Alison C Bryant-Smith, Anne Lethaby, Cindy Farquhar, Martha Hickey
BACKGROUND: Heavy menstrual bleeding (HMB) is an important physical and social problem for women. Oral treatment for HMB includes antifibrinolytic drugs, which are designed to reduce bleeding by inhibiting clot-dissolving enzymes in the endometrium.Historically, there has been some concern that using the antifibrinolytic tranexamic acid (TXA) for HMB may increase the risk of venous thromboembolic disease. This is an umbrella term for deep venous thrombosis (blood clots in the blood vessels in the legs) and pulmonary emboli (blood clots in the blood vessels in the lungs)...
April 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29652688/acute-coronary-artery-thrombus-after-tranexamic-acid-during-total-shoulder-arthroplasty-in-a-patient-with-coronary-stents-a-case-report
#5
Kathryn H Bridges, Sylvia H Wilson
Tranexamic acid (TXA), an antifibrinolytic, is routinely used to decrease transfusion rates in total joint replacement surgery. While recent publications have indicated a low risk of TXA-associated thromboembolic events in this orthopedic population, few studies specifically address the safety of TXA administration in high-risk patients. We present a case of acute coronary thrombus requiring emergent intervention in a patient with indwelling coronary stents who underwent shoulder arthroplasty with TXA administration...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29605152/pharmacologic-hemostatic-agents-in-total-joint-arthroplasty-a-cost-effectiveness-analysis
#6
Dipak B Ramkumar, Niveditta Ramkumar, Stephanie J Tapp, Wayne E Moschetti
BACKGROUND: Total knee and hip arthroplasties can be associated with substantial blood loss, affecting morbidity and even mortality. Two pharmacological antifibrinolytics, ε-aminocaproic acid (EACA) and tranexamic acid (TXA) have been used to minimize perioperative blood loss, but both have associated morbidity. Given the added cost of these medications and the risks associated with then, a cost-effectiveness analysis was undertaken to ascertain the best strategy. METHODS: A cost-effectiveness model was constructed using the payoffs of cost (in United States dollars) and effectiveness (quality-adjusted life expectancy, in days)...
March 3, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29590200/retrospective-harm-benefit-analysis-of-pre-clinical-animal-research-for-six-treatment-interventions
#7
Pandora Pound, Christine J Nicol
BACKGROUND: The harm benefit analysis (HBA) is the cornerstone of animal research regulation and is considered to be a key ethical safeguard for animals. The HBA involves weighing the anticipated benefits of animal research against its predicted harms to animals but there are doubts about how objective and accountable this process is. OBJECTIVES: i. To explore the harms to animals involved in pre-clinical animal studies and to assess these against the benefits for humans accruing from these studies; ii...
2018: PloS One
https://www.readbyqxmd.com/read/29574429/placenta-accreta-complicated-with-peripartum-cardiomyopathy
#8
Yuditiya Purwosunu, Agrifa Hasiholan Haloho
A 33-year-old G2P1 was referred to our hospital due to placenta accreta. During perioperative preparations, the patient was diagnosed with having a peripartum cardiomyopathy. The patient underwent caesarean hysterectomy at 36 weeks with an associated 2 L blood loss. Haemodynamic maintenance and stabilisation during the operation were challenging, with the combinations of fluid therapy, blood transfusions as well as vasoactive, antifibrinolytic and haemostatic drug. Postoperatively, the patient was managed in the intensive care unit and was subsequently transferred to intermediate care after less than 24 hours' observation...
March 23, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29573898/efficacy-of-prehospital-administration-of-tranexamic-acid-in-trauma-patients-a-meta-analysis-of-the-randomized-controlled-trials
#9
REVIEW
Ayman El-Menyar, Brijesh Sathian, Mohammed Asim, Rifat Latifi, Hassan Al-Thani
OBJECTIVE: Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings remains unclear. We conducted a systematic review and meta-analysis to evaluate whether pre-hospital administration of TXA compared to placebo improve patients' outcomes? METHODS: PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials...
March 16, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29557885/the-s100a10-pathway-mediates-an-occult-hyperfibrinolytic-subtype-in-trauma-patients
#10
Lewis S Gall, Paul Vulliamy, Scarlett Gillespie, Timothy F Jones, Rochelle S J Pierre, Sabine E Breukers, Christine Gaarder, Nicole P Juffermans, Marc Maegele, Jakob Stensballe, Pär I Johansson, Ross A Davenport, Karim Brohi
OBJECTIVE: To determine the characteristics of trauma patients with low levels of fibrinolysis as detected by viscoelastic hemostatic assay (VHA) and explore the underlying mechanisms of this subtype. BACKGROUND: Hyperfibrinolysis is a central component of acute traumatic coagulopathy but a group of patients present with low levels of VHA-detected fibrinolysis. There is concern that these patients may be at risk of thrombosis if empirically administered an antifibrinolytic agent...
March 19, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29502715/aneurysmal-subarachnoid-hemorrhage-unanswered-questions
#11
REVIEW
Alejandro A Rabinstein, Giuseppe Lanzino
Optimizing outcomes after aneurysmal subarachnoid hemorrhage remains a challenge for neurosurgeons and neurointensivists alike. Although we have learned a lot about the pathophysiology of this disease, many clinical questions are still unanswered. In this review, the authors discuss some of these questions, including the current diagnostic value of lumbar puncture in patients with negative computed tomography scans, the treatment value of blood pressure reduction and antifibrinolytics for prevention of early rebleeding, the indication for antiseizure medications, the optimal management of hydrocephalus and intracranial pressure, the role of clipping, and the options for diagnosis and treatment of delayed cerebral ischemia...
April 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29493552/pediatric-trauma-transfusion-and-cognitive-aids
#12
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29490682/therapeutic-and-pharmaco-biological-dose-ranging-multicentre-trial-to-determine-the-optimal-dose-of-tranexamic-acid-to-reduce-blood-loss-in-haemorrhagic-cesarean-delivery-traces-study-protocol-for-a-randomised-double-blind-placebo-controlled-trial
#13
Anne-Sophie Bouthors, Benjamin Hennart, Emmanuelle Jeanpierre, Anne-Sophie Baptiste, Imen Saidi, Elodie Simon, Damien Lannoy, Alain Duhamel, Delphine Allorge, Sophie Susen
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal death worldwide. Tranexamic acid (TA), an antifibrinolytic drug, reduces bleeding and transfusion need in major surgery and trauma. In ongoing PPH following vaginal delivery, a high dose of TA decreases PPH volume and duration, as well as maternal morbidity, while early fibrinolysis is inhibited. In a large international trial, a TA single dose reduced mortality due to bleeding but not the hysterectomy rate. TA therapeutic dosages vary from 2...
March 1, 2018: Trials
https://www.readbyqxmd.com/read/29462500/antifibrinolytic-drugs-for-treating-primary-postpartum-haemorrhage
#14
REVIEW
Haleema Shakur, Danielle Beaumont, Sue Pavord, Angele Gayet-Ageron, Katharine Ker, Hatem A Mousa
BACKGROUND: Postpartum haemorrhage (PPH) - heaving bleeding within the first 24 hours after giving birth - is one of the main causes of death of women after childbirth. Antifibrinolytics, primarily tranexamic acid (TXA), have been shown to reduce bleeding in surgery and safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events.An earlier Cochrane review on treatments for primary PPH covered all the various available treatments - that review has now been split by types of treatment...
February 20, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29456232/seizure-induced-by-tranexamic-acid-in-a-patient-with-chronic-kidney-disease-on-maintenance-dialysis
#15
Kar Wah Fuah, Christopher T S Lim, Daniel C L Pang, Jin Shyan Wong
Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to achieve hemostasis. However, there have been a few case reports suggesting that high-dose intravenous TXA has epileptogenic property. In patients with renal impairment, even administering the usual recommended dose of TXA can induce seizure episodes. We present here a patient on hemodialysis who developed seizures after receiving two doses of TXA over 5 h period.
January 2018: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/29446520/lenalidomide-as-a-novel-therapy-for-gastrointestinal-angiodysplasia-in-von-willebrand-disease
#16
N V Khatri, B Patel, D R Kohli, S S Solomon, K Bull-Henry, C M Kessler
INTRODUCTION: Lenalidomide is a thalidomide analog with anti-angiogenic properties. Previous case reports suggest its efficacy in preventing gastrointestinal bleeding (GIB) secondary to angiodysplasia (AD) in hereditary haemorrhagic telangiectasia and potentially in reversing AD. We present the first case series to explore lenalidomide as a treatment for AD-related GIB in patients with von Willebrand disease (VWD). METHODS: A retrospective chart review was conducted to include patients with VWD, who were evaluated from 2010 to 2013 and who had received lenalidomide to treat recurrent GIB secondary to AD...
February 15, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/29435313/comparison-of-the-efficacy-of-intravenous-tranexamic-acid-with-and-without-topical-administration-versus-placebo-in-urgent-endoscopy-rate-for-acute-gastrointestinal-bleeding-a-double-blind-randomized-controlled-trial
#17
Nader Tavakoli, Marjan Mokhtare, Shahram Agah, Ali Azizi, Mohsen Masoodi, Hassan Amiri, Mehrdad Sheikhvatan, Bahare Syedsalehi, Behdad Behnam, Mehran Arabahmadi, Maryam Mehrazi
Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding...
February 2018: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/29431141/does-tranexamic-acid-lead-to-changes-in-mri-measures-of-brain-tissue-health-in-patients-with-spontaneous-intracerebral-haemorrhage-protocol-for-a-mri-substudy-nested-within-the-double-blind-randomised-controlled-tich-2-trial
#18
Rob A Dineen, Stefan Pszczolkowski, Katie Flaherty, Zhe K Law, Paul S Morgan, Ian Roberts, David J Werring, Rustam Al-Shahi Salman, Tim England, Philip M Bath, Nikola Sprigg
OBJECTIVES: To test whether administration of the antifibrinolytic drug tranexamic acid (TXA) in patients with spontaneous intracerebral haemorrhage (SICH) leads to increased prevalence of diffusion-weighted MRI-defined hyperintense ischaemic lesions (primary hypothesis) or reduced perihaematomal oedema volume, perihaematomal diffusion restriction and residual MRI-defined SICH-related tissue damage (secondary hypotheses). DESIGN: MRI substudy nested within the double-blind randomised controlled Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH)-2 trial (ISRCTN93732214)...
February 3, 2018: BMJ Open
https://www.readbyqxmd.com/read/29413743/safety-of-a-high-dose-tranexamic-acid-protocol-in-complex-adult-spinal-deformity-analysis-of-100-consecutive-cases
#19
James D Lin, Lawrence G Lenke, Jamal N Shillingford, Joseph L Laratta, Lee A Tan, Charla R Fischer, Mark A Weller, Ronald A Lehman
STUDY DESIGN: Retrospective review of high-dose tranexamic acid (TXA) use in consecutive patients. OBJECTIVE: To determine the safety profile of a high-dose TXA protocol in complex adult spinal deformity patients. SUMMARY OF BACKGROUND DATA: Adult spinal deformity (ASD) surgery may involve significant amounts of blood loss, especially when various osteotomy techniques are used. Antifibrinolytic agents such as TXA have been used to reduce intraoperative blood loss...
March 2018: Spine Deformity
https://www.readbyqxmd.com/read/29411358/optimisation-of-the-dosage-of-tranexamic-acid-in-trauma-patients-with-population-pharmacokinetic-analysis
#20
S Grassin-Delyle, O M Theusinger, R Albrecht, S Mueller, D R Spahn, S Urien, P Stein
Tranexamic acid is used both pre-hospital and in-hospital as an antifibrinolytic drug to treat or prevent hyperfibrinolysis in trauma patients; dosing, however, remains empirical. We aimed to measure plasma levels of tranexamic acid in patients receiving pre-hospital anti-hyperfibrinolytic therapy and to build a population pharmacokinetic model to propose an optimised dosing regimen. Seventy-three trauma patients were enrolled and each received tranexamic acid 1 g intravenously pre-hospital. A blood sample was drawn after arrival in the emergency department, and we measured the plasma tranexamic acid concentration using liquid chromatography-mass spectrometry, and modelled the data using non-linear mixed effect modelling...
February 7, 2018: Anaesthesia
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