Seminars in thrombosis and hemostasis
-
Women experience increased thrombotic risk at pregnancy and puerperium as well as during hormonal therapy with oral contraceptives or hormone replacement therapy. Physiological and anatomical changes in pregnancy contribute to the hypercoagulable situation. ⋯ Children are at increased thrombotic risk, particularly at the neonatal period, and may express thrombosis often in association with thrombophilia. This article will focuses on the clinical association, pathogenesis, and treatment of thrombophilia-related issues in women and children.
-
Semin. Thromb. Hemost. · Jan 2005
Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting.
On-pump cardiac surgery is accompanied by complex alterations of hemostasis. The excessive postoperative bleeding has been attributed to acquired platelet dysfunction, impaired plasmatic coagulation, and increased fibrinolysis. The characterization of the hemostatic defects responsible for bleeding is crucial for specific treatment and optimal clinical management of the patient. ⋯ Platelet function appears to be rapidly restored in uncomplicated CABG. PHC determination by PFA-100 demonstrates a high specificity for adequate platelet function and, therefore, could be beneficial in improved transfusion of platelet concentrates. PHC testing by PFA-100 may help identify postoperative platelet hyper-reactivity associated with myocardial lesion.
-
Semin. Thromb. Hemost. · Dec 2004
ReviewPeriprocedural management of anticoagulation in patients on extended warfarin therapy.
Patients receiving chronic anticoagulation therapy pose a clinical challenge when therapy needs to be interrupted for surgical or invasive procedures. Maintaining anticoagulation places them at risk of serious bleeding complications, whereas discontinuing anticoagulation puts them at risk of thromboembolic complications. ⋯ Currently, there is little consensus on appropriate perioperative management of patients on long-term warfarin therapy. This article is an attempt to bring together all the available data on periprocedural bridging to assess the available options for patients undergoing surgical procedures and to provide a rationale for using low-molecular-weight heparins (LMWHs) while individualizing the risks versus benefits in a given patient population.
-
Over recent years, the use of portable coagulation monitors for prothrombin time-International Normalized Ratio (PT-INR) testing has been gaining popularity. Their advantages over traditional methods of monitoring include ease of use, short test duration, faster turnaround time for dosage changes, increased patient convenience by eliminating the need to go to the laboratory for venipuncture, and increased patient-provider interaction. Portable coagulation monitors for PT-INR testing are currently used in various settings, such as anticoagulation clinics, physician offices, at the patient's bedside in hospital wards, and independently by patients at home. ⋯ Various point of care (POC) coagulation monitors have been developed, and many models are commercially available in the United States. Because technology differs among the various devices, accuracy and precision need to be determined for individual devices. The various devices cannot be used interchangeably, and individual device performance cannot be generalized.
-
Semin. Thromb. Hemost. · Jun 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialBivalirudin in PCI: an overview of the REPLACE-2 trial.
The Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial is one of the largest acute randomized controlled trials evaluating the efficacy of two anticoagulant strategies during contemporary urgent or elective percutaneous coronary intervention (PCI). The direct thrombin inhibitor, bivalirudin, with provisional use of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor was compared to low-dose unfractionated heparin (UFH) plus planned GP IIb/IIIa inhibitor. At 30-day follow-up, the primary quadruple composite endpoint (death, myocardial infarction (MI), urgent repeat revascularization, or in-hospital major bleeding) occurred in 9.2% of patients in the bivalirudin group versus 10.0% of patients in the UFH plus GP IIb/IIIa inhibitor group. ⋯ There was a trend toward decreased mortality at 6 months in the bivalirudin arm (0.95% vs. 1.35%; p = 0.148). The relative efficacy of bivalirudin versus UFH plus GP IIb/IIIa inhibitor was similar in several high-risk subgroups, including patients with diabetes mellitus or prior MI, women, the elderly (age > 65 years), and patients undergoing PCI of bypass grafts. Bivalirudin represents an exciting alternative to UFH plus GP IIb/IIIa inhibitor in patients undergoing urgent and elective PCI with similar suppression of ischemic events, fewer bleeding complications, and the potential for greater cost savings and ease of administration.