Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Jul 2014
Review Meta AnalysisCangrelor for patients undergoing percutaneous coronary intervention: evidence from a meta-analysis of randomized trials.
Cangrelor is a new parenteral adenosine diphosphate P2Y12 receptor inhibitor with rapid, profound and reversible inhibition of platelet activity. The aim of this meta-analysis was to evaluate efficacy and safety of this new agent in patients undergoing percutaneous coronary intervention (PCI). We searched PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases from the inception through April 2013. ⋯ However, cangrelor significantly reduced the risk of ischemia-driven revascularization (RR 0.72, 95% CI 0.52-0.98), stent thrombosis (RR 0.60, 95% CI 0.44-0.82) and Q wave MI (RR 0.53, 95% CI 0.30-0.92) without causing extra major bleeding (Thrombolysis in Myocardial infarction criteria) and severe or life-threatening bleeding (Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries criteria). Separate analysis against only clopidogrel also showed similar findings except Q wave MI outcome. Use of cangrelor during PCI might reduce the risk of ischemia-driven revascularization and stent thrombosis, without causing extra major bleeding.
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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 · Apr 2001
Meta Analysis Comparative StudyThrombolysis for restoration of patency to haemodialysis central venous catheters: a systematic review.
Urokinase, previously used to restore patency to thrombosed haemodialysis catheters, is now unavailable in North America. We performed systematic reviews of four questions related to the safety and efficacy of alternative agents for catheter thrombolysis, searching Medline and the Cochrane Controlled Clinical Trials Register. In dialysis patients, large case series have documented that urokinase is safe and effective (>70 % efficacy for catheter instillation, and >80 % for systemic lysis). ⋯ This review suggests that 1--2 mg/lumen tPA is a suitable dose for catheter instillation and likely to be more effective than 5000 units/lumen urokinase. Systemic lysis with 5--10 mg tPA is likely to be safe and effective in suitably selected patients. Further studies are needed.