Vnitr̆ní lékar̆ství
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Anticoagulant therapy is one of the most common forms of medical intervention. It is the mainstay of prevention and treatment of thrombotic events. Omission of adequate anticoagulant prophylaxis at least for moderate-risk and high-risk patients is a widely recognized medical error. ⋯ Whereas unfractionated heparin and warfarin, the oldest and most widely used anticoagulants, have specific antidotes for their anticoagulant effect, many of the newer agents (direct and indirect inhibitors of coagulation factors Xa and/or IIa) do not have specific antidotes to reverse their actions. The use of novel anticoagulants is further complicated by a lack of easily available laboratory tests to measure their levels and thereby optimize their benefit and safety in clinical practice. In this review, we evaluate the risk of bleeding associated with current anticoagulants, review the data available on current and experimental agents used for the reversal of anticoagulation, and provide recommendations for the management of major bleeding associated with anticoagulant therapy and for the management of asymptomatic overdosing of the anticoagulants.
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Vnitr̆ní lékar̆ství · Mar 2009
Review[Venous thromboembolism prophylaxis in orthopaedics and traumatology].
The paper formulates the following recommendations: 1. Patients with total hip or knee replacement should be prescribed higher prophylactic dose of low molecular weight heparin (LMWH) or fondaparinux or rivaroxaban or dabigatran, patients with proximal femur fracture should be prescribed higher prophylactic dose of LMWH or fondaparinux. Pharmacological prophylaxis should in patients with knee replacement be administered for at least 14 days and longer in patients with increased risk of venous thromboembolism (VTE). ⋯ Computer tomography (CT) or nuclear magnetic resonance imagining (NMRI) should be performed in patients with spinal injury with incomplete spinal lesion to exclude perispinal haematoma. Should haematoma occur, IPC should be used and CT or NMRI repeated after a few days; it is recommended to commence LMWH administration only when the haematoma had been stabilized. In case of persisting immobility, continuing LMWH or warfarin prophylaxis is recommended.
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Vnitr̆ní lékar̆ství · Mar 2009
Review[Cardiac surgery as a significant interference with a patient coagulation status].
Cardiac surgery has been advancing intensively in recent years. However, it is often forgotten that cardiac surgery interventions represent a significant interference with patient's coagulation status. ⋯ The overview provided suggests that cardiac surgery conducted with the support of extracorporeal circuit represents a significant interference with the coagulation status of the patient. Awareness of the above listed changes is necessary to secure correct post-operative management of coagulation disorders.
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Vnitr̆ní lékar̆ství · Mar 2009
Treatment of deep vein thrombosis with continuous intravenous infusion of LMWH in children--an alternative to subcutaneous application when needed.
Incidence of thrombosis is age dependent with the lowest risk in the childhood. Children mostly suffer from vein thrombosis. Incidence of thrombosis in children is only 0.07/10,000, but it increases among hospitalized children (3.5/10,000). ⋯ The difference in the outcomes of the therapy between both groups appears to be statistically significant (p = 0.041, nonparametric Mann-Whitney test). We have not noticed any severe adverse event of the treatment in any of our patients. Our results support the hypothesis that the treatment of DVT with continuous infusion of LMWH might be efficient and safe alternative to subcutaneous application in those children in whom we want to avoid subcutaneous administration from certain reasons.
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Vnitr̆ní lékar̆ství · Feb 2009
Review[The combination of an ACE inhibitor and a calcium channel blocker is an optimal combination for the treatment of hypertension].
Combination of drugs from different classes of antihypertensives provides an additional antihypertensive effect thus minimising the probability of adverse effects related to the dose of antihypertensive. Combination therapy is indicated for the following groups of hypertensive patients: (a) all hypertensive patients whose systolic blood pressure exceeds the target systolic blood pressure value by > 20 mm Hg, or whose diastolic blood pressure exceeds the target diastolic blood pressure value by > 10 mm Hg; (b) in patients with diabetes mellitus (because the target values are < 130/80 mm Hg); (c) patients with target organ damage; (d) patients with a kidney or cardiovascular disease (patients with IHD, patients after a cerebrovascular accident); (e) patients with overall cardiovascular risk according the SCORE > or = 5%. The advantage of fixed combinations resides in the fact that they increase compliance with treatment by reducing the number of pills taken by the patients. ⋯ The fixed combination of perindopril and amlodipine will be indicated for hypertensive patients with uncontrolled hypertension or cardiovascular risk factors. This fixed combination will also be ideal for patients with a higher risk of diabetes mellitus, i.e. patients with a higher fasting glycaemia, in patients with impaired glucose tolerance and in patients with the metabolic syndrome. We strongly believe that it will improve the control of hypertension in our hypertensive patients, and improve the cardioprotective and nephroprotective effect of hypertension therapy.