European journal of internal medicine
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Eur. J. Intern. Med. · Aug 2010
ReviewMechanism of hemostasis defects and management of bleeding in patients with acute coronary syndromes.
The main cause of the hemostasis defects and related bleeding complications in patients with acute coronary syndromes (ACS) are the intake of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as coronary angiography and percutaneous coronary intervention (PCI). Antithrombotic drugs that impair several phases of hemostasis (platelet function, coagulation, and fibrinolysis) are causing bleeding particularly in elderly patients, in those underweight and with comorbidities such as renal insufficiency, diabetes, hypertension and malignancy. Identification of patients at high risk of bleeding is the most important preventive strategy, because the choice and dosages of drugs may to some extent be tailored to the degree of risk. ⋯ To reduce the need of transfusion, the hemostatic drugs that decrease blood loss and transfusion requirements in cardiac surgery (antifibrinolytic amino acids, desmopressin, and recombinant factor VIIa) might be considered. However, the efficacy of these drugs in the control of bleeding complications is not unequivocally established in ACS and there is concern for an increased risk of thrombosis. In conclusion, evidence-based recommendations for the management of bleeding in patients with ACS are currently lacking, so that prevention through accurate assessment of the individual risk is the most valid strategy.
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Eur. J. Intern. Med. · Aug 2010
Safety of withholding anticoagulant therapy in patients with suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography.
To assess the safety of withholding anticoagulant therapy in patients with clinically suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography (MCTPA). ⋯ Withholding anticoagulant therapy in patients with suspected venous thromboembolic disease with a negative result on MCTPA seems to be safe in our clinical setting.
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Eur. J. Intern. Med. · Aug 2010
Body height and sex-related differences in incidence of venous thromboembolism: a Danish follow-up study.
Sex-related differences in incidence rate of venous thromboembolism (VTE) have been reported. It is unclear whether these differences reflect sex-related differences in the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) or both and to which extent the differences are mediated by known risk factors for VTE. ⋯ In this middle-aged population, men experienced a higher incidence of VTE due to a higher incidence of DVT. The higher incidence among men appeared to be mediated by body height. Adjusted for body height, male sex was not associated with an excess risk of either VTE or DVT but the risk of PE was notably lower compared with women.
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Eur. J. Intern. Med. · Jun 2010
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of the effects of three angiotensin II receptor type 1 blockers on metabolic parameters in hypertensive patients with type 2 diabetes mellitus.
In a previous study involving 18 hypertensive patients with type 2 diabetes mellitus, we found that replacement of valsartan and candesartan by telmisartan significantly improved insulin sensitivity and significantly increased serum adiponectin levels in the patients. We investigated the effects of 3 angiotensin II type 1 receptor blockers (ARBs)-telmisartan, candesartan, and valsartan-on metabolic parameters in hypertensive patients with type 2 diabetes. ⋯ Low dose telmisartan had a neutral effect on metabolic dysfunction in hypertensive patients with type 2 diabetes; the effect produced by 40 mg telmisartan was comparable with that of 8 mg candesartan and 80 mg valsartan. Failure to detect metabolic differences among the various ARB treatments could have been due to the low statistical power of the study design.
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Eur. J. Intern. Med. · Jun 2010
Multicenter StudyCollaborative Audit of Risk Evaluation in Medical Emergency Treatment (CARE-MET I) - an international pilot.
The absence of an accepted model for risk-adjustment of acute medical admissions leads to suboptimal clinical triage and serves as a disincentive to compare outcomes in different hospitals. The Simple Clinical Score (SCS) is a model based on 16 clinical parameters affecting hospital mortality. ⋯ The SCS appears to be a feasible tool to assist clinical triage of medical emergency admissions. The ability to view the profile of the SCS for different clinical centres opens up the possibility of accurate comparison of outcomes across clinical centres without distortion by different regional standards of health care. This pilot study demonstrates that the adoption of the SCS is practical across an international range of hospitals.