Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Feb 2010
ReviewWhat you should know about the 2008 American College of Chest Physicians evidence-based clinical practice guidelines (8th) on antithrombotic and thrombolytic therapy.
The American College of Chest Physicians published their first consensus conference guidelines on antithrombotic therapy in 1986 and has updated these guidelines approximately every 3 years as a supplement to the journal Chest. These guidelines are widely accepted as an authoritative source of information and considered by many to be the textbook for antithrombotic therapy. ⋯ Examples from the literature that support the evolution these guidelines will focus on changes that are most germane to the majority of attendees at the 10th National Conference on Anticoagulant Therapy and members of the AC Forum. The objective of this article is to help answer ten common clinical questions frequently faced by anticoagulation management services.
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J. Thromb. Thrombolysis · Jul 2009
ReviewPlatelet reactivity and the identification of acute coronary syndromes in the emergency department.
Risk stratifying patients with potential acute coronary syndromes (ACS) in the Emergency Department is an imprecise and resource-consuming process. ACS cannot be ruled in or out efficiently in a majority of patients after initial history, physical exam, and ECG are analyzed. This has led to a reliance on cardiac markers of myocardial necrosis as a key means of making the diagnosis. ⋯ This has led to an ongoing search for one or more marker(s) that would be more sensitive in early ACS. With the central role that platelets play in the pathophysiology of coronary thrombosis, measures of platelet function represent one potential area where an early ACS marker might be identified. This review will focus on selected tests/markers of platelet function that have shown some promise with respect to the risk stratification of patients with potential ACS.
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J. Thromb. Thrombolysis · Jun 2008
ReviewVascular endothelial growth factors in pulmonary edema: an update.
Pulmonary edema is a life-threatening complication of critical illness. Identification of the underlying mechanisms of pulmonary edema is a prerequisite for the development of adequate treatment. The initial description of fluid transportation across capillaries (Starling's law) while of critical importance, did not provide full insight into the underlying pathophysiology of vascular leakage. ⋯ However, it has long been recognized that there is significant overlap between the various types of pulmonary edema, raising important questions regarding the role of novel mechanisms that may contribute to the development of interstitial and alveolar leakage. Recently, several studies on VEGF, an angiogenic growth factor which affects endothelial permeability, have identified this molecule as a potential regulator of vascular leakage and repair in pulmonary edema. We review here the underlying the mechanisms by which VEGF may do this and will discuss the still unanswered questions regarding vascular pharmacology in the setting of pulmonary edema.
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J. Thromb. Thrombolysis · Feb 2008
ReviewTreatment of DVT: how long is enough and how do you predict recurrence.
Currently available anticoagulants are effective in reducing the recurrence rate of venous thromboembolism (VTE). However, anticoagulant treatment is associated with an increased risk for bleeding complications. Thus, anticoagulation has to be discontinued when benefit of treatment no longer clearly outweigh its risks. ⋯ Currently available anticoagulants are effective in reducing the incidence of recurrent venous thromboembolism, but they are associated with an increased risk for bleeding complications. All patients with acute venous thromboembolism should receive oral anticoagulant treatment for three months. At the end of this treatment period physicians should decide for definitive withdrawal or indefinite anticoagulation with scheduled periodic re-assessment of the benefit from extending anticoagulation.