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https://www.readbyqxmd.com/read/28731874/novel-targets-for-anticoagulants-lacking-bleeding-risk
#1
Julia K Bickmann, Trevor Baglin, Joost C M Meijers, Thomas Renné
PURPOSE OF REVIEW: Arterial and venous thromboembolic diseases are associated with significant morbidity and mortality and present a major medical burden. Currently used anticoagulants for the prevention or treatment of thromboembolic events including heparins, vitamin K-antagonists and inhibitors of thrombin or factor Xa target enzymes of the coagulation cascade that are critical for fibrin formation. However, fibrin is also necessary for hemostatic mechanisms to terminate blood loss at injury sites...
July 20, 2017: Current Opinion in Hematology
https://www.readbyqxmd.com/read/28727608/evaluation-of-non-invasive-hemoglobin-monitoring-in-trauma-patients-with-low-hemoglobin-levels
#2
Medhat Gamal, Bassant Abdelhamid, Dina Zakaria, Omnia Abd El Dayem, Ashraf Rady, Maher Fawzy, Ahmed Hasanin
OBJECTIVE: Bleeding is a leading cause of death among trauma patients. Delayed assessment of blood hemoglobin level might result in either unnecessary blood transfusion in non-indicated patients or delayed blood transfusion in critically bleeding patients. In this study, we evaluate the precision of non-invasive hemoglobin monitoring in trauma patients with low hemoglobin levels. METHODS: We included trauma patients with low hemoglobin levels (less than 8 g/dL) scheduled for surgical intervention...
July 19, 2017: Shock
https://www.readbyqxmd.com/read/28726538/marked-bleeding-diathesis-in-patients-with-platelet-dysfunction-due-to-a-novel-mutation-in-rasgrp2-encoding-caldag-gefi-p-gly305asp
#3
Emilse Bermejo, Maria F Alberto, David S Paul, Aaron A Cook, Paquita Nurden, Analia Sanchez Luceros, Alan T Nurden, Wolfgang Bergmeier
Congenital platelet function disorders are often the result of defects in critical signal transduction pathways required for platelet adhesion and clot formation. Mutations affecting RASGRP2, the gene encoding the Rap GTPase activator, CalDAG-GEFI, give rise to a novel, and rare, group of platelet signal transduction abnormalities. We here report platelet function studies for two brothers (P1 and P2) expressing a novel variant of RASGRP2, CalDAG-GEFI(p.Gly305Asp). P1 and P2 have a lifelong history of bleeding with severe epistaxis successfully treated with platelet transfusions or rFVIIa...
July 20, 2017: Platelets
https://www.readbyqxmd.com/read/28724561/management-of-antithrombotic-agents-in-patients-undergoing-flexible-bronchoscopy
#4
REVIEW
Sami Abuqayyas, Shine Raju, John R Bartholomew, Roulan Abu Hweij, Atul C Mehta
Bleeding is one of the most feared complications of flexible bronchoscopy. Although infrequent, it can be catastrophic and result in fatal outcomes. Compared to other endoscopic procedures, the risk of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Patients using antithrombotic agents (ATAs) have higher bleeding risk. A thorough understanding of the different ATAs is critical to manage patients during the peri-procedural period...
September 30, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/28721285/ureteroscopy-for-stone-disease-expanding-roles-in-the-modern-era
#5
REVIEW
Adrian Ho, Piyush Sarmah, Ewa Bres-Niewada, Bhaskar K Somani
INTRODUCTION: The prevalence of urolithiasis is increasing worldwide and is causing significant morbidity and cost to the healthcare systems. While ureteroscopy (URS) has been established as a treatment option, our review highlights the expanding role of URS for the management of more complex stones and patients in the modern era. MATERIAL AND METHODS: Ureteroscopy has shown to have good outcomes with stone free rates (SFR) comparable to other treatment modalities...
June 30, 2017: Central European Journal of Urology
https://www.readbyqxmd.com/read/28720509/the-neuropeptide-galanin-promotes-an-anti-thrombotic-phenotype-on-endocardial-endothelial-cells-from-heart-failure-patients
#6
Christina Tyrrell, Amanda Toyooka, Faiza Khan, Kent L Thornburg, James O Mudd, Wohaib Hasan
Thromboembolic complications are a significant cause of mortality and re-hospitalization in heart failure (HF) patients. One source of thrombi is the ventricular endocardial surface that becomes increasingly pro-thrombotic as HF progresses. Anticoagulation comes with bleeding risks so identifying therapeutic agents for improving cardiac endothelial health are of critical clinical importance. Endocardial endothelial cells are closely apposed to cardiac sympathetic nerves. In HF, cardiac sympathetic nerves are dysregulated and promote disease progression...
July 12, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28718341/diagnostic-yield-and-outcomes-of-computed-tomography-of-the-head-in-critically-ill-nontrauma-patients
#7
Fabian Finkelmeier, Sophie Walter, Kai-Henrik Peiffer, Anjali Cremer, Andrea Tal, Thomas Vogl, Stefan Zeuzem, Stephan Fichtlscherer, Mireen Friedrich-Rust, Jörg Bojunga, Harald Farnik
BACKGROUND: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown. METHODS: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28717782/splenic-artery-aneurysm-with-the-double-rupture-phenomenon
#8
Jung Ho Kim, Han Sol Chung, Jong Ha Kim, Sin Youl Park, Sam Beom Lee, Byung Soo Do
Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient's situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management...
June 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28716309/arginine-vasopressin-copeptin-and-the-development-of-relative-avp-deficiency-in-hemorrhagic-shock
#9
Carrie A Sims, Yuxia Guan, Meredith Bergey, Rebecca Jaffe, Lilias Holmes-Maguire, Niels Martin, Patrick Reilly
BACKGROUND: Arginine vasopressin (AVP) is critical for maintaining vasomotor tone and low levels have been associated with the development of irreversible shock. We investigated the clinical relationship between AVP, copeptin (the C-terminal fragment of the AVP precursor), and the development of relative AVP deficiency following hemorrhagic shock. METHODS: A prospective, observational study of 21 hypotensive (SBP<90 mmHg X 2) or presumptively bleeding trauma patients was conducted...
June 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28716211/to-serve-and-protect-the-modulatory-role-of-von-willebrand-factor-on-factor-viii-immunogenicity
#10
REVIEW
Robin B Hartholt, Alice S van Velzen, Ivan Peyron, Anja Ten Brinke, Karin Fijnvandraat, Jan Voorberg
Hemophilia A is a bleeding disorder characterized by the absence or dysfunction of blood coagulation factor VIII (FVIII). Patients are treated with regular infusions of FVIII concentrate. In response to treatment, approximately 30% of patients with severe hemophilia A develop inhibitory antibodies targeting FVIII. Both patient and treatment related risk factors for inhibitor development have been described. Multiple studies comparing the immunogenicity of recombinant and plasma-derived FVIII have yielded conflicting results...
July 4, 2017: Blood Reviews
https://www.readbyqxmd.com/read/28704418/the-coll%C3%AE-gen-iii-fibril-has-a-flexi-rod-structure-of-flexible-sequences-interspersed-with-rigid-bioactive-domains-including-two-with-hemostatic-roles
#11
J Des Parkin, James D San Antonio, Anton V Persikov, Hayat Dagher, Raymond Dalgleish, Shane T Jensen, Xavier Jeunemaitre, Judy Savige
Collagen III is critical to the integrity of blood vessels and distensible organs, and in hemostasis. Examination of the human collagen III interactome reveals a nearly identical structural arrangement and charge distribution pattern as for collagen I, with cell interaction domains, fibrillogenesis and enzyme cleavage domains, several major ligand-binding regions, and intermolecular crosslink sites at the same sites. These similarities allow heterotypic fibril formation with, and substitution by, collagen I in embryonic development and wound healing...
2017: PloS One
https://www.readbyqxmd.com/read/28694703/secondary-sclerosing-cholangitis-in-critically-ill-patients-current-perspectives
#12
REVIEW
Hafsteinn O Gudnason, Einar S Björnsson
Secondary sclerosing cholangitis (SSC) is a term used for a group of chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation, which can lead to biliary cirrhosis. A newly recognized form of SSC is secondary sclerosing cholangitis in critically ill patients (SSC-CIP). Pathogenesis is believed to involve ischemic injury of intrahepatic bile ducts associated with prolonged hypotension, vasopressors administration, and/or mechanical ventilation in patients treated in the intensive care unit (ICU)...
2017: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/28688890/any-changes-in-recent-massive-transfusion-practices-in-a-tertiary-level-institution
#13
Romi Sinha, David Roxby
BACKGROUND & OBJECTIVES: A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT) METHODS: All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified...
June 8, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28688155/critical-care-management-of-the-cirrhotic-patient-awaiting-liver-transplant-in-the-intensive-care-unit
#14
REVIEW
J C Olson, C J Karvellas
Patients with cirrhosis who are awaiting liver transplantation are at high risk for development of critical illness. Current liver allocation policies which dictate a "sickest first" approach coupled with a mismatch between need and availability of organs results in longer wait times and thus, patients are becoming increasingly ill while awaiting organ transplantation. Even patients with well compensated cirrhosis may suffer acute deterioration, the syndrome of acute-on-chronic liver failure (ACLF) results in multi-system organ dysfunction and a marked increase in associated short-term morbidity and mortality...
July 8, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28684104/acid-base-disorders-in-liver-disease
#15
REVIEW
Scheiner Bernhard, Lindner Gregor, Reiberger Thomas, Schneeweiss Bruno, Trauner Michael, Zauner Christian, Funk Georg-Christian
Next to the kidneys and lungs, the liver has been recognized as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common acid-base disorder in chronic liver disease, various complex metabolic acid-base disorders may occur with liver dysfunction. Although the standard variables of acid-base equilibrium, such as pH and overall base excess, often fail to unmask the underlying cause of acid-base disorders, the physical-chemical acid-base model allows a more in-depth pathophysiological understanding and clinical judgement of acid-base disorders in patients with liver diseases...
July 3, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28680174/management-of-supratherapeutic-international-normalized-ratio-without-bleeding-after-warfarin-use-an-evaluation-of-vitamin-k-administration-supra-war-k-study
#16
Claire Tai, Hilary Wu, Cindy San, Doson Chua
BACKGROUND: For patients with supratherapeutic international normalized ratio (INR) and no evidence of bleeding, the 2012 guidelines of the American College of Chest Physicians discourage administration of vitamin K. At the study hospital, it was observed that vitamin K was frequently prescribed for patients with INR of 4.5 or higher and no bleeding. OBJECTIVES: To compare efficacy and safety outcomes between holding warfarin alone and holding warfarin with administration of vitamin K and to compare these outcomes among various doses and routes of vitamin K administration in non-critical care inpatients experiencing supratherapeutic INR without evidence of bleeding...
May 2017: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/28679320/a-rare-case-of-non-traumatic-acute-intraabdominal-hemorrhage-ruptured-superior-mesenteric-artery-aneurysm
#17
Ersin Borazan, Latif Yılmaz, Alper Aytekin, Gökhan Gökaslan, Selim Kervancıoğlu
INTRODUCTION: Rupture of superior mesenteric artery aneurysm (SMAA) is a very rare and life-threatening condition, presenting with acute intraabdominal hemorrhage. CASE: The patient was hospitalized upon complaint of nonspecific severe abdominal pain. Diagnosis of SMAA was established by abdominal Doppler ultrasound that showed a pseudo-aneurysmal lesion with size of 76 × 47 mm at the superior mesenteric main branch. Endovascular stenting was not performed because of the wide neck in the segment of the jejunal branches from SMA and the risk of branch loss during treatment...
July 6, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28673500/-state-of-the-art-direct-oral-anticoagulants-and-transfusion
#18
A-C Martin, A Godier, D M Smadja, L Mauge, A-M Fischer
Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain...
June 30, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/28672052/direct-acting-oral-anticoagulants-for-the-treatment-of-suspected-heparin-induced-thrombocytopenia
#19
Kyle A Davis, Daphne O Davis
OBJECTIVE: To evaluate the efficacy and safety of direct oral anticoagulant (DOAC) therapy in hospitalized patients with suspected heparin induced thrombocytopenia (HIT). METHODS: Retrospective cohort study of adult patients prescribed apixaban, dabigatran, or rivaroxaban for the treatment of acute HIT from January 1 2013 to January 1 2017. Eligibility requirements included an intermediate or high pretest probability for HIT (4T score ≥ 4) and a positive IgG-specific anti-PF4/ heparin complex assay...
July 3, 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/28667678/effects-of-photodynamic-therapy-in-periodontal-treatment-a-randomized-controlled-clinical-trial
#20
M Segarra-Vidal, S Guerra-Ojeda, L S Vallés, A López-Roldán, M D Mauricio, M Aldasoro, F Alpiste-Illueca, J M Vila
AIM: To evaluate the effects of photodynamic therapy (PDT) in the nonsurgical treatment of chronic periodontitis. MATERIALS AND METHODS: A randomized, single-blind, controlled, parallel-group clinical trial was performed. Sixty patients were enrolled: 20 healthy controls and 40 patients with periodontitis. The 40 patients were randomized for scaling and root planing (SRP) or SRP+PDT. Periodontal (plaque index, probing depth, clinical recession, clinical attachment level, bleeding on probing, and gingival crevicular fluid volume, corresponding to 381 vs 428 critical sites), microbiological (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia and Campylobacter rectus presence, 18 vs 19 samples) and biochemical (interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α, receptor activator of nuclear factor-kappaB ligand (RANK-L) and osteoprotegerin (OPG) levels, 18 vs 19 samples) parameters were recorded...
July 1, 2017: Journal of Clinical Periodontology
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