Thrombosis research
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Thrombosis research · Jan 2006
Review Comparative StudyOptimal INR for prevention of stroke and death in atrial fibrillation: a critical appraisal.
Patients with nonvalvular atrial fibrillation are at increased risk for systemic embolism, predominantly disabling stroke. To study how stroke and mortality rates vary with different degrees of anticoagulation reflected by the international normalised ratio (INR) we critically assess information from different sources. ⋯ 1. One randomised study showed a significantly lower risk of stroke for mean INR 2.4 compared to mean INR 1.3 combined with aspirin. Remaining studies found INRs of 2-2.5 to be as efficacious as higher anticoagulation intensities.2. Mortality as well as risk of admission to hospital or death due to diseases of the vessels of the brain followed U-shaped curves with minimum at INR 2.2 and 2.4, respectively. At high INR the risk increased 2.3 times per 1 unit increase of INR for death and 1.7 times for events in the vessels of the brain.3. The re-analysing of data of Hylek et al. indicated that there might be a substantial increase of the risk of intracranial hemorrhage when INR is increased from 2.5 to 4. We conclude that INRs in the interval 2.0--2.5 give the lowest risk of stroke and death in patients with nonvalvular atrial fibrillation.
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Thrombosis research · Jan 2006
ReviewAdvances in the pathogenesis, diagnosis and treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.
The thrombotic microangiopathies are microvascular occlusive disorders characterized by hemolytic anemia caused by fragmentation of erythrocytes and thrombocytopenia due to increased platelet aggregation and thrombus formation, eventually leading to disturbed microcirculation with reduced organ perfusion. Depending on whether brain or renal lesions prevail, two different entities have been described: thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). ⋯ Recent studies have contributed greatly to our current understanding of the molecular mechanisms leading to TTP and HUS. In this review, we briefly focus on the most important advances in the pathophysiology, diagnosis and treatment of these two thrombotic microangiopathies.
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Thrombosis research · Jan 2006
ReviewThe post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review.
Post-thrombotic syndrome is a chronic, potentially debilitating complication of deep vein thrombosis (DVT) of the lower extremity. Comparatively little is known about post-thrombotic syndrome after upper extremity DVT (UEDVT). ⋯ PTS is a frequent complication of UEDVT, yet little is known regarding risk factors and optimal management. A standardized means of diagnosis would help to establish better management protocols. The impact of upper extremity PTS on quality of life should be further quantified.
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Thrombosis research · Jan 2006
ReviewThe post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review.
Post-thrombotic syndrome is a chronic, potentially debilitating complication of deep vein thrombosis (DVT) of the lower extremity. Comparatively little is known about post-thrombotic syndrome after upper extremity DVT (UEDVT). ⋯ PTS is a frequent complication of UEDVT, yet little is known regarding risk factors and optimal management. A standardized means of diagnosis would help to establish better management protocols. The impact of upper extremity PTS on quality of life should be further quantified.
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Thrombosis research · Jan 2006
ReviewEpidemiology of venous thromboembolism in neonates and children.
Venous thromboembolism is an increasingly recognised problem in paediatric practice, particularly in the context of tertiary care paediatric services. In recent years, several national and international registries have helped to define the epidemiology of venous thromboembolism in both neonates and older children. These studies have generated information on the incidence and risk factors associated with venous thromboembolism in different age groups. Data from these and other studies have demonstrated important differences between paediatric and adult practice and highlight the need for specific evidence based guidelines for the prevention and management of venous thromboembolism in neonates and children.