Haemostasis
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Review Comparative Study
Aspirin in the treatment and prevention of cardiovascular disease.
Randomized trials of aspirin have been conducted in three main populations: patients with evolving acute myocardial infarction (MI), patients with a history of cardiovascular disease and apparently healthy subjects. Initiating aspirin therapy within 24 h after the onset of symptoms of an acute MI results in conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke and total cardiovascular death. ⋯ Randomized data from studies in women and other populations are lacking. Until more data are available, the decision to use aspirin in primary prevention should be based on the clinical judgment of the physician and it should be used as an adjunct in the management of other cardiovascular disease risk factors.
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Review Comparative Study
Risk assessment and prophylaxis of venous thromboembolism in acutely and/or critically ill patients.
Both undetected and clinically evident venous thrombosis and venous thromboembolism (VTE) can seriously impact the prognosis of acutely and/or critically ill patients. Pulmonary embolism (PE) is harder to diagnose in the acutely and/or critically ill, many of whom also have developed respiratory failure for other reasons. Deep vein thrombosis (DVT) of the upper and lower extremities can subsequently complicate insertion of central venous catheters, leading to PE, sepsis and septic shock. ⋯ While LMWH appears superior to UFH in acute stroke patients to prevent venographically-proven lower-extremity DVT, whether it provides a superior long-term outcome after acute stroke is uncertain. One study found that a high dosage of the LMWH dalteparin was more effective than placebo in preventing left ventricular thrombi after acute myocardial infarction, but there was a significant safety cost. Current questions surrounding prophylaxis of VTE and the use of LMWH in acutely and/or critically ill patients include whether monitoring levels and dosage adjustment in some of these patients would improve outcome, and whether the diagnosis of VTE can be improved so that treatment can be instituted when prophylaxis has failed.