Current opinion in pulmonary medicine
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Review Comparative Study
Subcutaneous unfractionated heparin compared with low-molecular-weight heparin for the initial treatment of venous thromboembolism.
Low-molecular-weight heparin is the preferred choice for the initial treatment of acute, uncomplicated venous thromboembolism. In this context, unfractionated heparin is as safe and effective as low-molecular-weight heparin but requires strict laboratory monitoring. Twice-daily subcutaneous unfractionated heparin is more effective than, and as safe as, intravenous unfractionated heparin and may simplify patient treatment in or out of the hospital, being possibly cost saving, especially if it is used in weight-based, fixed, unadjusted doses. The present review focuses on the relative values of low-molecular-weight heparin and subcutaneous unfractionated heparin for the initial treatment of venous thromboembolism. ⋯ Subcutaneous unfractionated heparin, targeted on activated partial thromboplastin time results or in fixed doses, may be used in or out of the hospital for the treatment of venous thromboembolism, being possibly cost effective; however, these findings need confirmation through appropriate, large-sample, randomized clinical trials.
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Exercise impairment and pulmonary hypertension are common features of interstitial lung disease. Antifibrotic therapies for interstitial lung disease remain unproved; therefore, some interest has been focused on treating the pulmonary vascular impairment these diseases. ⋯ Small case series have shown that some patients improve on receiving therapy for pulmonary hypertension secondary to interstitial lung disease. These findings suggest that larger treatment trials for medications targeting pulmonary hypertension in interstitial lung disease are warranted.
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To provide a timely and concise review of the most recent clinical data in the field of bridging (anticoagulation) therapy with heparin for the at-risk patient receiving long-term oral anticoagulation who requires temporary interruption for an elective invasive procedure or surgery. ⋯ Perioperative bridging therapy with heparin, either unfractionated heparin or low-molecular-weight heparin, appears to be safe and effective for patients, including those with mechanical heart valves, receiving long-term oral anticoagulation who require temporary interruption, especially for non-high-bleeding risk procedures such as minor surgery and invasive procedures. Further studies, including randomized double-blind placebo-controlled trials, are needed to optimize bridging therapy for specific patients and procedures.
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The pathogenesis of idiopathic pulmonary fibrosis as well as that of several other interstitial lung diseases is poorly understood. The role of autoimmunity in interstitial lung diseases associated with connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis as well as the vasculitides is well established. There is at least some evidence in the literature that supports the role of autoimmunity as one of the mechanisms of alveolar injury responsible for idiopathic pulmonary fibrosis. This review is an attempt to summarize the studies on this subject. ⋯ It might seem that the role of autoimmunity in interstitial lung disease has been underestimated or even underinvestigated. The subject requires further investigation, especially with regard to the problems of lung allograft rejection due to bronchiolitis obliterans of nonalloimmunity origin and the failure of patients with idiopathic pulmonary fibrosis to respond to most forms of currently available therapy.