Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · May 2012
ReviewCurrent status on plasma biomarkers for acute mesenteric ischemia.
Clinical diagnosis of acute mesenteric ischemia is difficult. The aim of this review is to provide current status on the search for an accurate plasma biomarker for acute mesenteric ischemia. A search using the medical subject heading terms marker and mesenteric ischemia or intestinal ischemia or superior mesenteric artery occlusion or mesenteric venous thrombosis in the Medline and Embase databases from 1980 to 2011. ⋯ The early clinical and laboratory diagnosis of intestinal ischemia remains a challenge. None of the proposed plasma-derived tests for acute mesenteric ischemia has as yet entered routine clinical practice. The proposed biomarkers need to be evaluated in a prospective clinical research project in patients with acute abdomen.
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J. Thromb. Thrombolysis · Apr 2012
ReviewVenous thromboembolism: a collaborative quality improvement model for practitioners, hospitals, and insurers.
Venous thromboembolism (VTE) carries significant morbidity and mortality and affects a large portion of hospitalized patients. VTE prophylaxis is rated by the Agency for Healthcare Research and Quality as the most effective of 79 patient safety practices it assessed in 2001. ⋯ The CQIs are uniquely structured to catalyze hospitals and practitioners to become self-optimizing. In this review, we describe the model BCBSM/BCN and participating Michigan hospitals have developed to improve the prevention and diagnosis of VTE for patients in the state of Michigan.
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Platelet adhesion, activation and aggregation play a pivotal role in atherothrombosis. Intracoronary atherothrombosis is the most common cause of the development of acute coronary syndrome (ACS), and plays a central role in complications occurring around percutaneous coronary intervention (PCI) including recurrent ACS, procedure-related myocardial infarction or stent thrombosis. Inhibition of platelet aggregation by medical treatment impairs formation and progression of thrombotic processes and is therefore of great importance in the prevention of complications after an ACS or around PCI. ⋯ The P2Y12 receptor is the predominant receptor involved in the ADP-stimulated activation of the glycoprotein IIb/IIIa receptor. Activation of the glycoprotein IIb/IIIa receptor results in enhanced platelet degranulation and thromboxane production, and prolonged platelet aggregation. The objectives of this review are to discuss the pharmacological limitations of the P2Y12 inhibitor clopidogrel, and describe the novel alternative P2Y12 inhibitors prasugrel and ticagrelor and the clinical implications of the introduction of these new medicines.
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J. Thromb. Thrombolysis · Jan 2012
Review Meta AnalysisD-dimer for risk stratification in patients with acute pulmonary embolism.
Risk stratification is currently recommended for the initial management of patients with acute pulmonary embolism (PE). ⋯ In patients with acute PE elevated D-dimer is associated with increased short-term and 3-month mortality, suggesting the potential of using this test for both diagnosis and risk stratification.
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J. Thromb. Thrombolysis · Oct 2011
ReviewStandard or extended-duration prophylaxis in medical patients? A review of the evidence.
Acutely ill medical patients are at significant risk of venous thromboembolism (VTE). Thromboprophylaxis can substantially reduce the incidence of VTE, but to be optimally effective must consist of the correct choice of agent, at an appropriate dose, and for sufficient duration. Increasing evidence suggests that VTE risk persists beyond the standard period of prophylaxis. ⋯ In addition to their underlying medical condition, medical patients often have multiple risk factors, placing them at sustained risk of VTE. Extended-duration prophylaxis might be most relevant in such patients. The development of appropriate risk assessment tools could help identify medical patients at greatest risk of late VTE events who might benefit most from extended-duration prophylaxis.