Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Feb 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.
Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities. ⋯ While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial, its use suggested a possible benefit for patients with the most severe heart failure or hypotension. ABBREVIATED ABSTRACT: We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infarction complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure. The primary end point, mortality at 6 months, did not differ between groups (34% for combined treatment versus 43% for fibrinolysis alone [n = 27]; adjusted P = 0.23), although patients with Killip class III or IV did show a trend toward greater benefit from IABP (39% for combined therapy versus 80% for fibrinolysis; P = 0.05).
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J. Thromb. Thrombolysis · Feb 2005
Case Reports Comparative StudyTreatment of patients with a history of heparin-induced thrombocytopenia and anti-lepirudin antibodies with argatroban.
Patients with heparin-induced thrombocytopenia (HIT) type II require anticoagulation with non-heparin immediate acting anticoagulants. Danaparoid may cross react with HIT-antibodies and lepirudin may generate anti-lepirudin antibodies influencing anticoagulation. We hypothesised, that the synthetic small molecular thrombin inhibitor argatroban does not induce immunoglobulins reacting towards lepirudin in patients with anti-lepirudin antibodies in the history and that titration of the anticoagulation may be easier with argatroban. ⋯ Patients on argatroban did not generate immunoglobulin IgG reacting towards lepirudin in contrast to both patients on lepirudin who developed anti-lepirudin antibodies. Both treatments were well tolerated. Despite the low number of patients argatroban seems to lead to a more stable anticoagulant response than lepirudin resulting in a lower variability of the dosage for prophylaxis or treatment of thromboembolism of patients with a history of HIT and lepirudin antibodies.
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J. Thromb. Thrombolysis · Aug 2004
Tenecteplase for the treatment of massive and submassive pulmonary embolism.
Data on thrombolytic therapy disclose benefits from thrombolytic therapy in patients with massive and submassive pulmonary embolism (PE). Previously published case reports have described the successful use of tenecteplase under these conditions. ⋯ These data support the use of this new thrombolytic agent in patients with massive and submassive PE; however, sufficiently powered, randomized trials have not yet taken place for these indications.
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J. Thromb. Thrombolysis · Jun 2004
Randomized Controlled Trial Multicenter Study Clinical TrialMyocardial salvage after reduced-dose thrombolysis combined with glycoprotein IIb/IIIa blockade versus thrombolysis alone in patients with acute myocardial infarction.
The aim of study was to examine the efficacy of reduced-dose alteplase plus abciximab versus alteplase alone by quantifying the amount of myocardium salvaged using myocardial scintigraphy. ⋯ When used as a general strategy in patients with acute myocardial infarction, adding abciximab to alteplase does not increase significantly the amount of salvaged myocardium as compared with alteplase alone. Combination therapy may offer advantages over thrombolytic agents alone if such therapy is applied within 2 hours from symptom onset; however these data need to be proven by studies of adequate power.
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J. Thromb. Thrombolysis · Apr 2004
Review Case ReportsThromboembolism and toxic shock syndrome: a case presentation and literature update.
A case of progressive shock and multisystem organ failure is reported for an 18 year old Lebanese woman, clinically diagnosed as toxic shock syndrome (TSS). The patient developed cough and dyspnea during hospitalization; chest CT angiography revealed thromboembolism of the pulmonary artery. ⋯ The patient improved gradually and was discharged from the hospital 7 days later on oral anticoagulation, and was followed up for six months with no disease recurrence or complications. To our knowledge, this is the first reported case in the literature of toxic shock syndrome associated with pulmonary thromboembolism.