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Статті в журналах з теми "Anticoagulation monitoring":
1
Smythe, Maureen A., and Anne Caffee. "Anticoagulation Monitoring." Journal of Pharmacy Practice 17, no. 5 (October 2004): 317–26. http://dx.doi.org/10.1177/0897190004271775.
Анотація:
Optimal management of anticoagulant therapy requires an understanding of the laboratory tests often employed to guide therapy. The activated partial thromboplastin time (aPTT) can detect abnormalities in the intrinsic and common clotting pathways. Despite numerous limitations in the aPTT test, it remains the gold standard for monitoring unfractionated heparin and direct thrombin inhibitor therapy. The aPTT can be performed in the central laboratory or at the bedside (point of care [POC] testing). The activated clotting time (ACT) is a POC test that is routinely employed to monitor high-dose heparin during invasive and surgical procedures. The ACT therapeutic range will depend on the specific procedure or surgery being performed. Heparin levels are becoming more routinely available and are used to establish the aPTT therapeutic range for heparin therapy as well as for direct monitoring of heparin and low-molecular-weight heparin therapy. The international normalized ratio (INR) is the gold standard for monitoring warfarin patients. The target INR depends on the indication for anticoagulation. POC monitoring for warfarin is becoming increasingly used. Clinicians should have a thorough understanding of the benefits as well as the limitations of warfarin POC monitoring.
2
Ng, Valerie L. "Anticoagulation Monitoring." Clinics in Laboratory Medicine 29, no. 2 (June 2009): 283–304. http://dx.doi.org/10.1016/j.cll.2009.05.003.
3
Pence, Catherine, and Kimberly McErlane. "Anticoagulation Self-Monitoring." AJN, American Journal of Nursing 105, no. 10 (October 2005): 62–65. http://dx.doi.org/10.1097/00000446-200510000-00036.
4
EBBERT, JON O., and ERIC G. TANGALOS. "Anticoagulation Self-Monitoring." Internal Medicine News 39, no. 20 (October 2006): 44. http://dx.doi.org/10.1016/s1097-8690(06)74379-7.
5
Chandler, Wayne L. "Anticoagulation Without Monitoring." American Journal of Clinical Pathology 140, no. 5 (November 1, 2013): 606–7. http://dx.doi.org/10.1309/ajcpe8cwkovg4agx.
6
Li Wan Po, Alain. "Self-monitoring of anticoagulation." Lancet 379, no. 9828 (May 2012): 1788–89. http://dx.doi.org/10.1016/s0140-6736(12)60757-0.
7
McPherson, Mary Lynn. "Home oral anticoagulation monitoring." Journal of Home Health Care Practice 4, no. 1 (February 1992): 63–77. http://dx.doi.org/10.1177/108482239200400110.
8
Hambleton, Julie. "Home Monitoring of Anticoagulation." Journal of Thrombosis and Thrombolysis 16, no. 1/2 (August 2003): 39–42. http://dx.doi.org/10.1023/b:thro.0000014591.32012.1f.
9
McRae, Hannah L., Leah Militello, and Majed A. Refaai. "Updates in Anticoagulation Therapy Monitoring." Biomedicines 9, no. 3 (March 6, 2021): 262. http://dx.doi.org/10.3390/biomedicines9030262.
Анотація:
In the past six decades, heparin and warfarin were the primary anticoagulants prescribed for treatment and prophylaxis of venous thromboembolism worldwide. This has been accompanied by extensive clinical knowledge regarding dosing, monitoring, and reversal of these anticoagulants, and the resources required to do so have largely been readily available at small and large centers alike. However, with the advent of newer oral and parenteral anticoagulants such as low molecular weight heparins, factor Xa inhibitors, and direct thrombin inhibitors in recent years, new corresponding practice guidelines have also emerged. A notable shift in the need for monitoring and reversal agents has evolved as well. While this has perhaps streamlined the process for physicians and is often desirable for patients, it has also left a knowledge and resource gap in clinical scenarios for which urgent reversal and monitoring is necessary. An overview of the currently available anticoagulants with a focus on the guidelines and available tests for anticoagulant monitoring will be discussed in this article.
10
Maier, Cheryl L., and Roman M. Sniecinski. "Anticoagulation Monitoring for Perioperative Physicians." Anesthesiology 135, no. 4 (September 9, 2021): 738–48. http://dx.doi.org/10.1097/aln.0000000000003903.
Анотація:
From preoperative medications to intraoperative needs to postoperative thromboprophylaxis, anticoagulants are encountered throughout the perioperative period. This review focuses on coagulation testing clinicians utilize to monitor the effects of these medications.
Дисертації з теми "Anticoagulation monitoring":
1
Coleman, B. "Requirements for a patient self monitoring service for oral anticoagulation." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1352827/.
Анотація:
Self-care is considered a means of meeting the challenge of providing care to patients with long-term conditions. However this has not achieved widespread penetration in the UK, the reasons for which are unclear. This research examined one area of self-care in depth - self-monitoring of oral anticoagulation therapy. The aim was to derive the requirements for an anticoagulation patient self-monitoring service from an analysis of the drivers for, the benefits of, the barriers to, and the challenges of establishing this service from the perspectives of key stakeholders – patients, healthcare professionals and healthcare managers. Qualitative and quantitative techniques - interviews, semi-structured questionnaire survey and focus groups – were used to gain an in-depth understanding of their views. From triangulated results, the candidate requirements for an anticoagulation self-monitoring service were derived, presented in Donabedian’s framework: structure, process and outcome. Most of these requirements were then validated through a pilot self-monitoring service. All stakeholder groups supported anticoagulation self-monitoring. However, financial, clinical and legal barriers were identified. 53% of surveyed patients were willing to undertake self-monitoring. However, only 17% of respondents felt able to purchase a coagulometer, a significant barrier. Lack of confidence in the ability to self-test was also demonstrated. Healthcare staff welcomed self-monitoring as a way to increase capacity and support evolution in the healthcare landscape. There were concerns about affordability to all stakeholders, the potential for increased clinical risk through sharing care with patients, and a fear of litigation compounded by a lack of clarity in the medicolegal position. Patient education and support were essential requirements, to prepare the patient, and on an ongoing basis. Primary care professionals felt expert support was essential for them to deliver this service. A definitive set of service requirements is proposed, and the implications of this research for other long term conditions discussed.
2
Moussa, Mouhamed Djahoum. "Déterminants cliniques, physiopathologiques et pronostics associés aux complications liées à l’hémostase au cours des assistances circulatoires de courte durée à pompe centrifuge." Electronic Thesis or Diss., Université de Lille (2022-....), 2022. http://www.theses.fr/2022ULILS055.
Анотація:
La problématique de cette thèse est la caractérisation des complications liées à l’hémostase chez le patient assisté par ECMO-VA périphérique afin d’en améliorer la prévention et de rationaliser les approches antithrombotiques en usage. Dans une première étude, nous avons décrit qualitativement et quantitativement la composition des thrombi formés sur les circuits d’ECMO-VA. Nous avons observé que ces thrombi sont majoritairement composés de VWF, de fibrine et dans une moindre proportion de plaquettes et d’érythrocytes. Notre approche quantitative a également permis de mettre en évidence la présence de NETs en l’absence de toute pathologie septique active, confirmant la possibilité d’une NETose aseptique sous ECMO-VA. Par une analyse en cluster hiérarchique, nous avons identifié 2 types de thrombi pouvant relever chacun d’un mécanisme de formation différent. Dans cette étude, la localisation des thrombi sur le circuit d’ECMO-VA n’impactait pas leurs compositions, ce qui souligne l’hétérogénéité des thrombi formés sous ECMO-VA et la multiplicité des mécanismes à l’origine de la thrombinoformation dans ce contexte. Dans un second travail, nous avons comparé la performance des revêtements de surfaces des circuits d’ECMO-VA à réduire la thrombinoforation et ses conséquences cliniques. Deux des revêtements les plus utilisés en routine étaient comparés : celle à base de phosphorylcholine et à base d’héparine. Nous avons observé un taux de complications thrombotiques plus conséquent dans le groupe phosphorylcholine sans surrisque hémorragique ou de mortalité dans les deux groupes. Par ailleurs, comparativement aux thrombi issus des jonctions de circuits traités par revêtement de phosphorylcholine, ceux provenant de circuits traités par polysaccharide-albumine étaient plus pauvres en VWF. Notre travail suggère que l’intensité de l’anticoagulation devrait être modulée en fonction du type de revêtement de surface du circuit d’ECMO. Notre troisième étude avait pour but d’identifier les saignements les plus graves justifiants d’une prise en charge clinique agressive et d’un investissement plus conséquent en recherche. À cette fin, nous avons comparé l’association entre 3 classifications de saignement avec la mortalité à 28 jours. La définition ELSO déjà en usage et les classes de la classification BARC ≥ type 2 étaient associées à la mortalité et retenues donc comme définitions de l’hémorragie majeure. Les facteurs biologiques prédictifs de l’hémorragie grave d’après la définition de l’ELSO étaient la baisse du fibrinogène, du compte plaquettaire et de l’hémoglobine à la canulation. L’indice de masse corporelle et l’étiologie postcardiotomie étaient également prédictifs de la survenue de cette complication. Dans un travail additionnel portant sur la thématique de la thèse, nous avons étudié deux des tests les plus utilisés pour la surveillance de l’héparinothérapie systémique sous ECMO, le TCA et l’activité Anti-Xa afin d’identifier le plus pertinent. Pour ce faire, dans un premier objectif nous avons étudié la relation entre ces deux tests puis avons analysé dans un second objectif l’impact de facteurs biologiques d’influences sur cette relation. Ensuite, nous avons déterminé leurs associations avec les complications thrombotiques et hémorragiques. Bien qu’étant linéairement associé, le taux de discordance entre leurs mesures était de 39 % pour une fenêtre référence d’Anti-Xa de 0,3 — 0,7 UI/mL. Ni le TCA et ni l’Anti-Xa n’étaient associées aux complications thrombotiques ou hémorragiques [...]The purpose of this dissertation is to characterize hemostasis-related complications in patients supported by peripheral VA-ECMO to improve their prevention and to optimize the antithrombotic therapeutic approaches in use. In a first study, we qualitatively and quantitatively described the composition of thrombi collected from the VA-ECMO circuits. We observed that these thrombi are mainly made of VWF, fibrin and in a lesser proportion of platelets and RBCs. Our quantitative approach also allowed us to demonstrate the presence of NETs while there was no active septic, confirming the possibility of aseptic NETosis under VA-ECMO. By hierarchical cluster analysis, we identified 2 types of thrombi, each of which may be related to a different mechanism of formation. In this study, the location of thrombi on the VA-ECMO circuit did not impact their compositions, highlighting the heterogeneity of thrombi formed within VA-ECMO and the multifactorial mechanisms that support thrombosis in this setting. In a second study, we compared the performance of surface coatings on VA-ECMO circuits to reduce thrombinoformation and its clinical consequences. Two of the most used coatings in daily practice were compared: the phosphorylcholin-based coating and the polysaccharide-albumin-based coating. We observed a higher rate of thrombotic complications in the phosphorylcholin group without any excess bleeding events or mortality in either group. In addition, compared with thrombi from phosphorylcholin-coated circuit junctions, those from polysaccharide-albumin-coated circuits were poorer in VWF. Our work suggests that the level of anticoagulation should be modulated according to the type of coating of the ECMO circuit.The aim of our third study was to identify the most relevant bleeding events that may guide clinical decision-making for more aggressive clinical management and a greater investment in research. To this end, we compared the association between 3 bleeding classifications with 28-day mortality. The ELSO definition already in use and the BARC classification classes ≥ type 2 were associated with 28-day mortality and thus retained as definitions of major bleeding. Laboratory parameters that are predictors major bleeding according to the ELSO definition were decreased fibrinogen, platelet count, and hemoglobin at cannulations. Body mass index and postcardiotomy etiology were also predictive of ELSO major bleeding. In an additional work related to the topic of the thesis, we studied two of the most used laboratory tests for the monitoring of systemic heparin during VA-ECMO, the APTT and the Anti-Xa activity, to identify the most relevant. First, we studied the relationship between these two tests and then analyzed in a second objective the impact of biological influencing factors on this relationship. Next, we determined their associations with thrombotic and hemorrhagic complications. Although linearly associated, the rate of discordance between their measurements was 39 % for an Anti-Xa reference range of 0.3 - 0.7 IU/mL. Neither APTT nor Anti-Xa was associated with thrombotic or bleeding complications. Taken together, our results highlight the heterogeneity of thrombi from peripheral VA-ECMO, the involvement of numerous causal factors that underline thrombotic and hemorrhagic complications, both not predictable by routine tests. Finally, our work underscored the need for new approaches in thrombotic or hemorrhagic complications management with targets set at an individual level considering both patient and ECMO circuit characteristics
3
van, Tienen EC. "Optimising warfarin management: an exploration of pharmacist-delivered models of care." Thesis, 2012. https://eprints.utas.edu.au/16143/2/whole-excl-app-vantienen-thesis-2012.pdf.
Анотація:
Warfarin has been the mainstay of preventing and treating thromboembolism for over 50 years and is currently taken by over 200,000 Australians. Optimal management of warfarin relies on regular monitoring of the International Normalised Ratio (INR), appropriate dose adjustment, effective communication and comprehensive patient education. Therapy may be managed by a range of healthcare providers in a variety of settings, and by patients themselves, although management in Australia has tended to focus on traditional office and pathology based models. Internationally, however, alternative models of care are playing an increasingly significant role with positive results and pharmacists have been shown to be effective in improving the quality use of warfarin through a variety of these service delivery models.
The main objective of this thesis was to examine the effect of using pharmacist delivered models of care on warfarin management within Australia through a number of complementary projects.
Guidelines recommend aiming for a target INR control of upwards of 70% time in range. Internationally, community-based studies consistently demonstrate suboptimal levels of INR control, although little data is available on the level of control achieved through usual models of care in Australia. A retrospective cross sectional study of INR results from 442 Australian veterans was undertaken to determine the INR control of a usual care population. The mean time in INR range was 61.8% in this population. This suggests a potential role for strategies aiming to improve INR control among Australian patients in line with best practice guidelines.
Review of the literature suggested pharmacists could play a role in improving warfarin management through optimising the delivery of education, improving access to INR testing and facilitating patient self-monitoring. A series of sub-projects were designed to develop and pilot tools to support pharmacists in addressing these strategies.
A website was designed to provide patients and health professionals with educational resources regarding anticoagulation. The site aimed to be a comprehensive and reliable online resource and was promoted directly to pharmacists. It received high levels of utilisation, with almost 250,000 views in 12 months, and positive feedback from health professionals and patients, and proved to be an important educational resource that was an easy and accessible tool for pharmacists to use to complement face to face counselling services and further improve patients’ knowledge about warfarin therapy.
Tools and resources were developed to improve access to INR testing by facilitating the introduction of anticoagulation services, including pharmacist-delivered INR clinics, in Australia. A pilot was conducted in three rural community pharmacies, with a subsequent project involving 36 pharmacies. While the resources received positive feedback from participating pharmacists, the rate of successful service implementation was low. Despite the perceived benefits to the communities, the current model of healthcare remuneration in Australia impacted on the long term financial viability of such services.
Development, implementation and evaluation of a pharmacy-centred pathway to enable patient self-monitoring (PSM) was also undertaken. Forty-eight patients successfully underwent training and participated in PSM for a median of 16.9 months. INR control data during PSM was compared to that from the six months prior to entering the study for 46 of the 48 patients. There was a significant improvement in INR control, with the mean time in range increasing from 64.0% to 72.9% (p<0.05). Clinical data analysis was complemented by a qualitative exploration of 38 patients’ experiences of self-monitoring and the impact of PSM on various aspects of their lives. It was found that patients discussed PSM positively, describing it passionately and as something of value, which reduced their anxiety and freed them to carry on with their lives.
The results of these projects suggest that expansion of the professional services offered by pharmacists has the potential to improve the control of warfarin therapy in Australia. Changes in remuneration for healthcare services are likely to increase the viability of pharmacist-delivered INR services and the uptake of PSM. Despite the arrival of newer oral anticoagulant agents, the use of warfarin is likely to continue for many years. Optimising warfarin management is arguably the safest and most clinically and cost-effective option for preventing and treating thromboembolism at this point in time. Pharmacists can play an important role in improving warfarin management by embracing opportunities to deliver professional services aimed at optimising outcomes for Australians taking warfarin.
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Ferreira, Cristina Maria Santos de Sousa. ""Modelo de acompanhamento de Doentes a tomar Anticoagulantes Orais, em âmbito de Consulta Farmacêutica. Proposta de Formação Avançada"." Master's thesis, 2017. http://hdl.handle.net/10316/83689.
Анотація:
Dissertação de Mestrado em Farmacologia Aplicada apresentada à Faculdade de FarmáciaRacional: Os anticoagulantes orais são habitualmente utilizados na prática clinica para o tratamento e prevenção de doenças cardiovasculares, acidentes cerebrovasculares e tromboembolismo venoso. Para além dos antagonistas da vitamina K, surgiram recentemente outros anticoagulantes orais com um mecanismo de ação mais específico e aparentemente com menos limitações. Os novos anticoagulantes dispensam a monitorização analítica de rotina, mas não dispensam o acompanhamento do doente por um profissional de saúde, com o objetivo de aumentar a eficácia e segurança e maximizar a adesão á terapêutica. O farmacêutico, pelos seus conhecimentos no âmbito da farmacologia e pelo sucesso de programas de acompanhamento farmacoterapêutico, desenvolvidos em outras áreas como por exemplo a hipertensão e a diabetes, está bem posicionado para uma intervenção na gestão e acompanhamento do doente anticoagulado.Objetivo: Este trabalho pretende dar um contributo na área em 3 vertentes:1. Fazer uma revisão dos modelos existentes em outros países de acompanhamento farmacoterapêutico de doentes medicados com anticoagulantes orais.2. Criar em Portugal um método para implementar a consulta farmacêutica de acompanhamento do doente sob anticoagulação oral.3. Identificar necessidades de formação que conferem competências ao farmacêutico para fazer o acompanhamento do doente anticoagulado.Métodos: • Pesquisa na Pubmed, e em outras fontes consideradas relevantes para o tema, com o objetivo de ver o que existe publicado na área.• Os parâmetros relevantes para uma correta utilização dos anticoagulantes e acompanhamento farmacoterapêutico destes doentes são definidos com base na informação encontrada e nas características de cada fármaco.• Criação de estrutura de programa de formação para farmacêuticos.Resultados: Foi feita uma revisão dos modelos de acompanhamento de doentes anticoagulados existentes em outros países quer para os fármacos antivitamínicos K quer para os anticoagulantes orais não antagonistas da vitamina K. Foram consultadas as principais Guidelines na área e as recomendações das sociedades científicas envolvidas na utilização de anticoagulantes orais. Verificou-se que existem registos de sucesso de programas de monitorização da anticoagulação com impacto na melhoria da correta utilização dos antagonistas da vitamina K. Estes programas de acompanhamento começam a incluir os novos anticoagulantes nos seus protocolos.Com base na informação encontrada, foi criado um modelo de acompanhamento destes doentes pelo farmacêutico, com o objetivo de melhorar a eficácia e a segurança na utilização destes fármacos. Em função dos conhecimentos requeridos ao farmacêutico para que possa de forma cabal desenvolver esta atividade, é proposta uma formação estruturada na área da anticoagulação que lhe permitirá o desenvolvimento destas competências.Conclusão: Este trabalho permitiu criar um modelo de consulta farmacêutica para acompanhamento de doentes anticoagulados, para futura validação na realidade portuguesa. Espera-se assim que este modelo contribua para a melhoria do controlo dos doentes anticoagulados em Portugal, em âmbito de consulta farmacêutica.
Rationale: Oral anticoagulants are commonly used in clinical practice for the treatment and prevention of cardiovascular diseases, strokes and venous thromboembolisms. In addition to vitamin K antagonists, other oral anticoagulants have recently appeared with a more specific mechanism of action and with less apparent limitations. New anticoagulants do not require routine analytical monitoring, but do require patient follow-up by a health care professional to increase efficacy and safety and maximize adherence to therapy. The pharmacist, due to his/her expertise in pharmacology and to the success of pharmacotherapeutic monitoring programs developed in other areas such as hypertension and diabetes, is well suited for an intervention in the management and follow-up of the anticoagulated patient.Objective:This paper intends to make a contribution in the area in three aspects:1. Review existing models in other countries of pharmacotherapeutic follow-up of patients receiving oral anticoagulants.2. Create in Portugal a method to implement the pharmaceutical consultation to follow the patient under oral anticoagulation.3. Identify training needs that grant the pharmacist the necessary skills to follow the anticoagulated patient.Methods: • Research in Pubmed, and other sources considered relevant to the main topic, with the purpose of analyzing what had been published in the area. • The relevant parameters for the correct use of anticoagulants and pharmacotherapeutic follow-up of these patients were defined based on the information found and on the characteristics of each drug.• Creation of a training program structure for pharmacists. Results: A review of the anticoagulated patient follow-up models available in other countries for both anti-vitamin K drugs and non-vitamin K antagonist oral anticoagulants was undertaken. The main guidelines in the area and the recommendations of the scientific societies involved in the use of oral anticoagulants have been consulted. There have been reports of successful anticoagulation monitoring programs with impact on improving the correct use of vitamin K antagonists. These follow-up programs begin to include the new anticoagulants in their protocols.Based on the information found, a model of follow-up of these patients by the pharmacist was created with the aim of improving the efficacy and safety in the use of these drugs.Finally, based on the knowledge required of the pharmacist so that he/she can fully exert this activity, a structured training in the area of anticoagulation is proposed, which will allow him to develop these competences.Conclusion: This work allowed the creation of a pharmaceutical consultation model for the monitoring of anticoagulated patients, for future validation in the Portuguese reality.It is thus expected that this model contributes to the improvement of the control of anticoagulated patients in Portugal, in the scope of pharmaceutical consultation.
Книги з теми "Anticoagulation monitoring":
1
Allen, Brown, Canadian Coordinating Office for Health Technology Assessment., and Canadian Agency for Drugs and Technologies in Health., eds. Devices for point-of-care monitoring of long-term oral anticoagulation therapy: Clinical and cost effectiveness. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 2007.
2
Waldmann, Carl, Neil Soni, and Andrew Rhodes. Haematological drugs. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0014.
Анотація:
Anticoagulants and heparin-induced thrombocytopenia 220Thrombolysis 224Antifibrinolytics 226For >50 years, the options for therapeutic anticoagulation were limited to unfractionated heparin (UFH) and oral vitamin K antagonists. While highly effective, both drugs have major safety problems. Both have narrow therapeutic ranges, substantial interindividual dose variability, major side effects and require regular therapeutic drug monitoring, with a narrow therapeutic window and high incidence of bleeding complications....
3
Prout, Jeremy, Tanya Jones, and Daniel Martin. Cardiac anaesthesia. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0014.
Анотація:
This chapter, written by Anaesthetists from the Heart Hospital, describes the general principles in cardiac anaesthesia. Patient pre-assessment, perioperative monitoring, management of anticoagulation, methods of patient cooling and rewarming, cardiopulmonary bypass and postoperative complications such as tamponade and neurological dysfunction are all discussed in detail. The principles of intra-aortic balloon pump counterpulsation with indications and practical aspects of use are included. The principles of providing anaesthesia for the adult patient with congenital heart disease follow a description of the physiological considerations in these patients.
4
Adam, Sheila, Sue Osborne, and John Welch. Haematological problems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0012.
Анотація:
This chapter discusses specific haematological disorders that require the patient to be admitted to the critical care unit. It describes the normal physiology of blood cells, clotting mechanisms, and fibrinolysis, and the management of related conditions such as thrombocytopenia, leukaemia, and clotting disorders such as disseminated intravascular coagulation. It also includes the management of the critical care patient with haematological malignancy. Specific therapies such as plasma exchange and anticoagulation therapy are discussed in detail and the monitoring of coagulation tests is explained. The chapter also describes the administration of blood and blood products, together with their associated hazards, and the effects of massive transfusions of blood.
5
Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0046.
Анотація:
Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
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Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0046_update_001.
Анотація:
Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
7
Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0046_update_002.
Анотація:
Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
8
Torbicki, Adam, Marcin Kurzyna, and Stavros Konstantinides. Pulmonary embolism. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0066.
Анотація:
Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
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Torbicki, Adam, Marcin Kurzyna, and Stavros Konstantinides. Pulmonary embolism. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0066_update_001.
Анотація:
Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
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Torbicki, Adam, Marcin Kurzyna, and Stavros Konstantinides. Pulmonary embolism. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0066_update_002.
Анотація:
Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
Частини книг з теми "Anticoagulation monitoring":
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Jayaram, Kavitha. "Monitoring Anticoagulation." In Transfusion Practice in Clinical Neurosciences, 417–29. Singapore: Springer Nature Singapore, 2022. http://dx.doi.org/10.1007/978-981-19-0954-2_38.
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Gurbel, Paul A., and Udaya S. Tantry. "Antiplatelet Drug Resistance and Variability in Response: The Role of Antiplatelet Therapy Monitoring." In Antiplatelet and Anticoagulation Therapy, 45–112. London: Springer London, 2012. http://dx.doi.org/10.1007/978-1-4471-4297-3_2.
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Sharda, Anish V., and Jeffrey I. Zwicker. "Anticoagulation Drugs: Indications, Therapeutic Monitoring, and Antidotes." In Nonmalignant Hematology, 503–17. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-30352-9_44.
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Yost, Gregory W., and Steven R. Steinhubl. "Monitoring and Reversal of Anticoagulation and Antiplatelet Agents." In Interventional Cardiology, 469–83. Chichester, UK: John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781118983652.ch49.
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Inaba, Wakiko, Akihiko Watanabe, Akitomo Koide, Sinnzo Sumita, Hiroaki Watanabe, and Akiyosi Namiki. "Use of the Coagulation Monitor 512 for Reversal of Heparin-Induced Anticoagulation and the Effect of Fresh Frozen Plasma." In Computing and Monitoring in Anesthesia and Intensive Care, 374–75. Tokyo: Springer Japan, 1992. http://dx.doi.org/10.1007/978-4-431-68201-1_121.
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McChesney, Ian. "Process Support for Continuous, Distributed, Multi-party Healthcare Processes - Applying Workflow Modelling to an Anticoagulation Monitoring Protocol." In Ubiquitous Computing and Ambient Intelligence, 255–66. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-48746-5_26.
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Kinard, Theresa N. "Anticoagulation Monitoring and Reversal." In Mayo Clinic Critical and Neurocritical Care Board Review, edited by Eelco F. M. Wijdicks, James Y. Findlay, William D. Freeman, and Ayan Sen, 353–58. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190862923.003.0055.
Анотація:
The balance of natural procoagulant and anticoagulant activity within the body is delicate, and a minor disruption may lead to bleeding or clotting complications. Anticoagulation in critical illness is often necessary for a host of reasons, either prophylactic or therapeutic. This chapter reviews common anticoagulation management issues in the critically ill patient, such as optimal laboratory monitoring of anticoagulation therapy and urgent reversal options, focusing on the most common anticoagulants used in current practice.
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Keeling, David. "Therapeutic anticoagulation." In Oxford Textbook of Medicine, 3018–22. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780199204854.003.161602_update_002.
Анотація:
Low molecular weight heparins (LMWH) have largely replaced unfractionated heparin. Their much more predictable anticoagulant response combined with high bioavailability after subcutaneous injection means that the dose can be calculated by body weight and given subcutaneously without any monitoring or dose adjustment. Their widespread use resulted in most patients with deep vein thrombosis being managed as outpatients, and this is also increasingly the case for uncomplicated pulmonary embolism....
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Mazzeffi, Michael, and Ashleigh Lowery. "Anticoagulation Options." In Coronary and Cardiothoracic Critical Care, 474–98. IGI Global, 2019. http://dx.doi.org/10.4018/978-1-5225-8185-7.ch022.
Анотація:
There are multiple indications for anticoagulation in the cardiac surgery intensive care unit including cardiac valve replacement, mechanical circulatory pumps (ECMO and ventricular assist devices), deep vein thrombosis prophylaxis, treatment of heparin-induced thrombocytopenia, and treatment of other thrombotic conditions including pulmonary embolism. Anticoagulant medications broadly fall into two categories: antiplatelet drugs and inhibitors of protein clotting factors. In this chapter we will review anticoagulant medications, therapeutic drug monitoring, common indications for anticoagulation, and the risks associated with anticoagulation after cardiac surgery.
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Keeling, David. "Therapeutic anticoagulation." In Oxford Textbook of Medicine, edited by Jeremy Dwight, 3729–34. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0376.
Анотація:
The main indications for therapeutic anticoagulation are venous thromboembolism, deep vein thrombosis, and pulmonary embolism, and the prevention of stroke in patients with atrial fibrillation or mechanical heart valves. Low-molecular-weight heparins have largely replaced unfractionated heparin in its treatment. Their much more predictable anticoagulant response combined with high bioavailability after subcutaneous injection means that the dose can be calculated by body weight and given subcutaneously without any monitoring or dose adjustment. Their widespread use resulted in most patients with deep vein thrombosis being managed as outpatients, and this is also increasingly the case for uncomplicated pulmonary embolism. Oral direct inhibitors of anticoagulation that specifically target thrombin or factor Xa are increasingly used to treat acute venous thromboembolism and for stroke prevention in atrial fibrillation.
Тези доповідей конференцій з теми "Anticoagulation monitoring":
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Seveso, M. P., A. Macagni, S. Viganò D'Angelo, C. Manotti, P. A. Bonini, and A. D'Angelo. "PROTHROMBIN TIME MONITORING OF ORAL ANTICOAGULANT TREATMENT: COMPARISON OF INSTRUMENTS AND THROMBOPLASTINS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643262.
Анотація:
The prothrombin time (PT) is the most widely used assay to monitor oral anticoagulation (OA). Although it has been established that both thromboplastin and instrumentation significantly affect the results, major standardization attempts have been devoted to the calibration of reagents rather than of instruments. To provide safe laboratory monitoring of OA, an International Sen sitivity Index (ISI) for thromboplastin has been introduced. We have compared two automatic coagulometers, the ACL (Instrumentation Laboratory), a laser-nephelometer centrifugal analyzer which measures the intensity of the light scattered by a plasma sample before, during and after clot formation and the KOAGULAB 40A (Ortho Diagnostics), an optical automatic coagulometer, with the till tube technique for the performance ofPT. Five calibrated commercial thromboplastins have been used for replicate determinations in 30 normals, 30 liver disease patients and 30 patients on stabilized OA. The overall observed imprecision (C.V.) was 1.1% for ACL, 2.9% for the KOAGULAB 40A and 3.0% for the till tube technique. The F test for the two-way interaction of ratios was statistically significant (p< O.OOl) for the large majority of reagent/technique combinations in normals and in liver disease patients. Internatio nal normalized ratios were also significantly different (p< O.OOl) in most instances in patients on OA. Inadequate anticoagulation (INR<2.0)was observed in 18% of patients with the ACL , in 31% with the KOAGULAB 40A and in 33% with the till tube technique. Excessive anticoagulation (INR> 4.5) was observed in 19% of the patients with the ACL, in 7% with KOAGULAB 40A and in 3% with the till tube tech nique. These data highlight the need for standardization of both instrumentations and reagents to improve monitoring of OA.
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Tshikudi, Diane M., Michael N. Andrawes, and Seemantini K. Nadkarni. "Anticoagulation and hemostasis monitoring at the bedside during cardiac surgical procedures (Conference Presentation)." In Optical Diagnostics and Sensing XX: Toward Point-of-Care Diagnostics, edited by Gerard L. Coté. SPIE, 2020. http://dx.doi.org/10.1117/12.2546717.
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Tshikudi, Diane M., Alexandra Wirth, Michael Andrawes, and Seemantini Nadkarni. "Bedside anticoagulation monitoring during cardiac surgery with a drop of whole blood (Conference Presentation)." In Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XVII, edited by Anita Mahadevan-Jansen. SPIE, 2019. http://dx.doi.org/10.1117/12.2510608.
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Shand, R. A., K. D. Butler, and J. A. Davies. "HEPARIN ANTICOAGULATION AND ITS EFFECT ON ARTERIAL THROMBUS FORMATION IN THE RABBIT." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643173.
Анотація:
Injury to the rabbit carotid was induced by clamping the vessel for 5 minutes. Deposition of radiolabelled fibrinogen (F) or platelets (PL) on the injured carotid was monitored continuously, for 45 minutes, using an iodide crystal scintillation detector positioned over the vessel linked to an automated isotope monitoring system (AIMS 8000). The results were expressed as the maximal increase or as the area under the curve (AUC) for the recording period.Following injury there was a simultaneous increase in both F associated and PL associated radioactivity of 29% (median value, range 10.9 - 4.37) and 11% (range 7.45 - 24.7) respectively above control values. The response as measured by the AUC was 47,000 ± 8,550 and 15,000 ± 5,600 respectively.Heparin (250 IU/kg, i.v. bolus) did not influence F deposition following injury and only produced a transient prolongation of the prothrombin time. If the same bolus dose of heparin was followed by an infusion of 670 IU/kg/hr there was a significant reduction of both the maximal increase and the AUC of F deposition (45% and 55% respectively). There was also a sustained (2-3 fold) prolongation of the prothrombin time. Heparin (500 IU/kg i.v. plus infusion of 670 IU/kg/hr) significantly impaired both the maximal increase and AUC of F deposition (by 33% and 69% respectively) and PL deposition (79% and 100% respectively). No significant changes in either albumin or erythrocyte associated radioactivity in the injured carotid artery of control or treated rabbits were found.This data demonstrates that anticoagulation, using heparin, inhibits fibrin(ogen) and platelet deposition, but not permeability changes, in the injured rabbit carotid artery. This highlights the interdependence in arterial thrombus formation of both the coagulation system and platelets.
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Tshikudi, Diane M., Alexandra G. Wirth, Michael N. Andrawes, and Seemantini K. Nadkarni. "Anticoagulation and hemostasis monitoring during cardiac surgery with a drop of whole blood using a novel optical sensor." In Novel Biophotonics Techniques and Applications, edited by Arjen Amelink and Seemantini K. Nadkarni. SPIE, 2019. http://dx.doi.org/10.1117/12.2537923.
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Tshikudi, Diane M., Alexandra G. Wirth, Michael N. Andrawes, and Seemantini K. Nadkarni. "Monitoring Anticoagulation and Hemostasis in Cardiac Surgical Patients with a Drop of Whole Blood Using a Novel Optical Sensor." In Clinical and Translational Biophotonics. Washington, D.C.: OSA, 2020. http://dx.doi.org/10.1364/translational.2020.tw4b.4.
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Hulbert, J. C., J. A. Krishnan, E. Heather, N. Shapiro, S. O'Neal, A. Baucom, L. Castro, et al. "A Novel Approach to Medical Monitoring During the SARS-CoV-2 Pandemic Supporting the ACTIV 4B Outpatient Anticoagulation Trial." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1749.
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Stewart, G. J., J. W. Lachman, P. D. Alburger, M. C. Ziskin, C. M. Philips, and K. Jensen. "VENODILATION AND DEVELOPMENT OF DEEP VEIN THROMBOSIS IN TOTAL HIP AND KNEE REPLACEMENT PATIENTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643696.
Анотація:
Postoperative deep vein thromboisis(DVT) is a frequent complication following total hip (THR) or knee (TKR)replacement but no test has been devised to identify specific patientswho will develop DVT. Because conventional prophylaxis does not significantly reduce the incidence of DVT, monitoring is widely used to detect evolving thrombosis. More intense anticoagulation (adjusted dose heparin,two step warfarin) may be effective but requires laboratory tests and carries increased risk of bleeding. Itwould be an economic and medical advantage to restrict prophylaxis and monitoring to patients who will develop DVT. Based on observations in a canine model of THR, we developed andtested a method that shows promise of being able toidentify, intraoperatively, patients who will develop DVT.In the canine model we found characteristic venous lesions (gaping tears through endothelium and basementmembrane, localized to confluences,selectively infiltrated with platelets and leukocytes). Incidence of lesions correlated with intraoperative venodilation, measured by a modified ultrasound scanner. Lesionsmight serve as sites for initiationand anchorage of thrombi. Diagnostic ultrasound was used to monitor cephalic vein diameter in 25 THR patients and 12 TKR patients. In THR patients, 1 of 9 patients with venodilation of 6-16% developed DVT. At 21-57% venodilation 12 of 12 THR patients developed thrombi. In the intermediate range of venodilation (19%,20%), 2 of 4 patients developedDVT. In 12 TKR patients, 10 had venodilation of 0-16% and none developedDVT in the non-operated leg. In patients with 22% and 55% venodilation,one did and one did not develop DVT in the non-operated leg (expectedfrcxn equal distribution between legs in THR patients).DVT in the operated leg did not correlate with venodilation. We suggest that in THR patients substances released at the operative site circulate briefly, causing venous dilation. In TKR patients the tourniquet prevented substances from being circulated, reducing venodilation and DVT in the non-operated leg. Proximitv of surgicalwound to calf veins and tourniquet pressure mav have contributed to DVT in the operated leg.