Thrombosis research
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Thrombosis research · Feb 2015
Randomized Controlled TrialRetrograde lung perfusion in the treatment of massive pulmonary embolism. A randomised porcine study.
The treatment of massive pulmonary embolisms with an associated cardiac arrest is controversial; however, surgical thrombectomy with extracorporeal circulation (ECC) is an option for treatment. It is difficult to remove all thromboembolic material. Theoretically, retrograde blood perfusion through the lungs may be beneficial. ⋯ Retrograde lung perfusion was not generally beneficial in the treatment of massive pulmonary embolism in this setup; however, it may be an option if only a modest amount of material is accessible in the pulmonary artery.
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Thrombosis research · Feb 2015
Case-fatality of recurrent venous thromboembolism and major bleeding associated with aspirin, warfarin, and direct oral anticoagulants for secondary prevention.
The duration of anticoagulation after venous thromboembolic events (VTE) is based on the balance between the risk of recurrent VTE and bleeding. The purpose of this study was to estimate the frequency and case-fatality rate of major bleeding and recurrent VTE during secondary prevention of VTE. ⋯ Case-fatality rates for major bleeding and recurrent VTE for DOACs appear to be similar to those for VKA and the composite of fatal events is lower for DOACs than placebo. Overall, given the favorable safety profile and comparable efficacy of DOAC therapy, the threshold to continue anticoagulation with DOACs after unprovoked VTE should be low if the baseline risk of anticoagulation-related bleeding is not high.
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Thrombosis research · Feb 2015
Historical ArticleTime trends in pulmonary embolism mortality in France, 2000-2010.
Pulmonary Embolism (PE) is a potentially fatal complication of venous thrombosis. Recent and comprehensive estimates of PE incidence and mortality are scarce. Moreover, while contemporary mortality trends of PE would enable the evaluation of prevention and quality of care, such data are lacking. The aim of this study was to provide nationwide estimations of PE mortality and time trends in France between 2000 and 2010. ⋯ This study is the first to provide a contemporary and exhaustive nationwide estimation of PE mortality and time trends in France. The observed decrease in PE mortality between 2000 and 2010 is encouraging, but further efforts in prevention are needed to ensure that this reduction is widespread in all age groups.
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Thrombosis research · Jan 2015
ReviewA systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy.
Management of patients with a major bleed while on vitamin K antagonist (VKA) is a common clinical challenge. Prothrombin Complex Concentrates (PCC) provide a rapid reversal of VKA induced coagulopathy. However, a well-defined PCC dosing strategy, especially in emergency setting, is still lacking. ⋯ We found no evidence that one dosing strategy is superior. Future studies should be designed to investigate if body weight and INR are relevant for PCC dosing. In these, we need uniform outcome definitions.
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Thrombosis research · Jan 2015
Review Meta AnalysisHow safe is acetaminophen use in patients treated with vitamin K antagonists? A systematic review and meta-analysis.
Acetaminophen is a commonly prescribed and over-the-count used drug, and is considered to be the preferred treatment choice for anticoagulated patients requiring analgesic drug therapy. However, observational data have suggested that this drug combination may increase the International Normalized Ratio (INR) values and bleeding events in patients taking Vitamin K antagonists (VKAs). Still, the clinical impact of this putative effect remains unknown. Therefore, we performed a systematic review of randomized controlled trials (RCTs) to estimate the impact of concomitant use of acetaminophen and VKA in the INR measurements ⋯ Acetaminophen is associated with a statistically significant and possible clinically relevant increase in the INR, with a dose dependent relationship. Patients treated concomitantly with VKA and acetaminophen should be monitored more regularly for possible VKA dosage adjustment.