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Статті в журналах з теми "Thrombotic complications":
1
Lim, Sunghee, Ji Yoon Lee, Seok Jin Kim, and Won Seog Kim. "The International Prognostic Index Is a Better Predictor of Thrombotic Complications Than the Khorana Score for Patients with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: Results of a Single Center Prospective Cohort Study." Blood 120, no. 21 (November 16, 2012): 5095. http://dx.doi.org/10.1182/blood.v120.21.5095.5095.
Анотація:
Abstract Abstract 5095 Background Thrombotic complication is a major life threatening condition in lymphoma patients because chemotherapy as well as lymphoma cell itself can result in thrombosis. Although high rates of thrombotic complication have been reported in patients with lymphoma, the majority of data were from retrospective studies with heterogeneous group of patients. Furthermore, the frequency of thrombotic complications varied depending o the nature of studies and subtypes of lymphoma included. Thus, it is still not determined about the risk factors for thrombotic complications in lymphoma patients. As a predictive model for cancer-associated thrombosis, Khorana risk score has been proposed including cancer type, body mass index (BMI), prechemotherapy white blood cell, hemoglobin, and platelet count. However, there is few data prospectively validating the role of this risk model in Asian lymphoma patients. Therefore, we explored risk factors influencing the occurrence of venous and arterial thrombotic complications in diffuse large B-cell lymphoma (DLBCL) patients who were uniformly treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Methods We analyzed the incidence of venous and arterial thrombotic complications from DLBCL patients enrolled in our prospective cohort study (NCT00822731). Patients were pathologically confirmed and treated with R-CHOP. Thrombotic complications defined as venous thrombosis including pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT), and arterial thrombosis including stroke and infarction occurred after diagnosis. The thrombotic complications were diagnosed with radiologic imaging studies including CT scan and ultrasound imaging. Results 352 patients were enrolled between 2008 and 2011, and they were prospectively monitored regarding the occurrence of thrombotic complications with the median follow-up duration of 22. 6 months. The median age was 56 years old (range 16–86) and male to female ratio was 1. 3:1. Thrombotic complications occurred in 48 patients (crude incidence: 13. 6%) including venous thrombosis (n = 37, 10. 5%) and arterial thrombosis (n = 11, 3. 1%). Venous thrombosis including DVT and PE occurred within 6 months after diagnosis (32/37, 86. 5%), so the actuarial incidence of venous thrombosis at one year was 10. 1%. However, arterial thrombosis mainly occurred around 12 months after diagnosis. Among 37 cases of venous thrombosis, anticoagulation therapy was used for 22 patients with symptomatic DVT or PE. Incidental cases of DVT or PE which were found during imaging follow-up for evaluation of tumor response did not require therapy. There were two deaths-related with venous thrombosis including refractory hypoxemia due to PE and bleeding due to anticoagulation while no death was found in arterial thrombosis. Age older 60 years and poor performance status (≥ ECOG grade 2) were significantly associated with thrombotic complications. However, other host factors including co-morbidity, body mass index (BMI), and gender were not related (P > 0. 05). Disease-related factors representing high tumor burden such as elevated serum LDH, two or more than two extranodal involvements, and Ann Arbor stage III/IV were significantly associated with increased risk of thrombotic complications (P < 0. 05). However, a particular extranodal site including stomach, pancreas, intestine, and mediastinum did not influence the thrombotic complications. Khorana score-based risk model failed to predict the occurrence of thrombotic complications in our study population. Furthermore, each parameter such as the level of hemoglobin, white blood cell and platlet count before chemotherapy, and BMI did not show a significant association with venous and arterial thrombotic complications. In fact, the number of patient more than 35 kg/m2 BMI was extremely small in our population. As a result, the International Prognostic Index was predictive for the occurrence of thrombotic complications in diffuse large B-cell lymphoma patients treated with R-CHOP. Conclusions The incidence of venous and arterial thrombotic complications in our study population was significantly associated with the IPI rather than Khorana score model. These results may help better defining lymphoma patients at high risk of thrombotic complications in Asian lymphoma patients. Disclosures: No relevant conflicts of interest to declare.
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Makatsaria, Alexander Davidovich, Svetlana Vladimirovna Akinshina, Viktoriya Omarovna Bitsadze, and Margarita Darchievna Andreeva. "Severe obstetric complications as a manifestation of thrombotic microangiopathy." Journal of obstetrics and women's diseases 64, no. 5 (December 15, 2015): 6–15. http://dx.doi.org/10.17816/jowd6456-15.
Анотація:
Thrombotic microangiopathy is one of the most serious thrombotic complications characterized by microvascular thrombosis in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy has incorporated several nosology, which are characterized by different mechanisms of microvascular thrombosis. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), heparin-induced thrombocytopenia, HELLP-syndrome. Pregnancy presents one of the key triggers to the development of thrombotic microangiopathy. This fact gives us a significant opportunity to study the pathogenesis of thrombotic microangiopathy in the context of the physiological changes of hemostasis during pregnancy. At the same time the discovery of molecular mechanisms of thrombotic microangiopathy allows for a new research on the field of pathogenesis of thrombotic complications associated with pregnancy, as well as the pathogenesis of so-called placental obstetric complications, including severe preeclampsia, premature detachment of normally situated placenta, septic shock.
3
Ogurkova, O. N., M. A. Dragunova, T. E. Suslova, Yu G. Lugacheva, and R. E. Batalov. "Evaluation of the CD40 receptor-ligand system in the patients with atrial fibrillation of non-valvular genesis." Medical Immunology (Russia) 24, no. 6 (December 8, 2022): 1255–64. http://dx.doi.org/10.15789/1563-0625-eot-2532.
Анотація:
Thromboembolic syndrome is the most dangerous complication of atrial fibrillation which develops in about 8-15% of cases, thus presuming the role of persisting left-heart thrombosis in presence of anticoagulant therapy in some patients. When activated, the blood platelets express multiple copies of CD40L on their membrane. Hence, the soluble form of CD40 ligand is considered a marker of platelet activation and pathogenic processes associated with increased activity of the thrombotic system. Our aim was to study the content of CD40, soluble CD40 ligand and thrombomodulin in the patients with atrial fibrillation of non-valvular genesis receiving anticoagulant therapy, discerning those with a history of thrombotic complications, and the cases with atrial fibrillation, however, free of thrombotic complications. The study group included 22 healthy volunteers and 60 patients diagnosed with atrial fibrillation who received anticoagulant therapy, of whom 21 patients have developed thrombotic complications in the course of adequate anticoagulant therapy. Quantitative assays of CD40, soluble CD40 ligand and soluble thrombomodulin were performed by enzyme immunoassay using Core Facility “Medical Genomics”, Tomsk National Research Medical Center. Concentration of soluble CD40 ligand in both groups of the patients with atrial fibrillation significantly exceeded appropriate values in the group of healthy volunteers. CD40L content was increased in the group of patients with thrombotic complications against the group of patients without thrombotic complications. Thrombomodulin content in blood serum was decreased in the patients with thrombotic complications, as compared to both thrombosis-free patients, and to practically healthy volunteers. The study of CD40/CD40L system and thrombomodulin showed that the patients with thrombotic complications exhibited higher serum level of soluble CD40L, with a simultaneous decrease of thrombomodulin, a physiological anticoagulant. A comparative analysis of the CD40/sCD40L system showed increased concentrations of the biomarkers in females, when compared to males.
4
Haman, Luděk, Petr Pařízek, Radovan Malý, Jiří Duda, and Jaroslav Malý. "Analysis of Thrombotic Complications After Catheter Ablation." Acta Medica (Hradec Kralove, Czech Republic) 49, no. 1 (2006): 47–50. http://dx.doi.org/10.14712/18059694.2017.109.
Анотація:
Introduction: Thromboembolic complications are described in about 1% of the patients undergoing radiofrequency catheter ablation (RFA). The aim of this study was to analyze thrombotic complications after RFA and to determine prothrombotic states in patients with thrombotic complications. Methods: We analyzed data from 400 patients (212 females) who underwent 453 RFA procedures for supraventricular tachycardias. Transthoracic echocardiography was performed one day before and after RFA in all patients. We evaluated the clinical and laboratory (in patients with thrombotic complications after RFA) risk factors of thromboembolism. Results: We observed thrombotic complication in 7 (1.75%) patients (6 females), thrice flail thrombus in the right atrium, flail thrombus in the inferior vena cava, femoral vein thrombosis with massive pulmonary embolism, femoral vein mural thrombus and upper extremity digital arteries embolization; four of them were asymptomatic. As a prothrombotic state we identified factor V Leiden mutation in one case and the use of oral contraceptives in two cases. Two other patients had a positive history of thromboembolic events. In a subgroup of females the use of oral contraceptives (p=0.13) or a positive history of thromboembolism (p=0.21) were not identified as important risk factors. Conclusion: Echocardiographic detection of asymptomatic thrombotic complications contributed to the higher percentage of these complications in our study. Although we can identify the risk factor (laboratory or clinical) in a majority of patients with a thromboembolic complication, occurrence of these complications is unpredictable.
5
Jenner, William J., Rahim Kanji, Saeed Mirsadraee, Ying X. Gue, Susanna Price, Sanjay Prasad, and Diana A. Gorog. "Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review." Journal of Thrombosis and Thrombolysis 51, no. 3 (February 14, 2021): 595–607. http://dx.doi.org/10.1007/s11239-021-02394-7.
Анотація:
AbstractA prothrombotic state is reported with severe COVID-19 infection, which can manifest in venous and arterial thrombotic events. Coagulopathy is reflective of more severe disease and anticoagulant thromboprophylaxis is recommended in hospitalized patients. However, the prevalence of thrombosis on the intensive care unit (ICU) remains unclear, including whether this is sufficiently addressed by conventional anticoagulant thromboprophylaxis. We aimed to identify the rate of thrombotic complications in ICU-treated patients with COVID-19, to inform recommendations for diagnosis and management. A systematic review was conducted to assess the incidence of thrombotic complications in ICU-treated patients with COVID-19. Observational studies and registries reporting thrombotic complications in ICU-treated patients were included. Information extracted included patient demographics, use of thromboprophylaxis or anticoagulation, method of identifying thrombotic complications, and reported patient outcomes. In 28 studies including 2928 patients, thrombotic complications occurred in 34% of ICU-managed patients, with deep venous thrombosis reported in 16.1% and pulmonary embolism in 12.6% of patients, despite anticoagulant thromboprophylaxis, and were associated with high mortality. Studies adopting systematic screening for venous thrombosis with Duplex ultrasound reported a significantly higher incidence of venous thrombosis compared to those relying on clinical suspicion (56.3% vs. 11.0%, p < 0.001). Despite thromboprophylaxis, there is a very high incidence of thrombotic complications in patients with COVID-19 on the ICU. Systematic screening identifies many thrombotic complications that would be missed by relying on clinical suspicion and should be employed, with consideration given to increased dose anticoagulant thromboprophylaxis, whilst awaiting results of prospective trials of anticoagulation in this cohort.
6
Sousa Nanji, Liliana, André Torres Cardoso, João Costa, and António Vaz-Carneiro. "Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783." Acta Médica Portuguesa 28, no. 1 (February 27, 2015): 12. http://dx.doi.org/10.20344/amp.6286.
Анотація:
<p>The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation <em>versus </em>anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.</p><p><strong>Keywords:</strong> Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.</p>
7
Capecchi, Marco, Alessandro Ciavarella, Andrea Artoni, Maria Abbattista, and Ida Martinelli. "Thrombotic Complications in Patients with Immune-Mediated Hemolysis." Journal of Clinical Medicine 10, no. 8 (April 18, 2021): 1764. http://dx.doi.org/10.3390/jcm10081764.
Анотація:
Autoimmune hemolytic anemias are rare and heterogeneous disorders characterized by hemolysis, which is a well-recognized risk factor for thrombosis. The most common immune-mediated anemias are represented by autoimmune hemolytic anemia and paroxysmal nocturnal hemoglobinuria, both associated with a high rate of thrombosis. Multiple pathophysiological mechanisms for thrombosis have been proposed, involving hemolysis itself and additional effects of the immune system. Despite the increasing awareness of the thrombotic risk in these conditions, evidence-based guidance on prevention and management of thrombotic events is lacking. We herein report available evidence on epidemiological data on thrombosis and thrombophilia in immune-mediated hemolysis, together with possible underlying pathophysiological mechanisms. In addition, we summarize current recommendations for treatment of thrombosis in immune-mediated hemolysis. In particular, we address the issue of thrombotic complications treatment and prophylaxis by proposing a therapeutic algorithm, focusing on specific situations such as splenectomy and pregnancy.
8
McFadyen, James D., Hannah Stevens, and Karlheinz Peter. "The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications." Circulation Research 127, no. 4 (July 31, 2020): 571–87. http://dx.doi.org/10.1161/circresaha.120.317447.
Анотація:
The recent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the ensuing global pandemic has presented a health emergency of unprecedented magnitude. Recent clinical data has highlighted that coronavirus disease 2019 (COVID-19) is associated with a significant risk of thrombotic complications ranging from microvascular thrombosis, venous thromboembolic disease, and stroke. Importantly, thrombotic complications are markers of severe COVID-19 and are associated with multiorgan failure and increased mortality. The evidence to date supports the concept that the thrombotic manifestations of severe COVID-19 are due to the ability of SARS-CoV-2 to invade endothelial cells via ACE-2 (angiotensin-converting enzyme 2), which is expressed on the endothelial cell surface. However, in patients with COVID-19 the subsequent endothelial inflammation, complement activation, thrombin generation, platelet, and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, ultimately causing (micro)thrombotic complications, such as deep vein thrombosis, pulmonary embolism, and stroke. Accordingly, the activation of coagulation (eg, as measured with plasma D-dimer) and thrombocytopenia have emerged as prognostic markers in COVID-19. Given thrombotic complications are central determinants of the high mortality rate in COVID-19, strategies to prevent thrombosis are of critical importance. Several antithrombotic drugs have been proposed as potential therapies to prevent COVID-19-associated thrombosis, including heparin, FXII inhibitors, fibrinolytic drugs, nafamostat, and dipyridamole, many of which also possess pleiotropic anti-inflammatory or antiviral effects. The growing awareness and mechanistic understanding of the prothrombotic state of COVID-19 patients are driving efforts to more stringent diagnostic screening for thrombotic complications and to the early institution of antithrombotic drugs, for both the prevention and therapy of thrombotic complications. The shifting paradigm of diagnostic and treatment strategies holds significant promise to reduce the burden of thrombotic complications and ultimately improve the prognosis for patients with COVID-19.
9
Routledge, David JM, Joanna Tomlins, Adrian Bloor, Kaz Mamat, Michael Dennis, Jim Cavet, Tim Somervaille, Sven Armin Sommerfeld, and Samar Kulkarni. "Incidence of Thrombotic Complications with Use of Peg-Asparginase in Treatment for Acute Lymphoblastic Leukemia (ALL) in Adults and Young Adolescent Patients." Blood 126, no. 23 (December 3, 2015): 4864. http://dx.doi.org/10.1182/blood.v126.23.4864.4864.
Анотація:
Abstract Introduction: Peg-Asparginase is routinely used in the chemotherapy regimens used for treatment of ALL. Incidence of thrombotic complications is well established in children but there is limited data in adult and young adolescent patients. This is retrospective analysis to assess the risk of thrombotic complications with use of Peg-Asparginase. Methods and Results: 100 patients with Acute Lymphoblastic Leukaemia treated between 2007-2015 who received Peg-Asparginase containing chemotherapy regimen were evaluated for development of thrombotic complications and pancreatitis. There were 69 male patients and 31 female patients. Median age was 29 yr. (range: 16-68 yr). Route of administration for Peg-Asparginase was intravenous in 51 cases and intramuscular in 49 cases. Peg-Aspraginase was administered during induction phase and consolidation cycles according to the relevant chemotherapy protocols. The adverse events included deep vein thrombosis (DVT) in 15 (15%), cerebral venous thrombosis in 7 (7%), Pancreatitis in 2 (2%), DVT and pancreatitis in 1 (1%) and 1 patient had clinically suspected DVT (1%). Complication rate was similar with IV or IM route of administration. 10 patients in IM group (20.4%) and 17 patients in IV group (33.3%) had at least one complication with Peg-Asparginase (P=0.31). Risk of individual complications was similar in both groups (DVT: 14.3% vs. 21.6%, p=0.34; Pancreatitis 2% vs. 3.9%, p=0.57; Cerebral venous thrombosis 4%% vs. 9.8%, p=0.25). There was no difference in the incidence of thrombotic complications with gender, age at diagnosis and use of central venous lines. Conclusions: There is a significant risk of thrombotic events including PE (18% risk of thrombotic events excluding CNS). Risk of CNS events is 7% in this population. Risk appears to be higher with IV administration but this is not statistically significant due to small sample size. Incidence of CNS events is similar to that reported in adolescents participating in UKALL2003 study. The analysis will be extended to evaluate other toxicities especially hepatic toxicity and identify if there are any high risk patients for CNS or thrombotic events including blood counts, clotting, and cytogenetics. Use of LMWH prophylaxis seems reasonable in view of high incidence of thrombotic events even if CNS events are excluded. Disclosures Cavet: Celgene: Consultancy, Research Funding, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau. Somervaille:Novartis Pharmaceuticals Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees.
10
Borota, A. V., A. A. Borota, and E. V. Onishchenko. "Thrombotic Complications in Inflammatory Bowel Disease." Russian Journal of Gastroenterology, Hepatology, Coloproctology 29, no. 2 (May 16, 2019): 23–26. http://dx.doi.org/10.22416/1382-4376-2019-29-2-23-26.
Анотація:
The risk of thrombotic complications is known to be 3 times higher in patients with inflammatory bowel disease (IBD) than in healthy individuals, with the relative risk being 15 times higher during the periods of relapses. Aim. To study and generalize literature data available on the prevention and treatment of IBD thrombotic complications.Key findings. In the сonditions under study, the presence of chronic inflammation and increased bleeding of the intestinal wall is shown to activate the coagulation system, impair the fibrinolysis system and reduce the activity of natural anticoagulation mechanisms. The concentration of fibrinogen — a protein of the acute inflammation phase — increases significantly. This results in an imbalance of the blood coagulation system with a tendency to hypercoagulation, which significantly increases the risk of thrombotic complications and the disseminated intravascular coagulation syndrome. In turn, the activation of the coagulation cascade may trigger the inflammatory response, which eventually leads to the formation of a vicious circle between chronic inflammation and thrombosis. The pathogenesis of thrombosis in inflammatory colon diseases is a multifactor process, which remains to be understood.Conclusion.The management of patients with IBD in combination with thromboembolic complications requires an individual multidisciplinary approach. Taking into account the pathogenetic factors, the following options are possible in the prevention and treatment of thrombotic complications in IBD: strengthening the basic therapy of the primary disease; administration of prophylactic doses of anticoagulants under dynamic continuous laboratory control in the acute period using the methods of conservative therapy of thrombotic complications (elastic compression of the lower extremities) in the period of exacerbation of the primary disease.
Дисертації з теми "Thrombotic complications":
1
Tardy-Poncet, Brigitte. "Potential roles of TFPI in both thrombotic and hemorrhagic diseases." Thesis, Saint-Etienne, 2012. http://www.theses.fr/2012STET007T/document.
Анотація:
L'inhibiteur de la Voie du Facteur Tissulaire (TFPI) est une protéine régulatrice de la coagulation plasmatique intervenant à la phase initiale de la cascade. Il inhibe en présence de la protéine S (PS) le facteur Xa et ce complexe TFPI-Xa inactive ensuite le complexe FT-VIIa. Nous avons recherché une résistance à l'activité anticoagulante du TFPI. La sensibilité du plasma à une quantité fixe de TFPI a été évaluée sur la base d'un temps de thromboplastine diluée (TTD) réalisé avec et sans TFPI : - chez des patients ayant présenté une thrombose veineuse profonde inexpliquée ; cette résistance suspectée sur une 1ère étude n'a pas été confirmée sur la 2ème. - chez des patientes enceintes ; une résistance au TFPI acquise a été montrée et rapportée au déficit acquis en PS ; cependant le degré de résistance au TFPI ne peut pas être utilisé comme marqueur de risque de pathologie vasculaire placentaire. Chez des patients obèses l'effet inhibiteur des taux élevés de Lp(a) sur l'activité TFPI décrit in vitro n'a pas été retrouvé in vivo pas plus que l'effet de l'aspirine sur la normalisation des taux de Lp(a). Le TFPI joue un rôle dans les manifestations hémorragiques des hémophiles. Nous avons montré que les hémophiles B ont comparativement aux A des taux moindres de TFPI ce qui pourrait expliquer leur différence en terme de manifestations hémorragiques. Les taux de TFPI libre sont bien corrélés aux paramètres de la génération de thrombine surtout au temps de latence. En présence d’un anti TFPI humain la génération de thrombine est corrigée chez l'hémophile. Cette correction dépend de la concentration d'anti TFPI, est saturable et doit être étudiée sur du plasma riche en plaquettesTFPI is a multivalent Kunitz-type proteinase inhibitor that directly inhibits FXa and produces FXa-dependent feedback inhibition of the FVIIa–TF complex. It was recently demonstrated that Protein S (PS) plays the role of TFPI cofactor by enhancing the TFPI inhibition of factor Xa in vivo. Approximately 80% of plasma TFPI circulates as a complex with plasma lipoproteins, about 5–20% circulating as free TFPI. Under quiescent conditions, approximately 50–80% of intravascular TFPI is stored in association with the endothelium. Full-length TFPI α carried in platelets constitutes 8-10% of the total amount of TFPI in the blood, corresponding to a quantity comparable to that of soluble full-length TFPI α in the plasma. We searched for resistance to TFPI activity in patients who presented idiopathic venous thrombosis at a young age. Plasma sensitivity to TFPI was evaluated on the basis of diluted prothrombin time (dPT) measured in patients and in control plasma in the presence (W) and absence (Wo) of exogenous TFPI. At the same time, dPT was measured on a reference plasma to establish a normalized ratio termed TFPI NR and defined as (dPT wTFPI/ dPT Wo TFPI) patient or control / (dPT wTFPI/ dPT Wo TFPI) reference plasma. In an initial study, we found that TFPI resistance could be considered as a new coagulation abnormality that could be related to unexplained thrombosis. In a second study, we failed to demonstrate a role of TFPI resistance in patients with venous thrombosis, abnormal TFPI NR being more likely related to the non-respect of preanalytical conditions rather than to an inherited trait. However, in another study, we showed that inherited or acquired PS deficiency was responsible for a TFPI resistance, providing an ex vivo demonstration that PS is the cofactor of TFPI activity. We showed that this TFPI resistance existed throughout pregnancy and that it disappeared when PS returned to normal values after delivery. We evaluated this TFPI resistance as a possible marker of the risk of a gestational vascular complication (GVC) in 72 patients at risk of developing a GVC. TFPI NR did not differ between GVC+ patients (n =15) and GVC– patients (n = 57). High levels of Lipoprotein(a) (Lp(a) have been shown to be an independent risk factor for cardiovascular disease, lowering of these levels not being achievable by any treatment except possibly aspirin. An in vitro study showed that TFPI activity could be inhibited by Lp(a). We did not confirm this TFPI inhibition in vivo in 20 obese patients with coronary insufficiency who had either normal Lp(a) levels (≤ 0.3 g/L; n = 15) or high Lp(a) levels (≥ 0.3 g/L; n = 5) . Moreover, we found no effect of aspirin treatment on Lp(a) whatever the initial level of Lp(a). Haemophilia B patients bleed less than haemophilia A patients. We showed that this difference in bleeding profile could be explained by lower free TFPI levels in haemophilia B patients compared to haemophilia A patients. In an ongoing study, we showed that in haemophilia A patients there was a strong correlation between the different parameters of thrombin generation (TG) and free TFPI. We also showed, in a TG assay performed in platelet-rich plasma (PRP) with a low TF concentration, that LT was sensitive to free TFPI levels whatever the type of haemophilia and whatever theseverity of the disease. We demonstrated that blocking TFPI by an anti-TFPI Antibody (Ab) allows complete correction of the TG profile in PRP. We showed that it is of major importance to perform a TG assay in PRP in order to evaluate the efficacy of anti-TFPI Ab in correcting TG parameters in haemophilia patients
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
Lapidus, Lasse. "Thromboembolism following orthopaedic surgery : outcome and diagnostic procedures after prophylaxis in lower limb injuries /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-111-1/.
4
Smith, Sarah Faith. "Influences on the incidence of clinical deep vein thrombosis and pulmonary embolism in a prospectively collated population of 21,000 neurosurgical inpatients." Thesis, The University of Sydney, 2001. http://hdl.handle.net/2123/818.
Анотація:
Records of all neurosurgical inpatients admitted to Royal North Shore Hospital since 1976 have been prospectively kept in a relational database. Demographic details, diagnoses, operations and complications have been entered continuously since 1982 by the author of this study. Complications are monitored at monthly review meetings attended by medical staff. The recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) at these meetings, despite continual improvements in patient care, prompted this study. It aims to use the database to study changes in the incidence of DVT and PE over the previous twenty years; to find what database variables predict these complications; and whether use of mechanical and pharmacological agents has had an impact on DVT and PE rate. Univariate analysis of the incidence of DVT and PE by age, sex, length of stay (LOS), admission month, diagnosis, operation and surgeon over time was run. Any significant variables were then analysed by multivariate logistic regression. The DVT rate was low by world standards, but rose from 0.6% in 1979-83 to 1.2% in 1984-88, then rose exponentially to 3.60% in 1994-98 with a significantly increasing trend over the twenty years (c2 MH =114.20, with IDF, P<0.001). PE rate doubled significantly over the twenty years from 0.6% to 1.2% (c2 MH =17.94 with 1DF, P<0.001). Age, LOS, diagnosis, operation and surgeon were significant predictors of DVT and PE. After adjustment for LOS, time period and age, vascular surgery was found to be the strongest predictor of DVT (OR=2.82, 95% CI: 2.08-3.82, c2 =43.91, P<0.01). Vascular diagnosis was the strongest diagnosis predictor. No effect of sex or month of admission was shown. After adjustment for LOS, time period and age, spinal fusion was the strongest predictor of PE (OR=4.04, 95% CI: 1.81-9.03). Anterior communicating artery aneurysm was the diagnosis most highly associated with PE. The rise in DVT rate may be due to increased complexity of surgical and nursing management, and some screening of patients with the introduction of duplex scanning. The doubling of PE rate is unexplained. The risk of brain or spinal cord haemorrhage makes prophylactic anticoagulation a difficult choice. This study reveals groupings which can be used to determine appropriate prophylaxis. Use of mechanical and pharmaceutical agents is not recorded consistently in the database, but it is known approximately when they were introduced. No impact on the rate of DVT and PE can be demonstrated by these agents. More vigilant and widespread use of mechanical prophylaxis might be just as effective in controlling DVT and PE.
5
Smith, Sarah Faith. "Influences on the incidence of clinical deep vein thrombosis and pulmonary embolism in a prospectively collated population of 21,000 neurosurgical inpatients." University of Sydney. Public Health and Community Medicine, 2001. http://hdl.handle.net/2123/818.
Анотація:
Records of all neurosurgical inpatients admitted to Royal North Shore Hospital since 1976 have been prospectively kept in a relational database. Demographic details, diagnoses, operations and complications have been entered continuously since 1982 by the author of this study. Complications are monitored at monthly review meetings attended by medical staff. The recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) at these meetings, despite continual improvements in patient care, prompted this study. It aims to use the database to study changes in the incidence of DVT and PE over the previous twenty years; to find what database variables predict these complications; and whether use of mechanical and pharmacological agents has had an impact on DVT and PE rate. Univariate analysis of the incidence of DVT and PE by age, sex, length of stay (LOS), admission month, diagnosis, operation and surgeon over time was run. Any significant variables were then analysed by multivariate logistic regression. The DVT rate was low by world standards, but rose from 0.6% in 1979-83 to 1.2% in 1984-88, then rose exponentially to 3.60% in 1994-98 with a significantly increasing trend over the twenty years (c2 MH =114.20, with IDF, P<0.001). PE rate doubled significantly over the twenty years from 0.6% to 1.2% (c2 MH =17.94 with 1DF, P<0.001). Age, LOS, diagnosis, operation and surgeon were significant predictors of DVT and PE. After adjustment for LOS, time period and age, vascular surgery was found to be the strongest predictor of DVT (OR=2.82, 95% CI: 2.08-3.82, c2 =43.91, P<0.01). Vascular diagnosis was the strongest diagnosis predictor. No effect of sex or month of admission was shown. After adjustment for LOS, time period and age, spinal fusion was the strongest predictor of PE (OR=4.04, 95% CI: 1.81-9.03). Anterior communicating artery aneurysm was the diagnosis most highly associated with PE. The rise in DVT rate may be due to increased complexity of surgical and nursing management, and some screening of patients with the introduction of duplex scanning. The doubling of PE rate is unexplained. The risk of brain or spinal cord haemorrhage makes prophylactic anticoagulation a difficult choice. This study reveals groupings which can be used to determine appropriate prophylaxis. Use of mechanical and pharmaceutical agents is not recorded consistently in the database, but it is known approximately when they were introduced. No impact on the rate of DVT and PE can be demonstrated by these agents. More vigilant and widespread use of mechanical prophylaxis might be just as effective in controlling DVT and PE.
6
Ziaziaris, William Andrew. "Pediatric Liver Transplantation: Improvement in Outcomes." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16265.
Анотація:
Introduction and Aims Although relatively uncommon in children, end-stage liver failure is a potentially devastating condition that occurs secondary to either a congenital anomaly causing cholestasis, metabolic disease (MTBD), neoplasia or fulminant hepatic failure (FHF). When this occurs, patients will likely require liver transplantation (LT). LT remains the gold-standard for children with end-stage liver failure despite high morbidity and mortality associated with the complex pathophysiology of liver failure, the procedure itself and subsequent lifelong immunosuppression. Surgical complications, often grouped as either general and gastrointestinal (GI), vascular or biliary complications are commonly seen in these patients and can impact on patient morbidity, mortality and graft survival. However, new immunosuppressants, surgical techniques such as in-situ split liver grafts, delayed primary closure (DPC) and microsurgery, as well as better post-operative care involving routine anti-coagulation protocols have improved outcomes significantly. The aim of this work was to assess the impact of new surgical techniques on the incidence of complications following pediatric LT at a single tertiary liver transplant center. Materials and Methods To address these aims, this thesis includes two studies. In the first study, we assessed the impact of DPC and the risk of general and GI surgical complications. We retrospectively collected data on children under the age of 18 who underwent LT between April 1986 and May 2014. The primary outcome measured was the incidence of general and GI complications either in the early (<3 months), intermediate (3 months–1 year) or late (>1 year) post-transplant period. The second study explored the impact of split grafts, microsurgical anastomosis and routine anti-coagulation on incidence of hepatic artery thrombosis (HAT). We did this by assessing the incidence of HAT in three distinct eras between April 1986 and April 2016, which marked the introduction of microsurgical anastomosis (Era 2) and in addition, a routine anti-coagulation protocol (Era 3). The major outcome measured was incidence and management of HAT in each of the three eras. Research ethics approval was obtained from the Sydney Children’s Hospital Network Ethics Committee. Results In our first study, a positive association was found between biliary atresia (BA) patients and the incidence of bowel perforation post-LT. We confirmed that DPC with or without the use of prosthetic implants was safe and did not increase the rate of general and GI complications. The second study found that the introduction of a routine anti-coagulation protocol significantly reduced incidence of HAT independent of the introduction of microvascular anastomotic techniques. A secondary finding was that minor bleeding (not requiring operative intervention) was more common Era 3. In both studies, the use of split liver grafts was not associated with an increase in surgical complications. Conclusions Recent advances in pediatric LT are safe and in some cases have been beneficial in reducing the incidence of post-operative complications. The advent of split graft LT has decreased the organ wait time and is a safe alternative to whole or reduced grafts. DPC provides a means of difficult abdominal closure and does not increase the risk of general and GI complications. The introduction of microvascular techniques for vessel anastomosis and a routine anticoagulation protocol have been efficacious, with the later significantly reducing the incidence of HAT.
7
Matielo, Marcelo Fernando. "Incidência de trombose venosa profunda pós-operatória no membro amputado de pacientes com doença arterial oclusiva periférica." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5132/tde-29012009-165529/.
Анотація:
Introdução: Pacientes submetidos à amputação de membro inferior por doença arterial obstrutiva periférica (DAOP) estão em risco para o desenvolvimento de trombose venosa profunda (TVP). Há poucos estudos na literatura sobre a incidência no pós-operatório precoce e quanto aos fatores de risco no desenvolvimento da TVP no membro amputado. Objetivo: A finalidade deste estudo é avaliar, de modo prospectivo, a incidência de trombose venosa profunda pós-operatória em até 35 dias, em pacientes submetidos à amputação de membro inferior por doença arterial obstrutiva periférica, sua relação com comorbidades e com óbito. Método: De setembro de 2004 a março de 2006, foram estudados 56 pacientes (29 homens; média de idade 67,25 anos) submetidos a 62 amputações (36 transtibiais e 26 transfemorais), utilizando-se eco-Doppler no pré-operatório e aproximadamente no 7º e 31° dia de pós-operatório. Resultado: Houve TVP em 16 (25,8%) membros amputados, sendo 10 casos em amputações transfemorais e 6 casos em transtibiais. A incidência cumulativa no período até 35 dias foi de 28% (Kaplan-Meier). Houve diferença significativa na incidência de TVP entre amputações transfemorais (37,5%) e transtibiais (21,2%), p = 0,04. Outro fator de risco para TVP foi idade igual ou superior a 70 anos (48,9 vs 16,8%, p=0,021). Houve 01 caso de embolia pulmonar sintomática não fatal em paciente com TVP já diagnosticada. Não houve relação entre outras comorbidades e TVP. A trombose venosa no membro amputado não influenciou na taxa de óbito que foi de 9,7%. Conclusões: A incidência de TVP no pós-operatório recente (até 35 dias) foi elevada principalmente em pacientes com idade igual e superior a 70 anos e nas amputações transfemorais. Os pacientes com DAOP submetidos a grandes amputações devem ser considerados de alto risco para TVP, mesmo após alta hospitalar.Introduction: Patients undergoing amputation of the lower limb due to Peripheral Arterial Disease (PAD) are at risk for developing Deep Venous Thrombosis (DVT). There are few studies in the research literature on the incidence of DVT during the early postoperative period and the risk factors for the development of DVT in the amputation stump. Objective: The goal of this prospective study was to evaluate the incidence of deep venous thrombosis during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD, and its relation to comorbidities and death. Method: From September 2004 to March 2006, fifty-six patients (29 men, mean age 67.25 years) underwent 62 amputations (36 below knee amputation BKA and 26 above knee amputation- AKA), and echo- Doppler scanning on preoperative, and approximately the seventh and 31st postoperative days. Results: DVT occurred in 16 (25.8%) of the amputated extremities, (10 AKA and 06 BKA). The cumulative incidence in the 35 day postoperative period was 28% (Kaplan-Meier). There was a significant difference in the incidence of DVT between AKA (37.5%) and BKA (21.2%), p = .04. Another DVT risk factor was age equal to or above 70 years (48.9 vs. 16.8%, p= .021). There was one case of symptomatic non-fatal pulmonary embolism in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. Venous Thrombosis in the amputation stump did not influence the mortality rate which was 9.7%. Conclusions: The incidence of DVT in the early post-operative period (up to 35 days) was elevated mainly in patients 70 years of age or older and in AKA. Patients with PAD who have recently undergone major amputations should be considered at high risk for DVT, even after hospital discharge.
8
Oliveira, Samantha Carlos de. "Trombocitopenia induzida por heparina: aspectos clínicos e laboratoriais." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5146/tde-04112008-155406/.
Анотація:
A trombocitopenia induzida por heparina (TIH) é uma síndrome imunohematológica mediada por um anticorpo que causa ativação plaquetária na presença de heparina, induz à agregação plaquetária e pode estar associada a graves e paradoxais complicações trombóticas e morte. A freqüência de TIH nos pacientes que recebem heparina por mais de cinco dias é de 1% a 5%, e está relacionada a vários fatores. Este é um estudo pioneiro no Brasil, que objetivou avaliar aqui a freqüência de TIH nos pacientes em uso de heparina, a relação ao gênero, ao tipo de heparina e a associação do genótipo da FcRIIa de receptores plaquetários. Foram selecionados 278 pacientes das Unidades de Terapia Intensiva e Unidades Coronariana do InCor-HCFMUSP, que receberam anticoagulação por heparina não fracionada (HNF) e/ou heparina de baixo peso molecular (HBPM), por pelo menos 5 dias, e excluídas as possíveis causas conhecidas de trombocitopenia. Foi realizada a contagem plaquetária pré e pós terapia com heparina, e o teste de detecção do anticorpo anti-fator 4 plaquetário/heparina (ID-PaGIA, DiaMed; e Asserachrom®-HPIA, Stago). O estudo da genotipagem da FcRIIa de receptores plaquetários foi realizado pelo método de digestão com enzima de restrição alelo específica. A freqüência de TIH encontrada foi de 6 (2,2%), e a freqüência de trombocitopenia com a presença do anticorpo anti-fator 4 plaquetário foi de 24,3%. A análise do gênero do paciente não demonstrou correlação com a TIH, nem com a trombocitopenia e nem com o anticorpo anti-fator 4 plaquetário. As mulheres apresentaram mais trombose do que os homens. A trombocitopenia ocorreu com maior freqüência nos pacientes que utilizaram os dois tipos de heparina (HNF-HBPM) e, com menor freqüência, nos que utilizaram apenas HBPM. O genótipo da FcRIIa de receptores plaquetários não apresentou relação com o gênero, nem com a TIH. Este estudo determinou a freqüência de TIH em uma população brasileira com uso de heparina e auxiliou no diagnostico. O melhor teste para detectar o anticorpo anti-fator 4 plaquetário/heparina, na presença de trombocitopenia e trombose, foi o teste de imunoaglutinação ID-PaGIA (DiaMed). A utilização dos dois tipos de heparina promoveu uma maior freqüência de trombocitopenia. Porém, novos estudos precisam confirmar as relações entre o tipo de heparina, com a trombocitopenia e com a TIHHeparin induced thrombocytopenia (HIT) is an immune-hematologic syndrome mediated by a heparin dependent antibody that causes platelet activation, platelet aggregation, and can be associated with thrombosis and death. HIT occurs in about 1-5% of patients receiving heparin therapy up to 5 days or more. Many factors influence on the frequency of HIT. This is a pioneer Brazilian study to determine the frequency of HIT on patients under heparin therapy, and the relationship of HIT with gender, heparin type and the FcRIIa platelet receptor genotype. 278 patients from the Intensive Care Unit and Cardiac Care Unit at InCor-HCFMUSP treated with Unfractionated Heparin (UFH) and/or Low Molecular Weight Heparin (LMWH) for 5 or more days were studied. Known causes of thrombocytopenia were excluded. Platelet count was monitored pre and post heparin therapy. All selected patients were tested for detection of anti-heparin/PF4 antibody (ID-PaGIA, DiaMed; and Asserachrom®-HPIA, Stago). HIT frequency found was 6 (2,2%) and the frequency of thrombocytopenia (determined by a decrease in the platelet count below 50%, after the introduction of heparin therapy) and positive anti-heparin/PF4 antibody test was 24,3%. Patients gender was not related to TIH, neither to thrombocytopenia nor to the presence of antiheparin/ PF4 antibody. Thrombosis events were more frequent in women than in men. Thrombocytopenia, related to the type of heparin, was more frequent in patients that had used both types of heparin and less frequent in those that used only LMWH. FcRIIa platelet receptor genotype was associated with neither HIT nor with gender. This study has provided the frequency of HIT in a Brazilian patient population under heparin therapy and auxiliary in the HIT diagnosis. The ID-PaGIA (DiaMed) was shown to be the best test to correlate the presence of anti-heparin/PF4 antibody to thrombocytopenia and thrombosis event. The use of both heparin types promotes more thrombocytopenia. New studies are needed to confirm the relationship between heparin type and thrombocytopenia with HIT
9
Nilsson, Elin, and Linnéa Oskarsson. "Graderade kompressionsstrumpors preventiva effekt för djup ventrombos och posttrombotiskt syndrom." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-408302.
Анотація:
Bakgrund: Djup ventrombos (DVT) är en allvarlig komplikation postoperativt och kan leda till ett livshotande tillstånd för patienten. Graderade kompressionsstrumpor (GCS) används på många postoperativa avdelningar tillsammans med andra profylaktiska åtgärder för att förebygga utvecklingen av DVT. Kompressionsstrumpor används även till att förebygga posttrombotiskt syndrom (PTS) efter en DVT. PTS kan utvecklas på grund av att de venösa klaffarna skadas vid en DVT, till följd stockar sig blodet och ödem bildas vilket leder till försämrad näring- och syretillförsel till vävnaderna. Syfte: Syftet var att genom en litteraturstudie undersöka om kompressionsstrumpor hade någon effekt för att förebygga DVT postoperativt samt om kompressionsstrumpor hade någon effekt att förebygga PTS efter en DVT. Metod: Litteraturstudie som baserads på 11 RCT studier. Resultat: GCS utan andra profylaktiska åtgärder visade sig ha en god effekt för att undvika utvecklingen av DVT på patienter som genomgått en operation. Däremot visade sig användandet av GCS i kombination med andra beprövade profylax inte ha någon större effekt för att reducera uppkomsten av DVT ytterligare. Resultatet angående GCS effekt för att undvika utvecklingen av PTS visade ingen entydighet. Slutsats: GCS har en förebyggande effekt för att undvika uppkomsten av DVT. Användningen av GCS i kombination med andra profylax potentierar däremot inte effekten av preventionen för DVT. GCS verkan för att förebygga uppkomsten av PTS är inte entydigt och flera studier behövs för att se evidens kring detta.ABSTRACT Background: Deep vein thrombosis (DVT) is a serious complication postoperatively and can lead to a life threatening condition for the patient. Graded compression stockings (GCS) are used in many post-operative departments along with other prophylactic measures to prevent the development of DVT. Compression stockings are also used to prevent postthrombotic syndrome (PTS) after a DVT. PTS can develop because the venous valves are damaged by a DVT, as a result, the blood is stored and edema is formed, which leads to poor nutritional and oxygen supply to the tissues. Aim: The aim of the literature study was to investigate whether compression stockings had any effect in preventing DVT postoperatively, and also whether the compression stockings had any effect in preventing PTS after a DVT. Method: Literature study based on 11 RCT studies. Results: GCS without other prophylactic measures was found to have a good effect in avoiding the development of DVT in patients who underwent surgery. However, the use of GCS in combination with other proven prophylaxis was found to have no significant effect in further reducing the onset of DVT. The results regarding the GCS effect to avoid the development of PTS showed no unambiguity. Conclusion: GCS has a preventive effect to avoid the onset of DVT. However, the use of GCS in combination with other prophylaxis does not potentiate the effect of prevention for DVT. The effect of GCS in preventing the onset of PTS is not unambiguous and several studies are needed to see evidence of this.
10
Galanaud, Jean-Philippe. "Les thromboses veineuses méconnues des membres inferieurs : thromboses veineuses profondes distales et thromboses veineuses superficielles." Thesis, Montpellier 1, 2011. http://www.theses.fr/2011MON1T027.
Анотація:
Rationnel: Bien qu'elles constituent la majorité des thromboses veineuses des membres inférieurs, les thromboses veineuses profondes (TVP) distale et les thromboses veineuses superficielles (TVS) ont été peu étudiées et leur significativité clinique et leur prise en charge sont débattues.Méthodes: Cette thèse collige les résultats des travaux effectués par J.P. Galanaud sur les TVP distales et les TVS à partir des études épidémiologiques OPTIMEV, POST et RIETE.Résultats commentés: TVP distale: La TVP distale n'a pas le même profil de facteur de risque que la TVP proximale. Sa mortalité associée à court terme est plus faible que celle des TVP proximales mais supérieure à celle de témoins confirmant qu'il s'agit d'une entité cliniquement significative. Les différences de profil de population et de complications entre ces deux types de TVP suggèrent que le rapport bénéfice/risque du traitement anticoagulant est différent. Il n'est donc pas légitime d'extrapoler les résultats des essais des TVP proximales aux TVP distales. Des essais spécifiques sont donc nécessaires.TVS: En cas de TVS le risque de TVP concomitante est élevé. Un examen écho-doppler doit être réalisé et devra au moins explorer l'ensemble du réseau profond du membre inférieur affecté. Sexe masculin et antécédents de TVP/Embolie pulmonaire constituent des facteurs prédictifs indépendants de récidive. Si certaines TVS peuvent être traitées avec succès sans traitement anticoagulant, celles associées à un cancer ou à une atteinte saphéno-fémorale sont à haut risque de récidive y compris après un traitement anticoagulant curatifBackground: Though they represent the majority of all lower limbs thromboses, isolated distal deep-vein thrombosis (DVT) (without symptomatic pulmonary embolism (PE)) and isolated superficial vein thrombosis (SVT) (without DVT or PE) have been poorly studied. Their clinical significance and management are under debate.Methods: Data from epidemiological multicenter prospective studies OPTIMEV, POST, RIETEResults and comments: Isolated distal DVT: Distal and proximal DVTs exhibit a different risk factor profile, the latter being more associated with chronic risk factors. Three-month mortality of distal DVT patient is lower than that of proximal DVT ones but is higher than that of controls. This evidences that distal DVT is a clinically significant finding. Differences in population profile and outcomes suggests that the benefit/risk ratio of anticoagulant treatment is not similar. Data from proximal DVT clinical trials should no longer be extrapolated to distal DVT.Isolated SVT: In case of SVT the risk of concomitant DVT is high. A compression ultrasonographic exam should be performed and at least explore the whole deep venous system of the affected limb. Male gender and history of DVT/Pulmonary embolism are independent predicators of recurrence. Some SVT can be safely treated without anticoagulants. On contrary, in patients with cancer or a sapheno-femoral junction involvement, the risk of deep venous recurrence is high even upon full therapeutic dose of anticoagulants
Книги з теми "Thrombotic complications":
1
Hans, Renck, ed. Bleeding and thrombotic disorders in the surgical patient. Norwalk, Conn: Appleton & Lange, 1988.
2
Gilles, Lugassy, ed. Thrombosis and cancer. London: Martin Dunitz, 2004.
3
Greco, Caterina F. Stent thrombosis: Epidemiology, prevention, and management. Hauppauge, N.Y: Nova Science, 2011.
4
Paidas, Michael J. Hemostasis and thrombosis in obstetrics & gynecology. Chichester, West Sussex, UK: Wiley-Blackwell, 2011.
5
International School of Medical Sciences (22nd 1983 Ettore Majorana Center for Scientific Culture). Advances in hemostasis and thrombosis. New York: Plenum Press, 1985.
6
Valentin, Fuster, and Verstraete M, eds. Thrombosis in cardiovascular disorders. Philadelphia: Saunders, 1992.
7
Bodnar, Endre, and Eric G. Butchart. Thrombosis, embolism and bleeding. London: ICR Publ., 1992.
8
Wang, Meng-Jiy. Biomaterials in blood-contacting devices: Complications and solutions. New York: Nova Science Publishers, 2010.
9
M, Verstraete, Fuster Valentin, and Topol Eric J. 1954-, eds. Cardiovascular thrombosis: Thrombocardiology and thromboneurology. 2nd ed. Philadelphia: Lippincott-Raven, 1998.
10
1958-, Greer I. A., Turpie, A. G. G. 1939-, and Forbes C. D. 1938-, eds. Haemostasis and thrombosis in obstetrics and gynaecology. London: Chapman & Hall Medical, 1992.
Частини книг з теми "Thrombotic complications":
1
Shah, Rahul, Bipin N. Savani, and Shruti Chaturvedi. "Bleeding and Thrombotic Complications." In The EBMT Handbook, 355–63. Cham: Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-44080-9_40.
Анотація:
AbstractBleeding and thrombotic complications are an important cause of morbidity and mortality in patients undergoing hematopoietic cell transplantation (HCT). The major thrombotic complications include venous thromboembolism (VTE) including catheter-related thrombosis (CRT), sinusoidal obstruction syndrome (SOS), and transplant-associated thrombotic microangiopathy (TA-TMA), while bleeding commonly involves the gastrointestinal or respiratory tracts and is most common in thrombocytopenic patients or those with graft-versus-host disease (GVHD). HCT is associated with multiple risk factors for both thrombosis and bleeding including the underlying malignancy, thrombocytopenia, high-dose myeloablative chemotherapy (MAC) and immune-modulatory drugs, GVHD, infections, indwelling vascular catheters, and prolonged immobilization (Chiu and Lazo-Langner 2023; Gerber et al. 2008; Chaturvedi et al. 2016; Nadir and Brenner 2007). In addition, HCT is also associated with alterations in the coagulation system with activation of endothelium-dependent coagulation factors, increase in von Willebrand factor (vWF) and platelet adhesion, increased thrombin generation, decreased antithrombin levels, and decreased levels of anticoagulant proteins such as protein C (Vannucchi et al. 1994). Collectively, major patient-, disease-, and therapy-related factors contribute to hemostatic complications in HCT patients. Thrombotic and bleeding complications in HCT are discussed separately in the following section.
2
Chaturvedi, Shruti, Binsah George, and Bipin N. Savani. "Bleeding and Thrombotic Complications." In The EBMT Handbook, 301–6. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-030-02278-5_40.
3
Penner, John. "Leukemia: Hemorrhagic and Thrombotic Complications." In Biology and Therapy of Acute Leukemia, 245–59. Boston, MA: Springer US, 1985. http://dx.doi.org/10.1007/978-1-4613-2609-0_17.
4
Duléry, Rémy, Martin Schmidt-Hieber, and Basil Sharrack. "Neurological Complications." In The EBMT Handbook, 481–87. Cham: Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-44080-9_53.
Анотація:
AbstractNeurological complications of allogeneic hematopoietic cell transplantation are frequent and often highly challenging to manage. These complications can stem from various causes, including neurotoxic drugs, infectious pathogens, cerebrovascular illness, metabolic encephalopathy, hematological disease relapse, immune-mediated disorders, thrombotic microangiopathy, and post-transplant lymphoproliferative disorder. While many of these complications are transient, a substantial subset is potentially fatal. Therefore, prompt diagnosis and treatment, guided by a neurologist, can be crucial in reducing the risks of irreversible complications, impairment of the quality of life, and transplantation-related mortality.
5
Triozzi, Jefferson L., and Saed Shawar. "Recurrent Thrombotic Microangiopathy in a Kidney Transplant Recipient." In Complications in Kidney Transplantation, 255–64. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-13569-9_41.
6
Srivastava, Swati, Iti Garg, Lilly Ganju, Rajeev Varshney, and Bhuvnesh Kumar. "Thrombotic Complications in Women: Risks and Prevention." In Biomedical Translational Research, 451–63. Singapore: Springer Nature Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-8845-4_22.
7
Lawrence, Peter F., Juan Carlos Jimenez, and Kellie R. Brown. "Management of thrombotic complications of endovenous ablations." In Handbook of Venous and Lymphatic Disorders, 479–84. 5th ed. Boca Raton: CRC Press, 2024. http://dx.doi.org/10.1201/9781003328971-52.
8
Rollo, Johnathon C., and Juan Carlos Jimenez. "Thrombotic Complications Following Treatment of Peripheral Varicose Veins." In Contemporary Management of Acute and Chronic Venous Disease, 96–107. Boca Raton: CRC Press, 2024. http://dx.doi.org/10.1201/9781003316626-13.
9
Wallhult, Elisabeth, Michelle Kenyon, and Barry Quinn. "Early and Acute Complications and the Principles of HSCT Nursing Care." In The European Blood and Marrow Transplantation Textbook for Nurses, 185–216. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-23394-4_10.
Анотація:
AbstractHaematopoietic stem cell transplantation (HSCT) generally includes preparative or conditioning regimens containing combinations of chemotherapy and/or radiotherapy and sometimes immunotherapy. These regimens, as well as other treatments before and after HSCT such as immunosuppressive drugs to prevent graft-versus-host disease (GvHD) (see Chap. 11), may affect the patient’s organs and tissues and cause both early and long-term complications. In the evolving field of stem cell therapies, some complications that traditionally have been regarded as early complications are now, due to changes in preparative regimens and choice of stem cell source, sometimes seen later in the post-transplant outpatient setting. The complications covered in this chapter generally occur within 100 days post-HSCT and are thus classified as early complications. Two of the most common early complications are oral complications/mucositis and sepsis. Some other relatively rare complications are also covered here: haemorrhagic cystitis (HC), endothelial damage syndromes including engraftment syndrome (ES), idiopathic pneumonia syndrome (IPS), diffuse alveolar haemorrhage (DAH), thrombotic microangiopathy (TMA) and sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). For all complications, recommendations for prevention and principles for nursing care are presented since careful nursing monitoring and prompt intervention and care may have an impact on patients’ morbidity and mortality.
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Petrolla, Amber A., Hillard M. Lazarus, and Alvin H. Schmaier. "Unique Thrombotic and Hemostatic Complications Associated with Allogeneic Hematopoietic Stem Cell Transplantation." In Allogeneic Stem Cell Transplantation, 695–715. Totowa, NJ: Humana Press, 2009. http://dx.doi.org/10.1007/978-1-59745-478-0_39.
Тези доповідей конференцій з теми "Thrombotic complications":
1
Vasil'ceva, O. YA, and K. N. Vitt. "Diabetes mellitus and thrombotic complications." In Scientific dialogue: Medical issues. ЦНК МОАН, 2019. http://dx.doi.org/10.18411/spc-15-05-2019-07.
2
Ivanov, A. A., A. I. ZHdanov, M. S. SHevelin, and A. S. Brezhnev. "Analytical assessment of thrombotic and non-thrombotic complications after surgical treatment of abdominal aortic aneurysms." In Scientific achievements of the third millennium. L-Journal, 2020. http://dx.doi.org/10.18411/scienceconf-09-2020-01.
3
Yan, Li, Rajeev Kumar Nallamothu, and Dan Rafiroiu. "Thrombotic complications of mechanical heart valves: An experimental and theoretical study." In 2013 8th International Symposium on Advanced Topics in Electrical Engineering (ATEE). IEEE, 2013. http://dx.doi.org/10.1109/atee.2013.6563435.
4
Schwartz, R., E. Kavanagh, K. Bauer, R. Rosenberg, J. Ballard, J. Latino, V. Strother, M. Mosesson, W. Haire, and M. DeLeo. "ANTITHROMBIN III CONCENTRATE (AT-III) FOR PROPHYLAXIS ANDTREATMENT OF CONGENITAL AND ACQUIREDAT-III DEFCIENCY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643678.
Анотація:
An investigation has been undertakenin 13 patient studies to determine the efficacy of AT-III in prevention and treatment of thrombosis in patients with congenital (cong.) and acquired (acq.) AT-III deficiency. The mean in vivo incremental recovery of 17 infusions of AT-III in 7 patientswith cong. AT-III deficiency (2 kinetic studies, 5 prophylaxis) was 1.4%/U/kg (functional assay) administered. The mean in vivo recovery of 38 infusions in 4 non-bleeding patients(3 cong., 1 acq.) treated for thrombosis or pulmonary embolism (P.E.) with heparin was 1.33%/U/kg which was not significantly different. The half-life determined in an earlier study exceeded 2.5 days. All patients treated prophylactically or therapeutically received a loading dose to increase plasma AT-III to 120%, and then received maintenance doses, generally every 24 hours, to maintain plasma AT-III levels in the general range 80-120%. AT-III levels were monitored every 12 hours initially and doses and intervals modified accordingly. None of 5 patients with cong. deficiency treated prophylactically for high risk situations (surgery, delivery, catheterization) developed a thrombotic complication. Six patients (3 cong., 2 acq., 1 probably acq.) were treated for thrombosis/P.E., two of whom were pregnant. Heparin resistance was reversed in two, both pregnant. One patient with superior mesenteric-portal vein thrombosis (cong. deficiency) and another with superior mesenteric artery-aortic occlusion (acq. deficiency) survived without further progression of thrombosis. DIC resolved in one patient treated with AT-III and benefit was observed in a 2nd patient as well. AT-III was well tolerated, with but a single mild reaction in 176 infusions. We conclude AT-III may be beneficialas prophylaxis in patients with cong.AT-III deficiency during high thrombotic risk situations, as well as anadjunct to heparin in treatment for thrombotic complications in congenital and acquired AT-III deficiency.
5
Ivanov, A. A., A. I. ZHdanov, M. S. SHevelin, and A. S. Brezhnev. "Optimized postoperative prevention program thrombotic complications during intervention for abdominal aneurysm aortic department." In General question of world science. "Science of Russia", 2020. http://dx.doi.org/10.18411/gq-31-07-2020-05.
6
Kontopoulou-Griva, Ir, J. Spiliotopoulou, L. Digenopoulou, and J. Georgopoulos. "THE THROMBOTIC COMPLICATIONS OF TWO GROUPS OF PATIENTS WITH DIFFERENT INR THERAPEUTIC RANGES. THE NECESSITY OF INTENSE ORAL ANTICOAGULANT TREATMENT." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643263.
Анотація:
One of the reasons why oral anticoagulants fell into disrepute is the absence of internationally acceptable standarised procedures for controlling the level of anticoagulation. This deplorable situation resulted in over and under coagulation and uncertainty in the therapeutic range. The International Normalised Ratio (INR) can safely be applied in patients on oral anticoagulants.We present two Groups of patients under long term anti coagulation, mainly because of prosthetic heart valves that have recently been added to our outpatients clinic. These patients were till then attended by two cardiologists with different attitudes on the intensity of the anticoagulant treatment. The thromboplastin reagent used is that of ox origin and the results are expressed on INR.The Group A with 32 patients had at the time that we started attending them an INR x = 1,80 ± 0,48 and a daily dose of acenocoumarol x = 1,65 ± 0,51.The Group B with 49 patients had an INR x = 2,75 ± 0,51 and a daily dose of acenocoumarol x = 2,52 ± 1,53.Seven patients of the Group A referred thrombotic complications, while three patients of the Group B referred transiant thrombotic complications.The statistical analysis with the t-test of the INR between the two Groups is p<0,001 while that of the thrombotic complication with the x2 is p<0,05.The introduction of the INR and the acceptance by the medical people of the necessity of the intense oral anticoagulant treatment especially on high risk patients with mechanical heart valves as is the majority of the presented patients, will minimize the thromboembolic complications without high risk of bleeding.
7
Koutts, K., and T. Exner. "HIGH INCIDENCE OF CARDIOLIPIN-BINDING ANTIBODIES IN PATIENTS TAKING ORAL ANTICOAGULANTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644239.
Анотація:
It is known that patients with thrombosis in autoimmune disease often suffer recurrent thrombotic episodes on withdrawl of oral anticoagulants, frequently have raised ACA and may require long term therapy. In view of the association between lupus inhibitors, phospholipid binding antibodies and thrombotic episodes we investigated a broad group of patients (n=140) taking oral anticoagulants for anti-cardiolipin antibodies (ACA).The incidence of raised ACA (defined here as more than 5 S. D. above normal) was 10%, in comparison with less than 2% in both healthy volunteers and randomized hospital patients. Analysis of patients with raised ACA indicated an approximately equal distribution among those with artifical valves and patients treated for thrombotic episodes. ANF and DNA binding studies were negative in most cases and a lupus inhibitor (KCT mixing test) was detectable only in 1/15. APTT/PT ratios were not significantly high in comparison with other clinic patients. The-ACA were predominantly IgG (12/15) in contrast to those fpund in females with recurrent abortions which are frequently IgM's. The binding antibodies appeared to be much weaker in the presence of calcium than in phosphate buffered saline.The patients having high ACA had no excess thrombotic or bleeding complications during their treatment compared with others in this group. This suggests that thrombotic or occlusive events associated with ACA may be adequately treated with oral anti-coagulants.
8
Lang, L., G. Cattaneo, F. Popov, T. Krüger, C. Salewski, A. Nemeth, H. P. Wendel, S. Krajewski, and C. Schlensak. "Nitrated Oleic Acid Coating of Nitinol Grafts to Diminish Stent-Angioplasty-Associated Thrombotic Complications." In 48th Annual Meeting German Society for Thoracic, Cardiac, and Vascular Surgery. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1678977.
9
Broekmans, A. W., F. J. M. der Meer, and K. Briët. "TREATMENT OF CONGENITAL THROMBOTIC SYNDROMES." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643718.
Анотація:
Hereditary antithrombin III deficiency,protein C deficiency, and protein S deficiency predispose to the occurrence of venous thrombotic disease at a relatively youngage and often without an apparent cause. These disorders inherit as an autosomal dominant trait. Heterozygotes are at risk fosuperficial thrombophlebitis, thrombosis atnearly every venous site, and pulmonary embolism. Homozygous protein C deficiency may present itself with a purpura fulminans syndrome shortly after birth.In the acute phase of venous thromboembolism heparin is effective for preventing extension of the thrombotic process, and pulmonary embolism. In patients with antithrombin III deficiency the concomittant useof antithrombin III concentrate is controversial, although some patients may requirehigher doses of heparin.Substitution therapy is only indicated in homozygous protein C deficient patientswith purpura fulminans. Fresh frozen plasma i.v. is the treatment of choice, in a dosage of 10 ml/kg once or twice daily. The current prothrombin complex concentrates may induce new skin lesions and disseminated intravascular coagulation. After the lesions have been healed(mostly in 4 to6 weeks)coumarin therapy may effectively prevent new episodes of purpura fulminans, provided the prothrombin time is kept within 2,5 - 4,0 INR. Heparin is ineffective for preventing purpura fulminans due to homozygous protein C deficiency.The thrombotic manifestations in heterozygotes are effectively prevented by coumarin therapy. This is supported by the observation that patients may remain free of thrombosis during long-term treatment and may have recurrences shortly after the withdrawal of the coumarin drug. The therapeutic range for the prothrombin time should be within 2,0 - 4,0 INR, target value 3,0 INR. In the initial phase of oral anticoagulant therapy protein C deficient patients are prone to the development of coumarin induced hemorrhagic skin (tissue) necrosis.In the patients studied in Leiden, it occurred in about 3% of the treated patients. Heparin appears to be ineffective for the prevention of coumarin-induced skin necrosis; high loading doses of coumarin should be avoided and the prothrombin timeshouldbe checked dialy during the initial phase of oral anticoagulant treatment. Tissue necrosis may contribute to bleeding complications after fibrinolytic therapy, ashas been observed in two protein C deficient patients.In clinical situations with an increased risk for thrombosis such as surgery and pregnancy, heparin (in-low-doses) alone orin combination with coumarins have been used succesfully for the prevention of thrombosis. The need for antithrombin III concentrates in patients with hereditary antithrombin III deficiency in such situations is not substantiated.Although anabolic steroids are capable to increase the plasma concentrations of antithrombin III and of protein C in the respective deficiency states, its efficacy in preventing thrombotic episodes remains to be established.An optimal strategy for preventing thrombosis in congenital thrombotic syndromes is to identify still asymptomatic patients. In case of antithrombin III, protein C, and protein S deficiency this search is feasible. During risk situations for thrombosis patients are to be protected against the development of thrombosis.In Leiden pregnant women with one of the deficiencies are treated from the 14th week of pregnancy, initially with a shortacting coumarin drug, after the 34th week withheparin s.c. b.i.d. at therapeutic dosages,and after delivery coumarin therapy is reTnstituted during 6 weeks. The use of oralcontraceptives should be avoided, unlesspatients are under coumarin treatment. As long as deficient patients remain asymptomatic no antithrombotic treatment is indicated. After the first documented thromboticincident patients are treated indefinitelywith oral anticoagulants.
10
Sheriff, Jawaad, Gaurav Girdhar, Sheela George, Wei-Che Chiu, Bryan E. Lynch, Jolyon Jesty, Marvin J. Slepian, and Danny Bluestein. "In Vitro Evaluation of Shear-Induced Platelet Activation in the MicroMed DeBakey Ventricular Assist Device With Antiplatelet Therapy." In ASME 2013 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/sbc2013-14088.
Анотація:
Mechanical circulatory support (MCS) devices, which include ventricular assist devices (VADs), offer an attractive solution to approximately 35,000 end-stage heart failure patients eligible for transplants, of which only 2,000–2,300 are performed annually [1]. These devices are employed to augment the function of the ailing left and/or right ventricle and serve as bridge-to-transplant or destination therapy, but are often accompanied by thrombotic complications. Pathologic flow patterns are characteristic of VADs and increase susceptibility to shear-induced platelet activation, which leads to thrombus formation [2]. Patients implanted with such devices are routinely prescribed antiplatelets to tackle these complications. Despite this concurrent therapy, thromboembolic incident rates of 0.9–13% are reported for the widely-implanted Thoratec HeartMate II and MicroMed DeBakey VADs [3, 4]. This has spurred the development of design optimization techniques to lower or eliminate the incidence of thrombosis and reduce the dependence on pharmacotherapy management.
Звіти організацій з теми "Thrombotic complications":
1
Ding, Yukang, Xixia Chen, and Yongpeng Ge. Inflammatory myopathy following coronavirus disease 2019 vaccination: a systematic review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, September 2022. http://dx.doi.org/10.37766/inplasy2022.9.0084.
Анотація:
Review question / Objective: Reports of unexpected side effects have accompanied the vaccination of larger proportions of the population against coronavirus disease 2019 (COVID-19), including a few cases of inflammatory myopathy (IM). In a bid to improve understanding of the clinical course of vaccine complications, a systematic review of reported cases of IM following COVID-19 vaccination has been conducted. Condition being studied: Safety concerns have surrounded the vaccines since their development, with common adverse effects including local reaction at the site of injection and diverse non-specific flu-like symptoms (9). Most symptoms occur soon after vaccination and resolve within a short period but some serious events such as myopericarditis and cerebral venous thrombosis post COVID-19 vaccination had been reported. Meanwhile, some rare cases of vaccine-associated IMs have been reported. The current study systematically reviewed IM cases reported post-COVID-19 vaccination to date. Clinical and laboratory features are described and therapy and prognosis discussed.
2
Saldanha, Ian J., Wangnan Cao, Justin M. Broyles, Gaelen P. Adam, Monika Reddy Bhuma, Shivani Mehta, Laura S. Dominici, Andrea L. Pusic, and Ethan M. Balk. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis. Agency for Healthcare Research and Quality (AHRQ), July 2021. http://dx.doi.org/10.23970/ahrqepccer245.
Анотація:
Objectives. This systematic review evaluates breast reconstruction options for women after mastectomy for breast cancer (or breast cancer prophylaxis). We addressed six Key Questions (KQs): (1) implant-based reconstruction (IBR) versus autologous reconstruction (AR), (2) timing of IBR and AR in relation to chemotherapy and radiation therapy, (3) comparisons of implant materials, (4) comparisons of anatomic planes for IBR, (5) use versus nonuse of human acellular dermal matrices (ADMs) during IBR, and (6) comparisons of AR flap types. Data sources and review methods. We searched Medline®, Embase®, Cochrane CENTRAL, CINAHL®, and ClinicalTrials.gov from inception to March 23, 2021, to identify comparative and single group studies. We extracted study data into the Systematic Review Data Repository Plus (SRDR+). We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42020193183). Results. We found 8 randomized controlled trials, 83 nonrandomized comparative studies, and 69 single group studies. Risk of bias was moderate to high for most studies. KQ1: Compared with IBR, AR is probably associated with clinically better patient satisfaction with breasts and sexual well-being but comparable general quality of life and psychosocial well-being (moderate SoE, all outcomes). AR probably poses a greater risk of deep vein thrombosis or pulmonary embolism (moderate SoE), but IBR probably poses a greater risk of reconstructive failure in the long term (1.5 to 4 years) (moderate SoE) and may pose a greater risk of breast seroma (low SoE). KQ 2: Conducting IBR either before or after radiation therapy may result in comparable physical well-being, psychosocial well-being, sexual well-being, and patient satisfaction with breasts (all low SoE), and probably results in comparable risks of implant failure/loss or need for explant surgery (moderate SoE). We found no evidence addressing timing of IBR or AR in relation to chemotherapy or timing of AR in relation to radiation therapy. KQ 3: Silicone and saline implants may result in clinically comparable patient satisfaction with breasts (low SoE). There is insufficient evidence regarding double lumen implants. KQ 4: Whether the implant is placed in the prepectoral or total submuscular plane may not be associated with risk of infections that are not explicitly implant related (low SoE). There is insufficient evidence addressing the comparisons between prepectoral and partial submuscular and between partial and total submuscular planes. KQ 5: The evidence is inconsistent regarding whether human ADM use during IBR impacts physical well-being, psychosocial well-being, or satisfaction with breasts. However, ADM use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections not explicitly implant related (low SoE). Whether or not ADM is used probably is associated with comparable risks of seroma and unplanned repeat surgeries for revision (moderate SoE for both), and possibly necrosis (low SoE). KQ 6: AR with either transverse rectus abdominis (TRAM) or deep inferior epigastric perforator (DIEP) flaps may result in comparable patient satisfaction with breasts (low SoE), but TRAM flaps probably increase the risk of harms to the area of flap harvest (moderate SoE). AR with either DIEP or latissimus dorsi flaps may result in comparable patient satisfaction with breasts (low SoE), but there is insufficient evidence regarding thromboembolic events and no evidence regarding other surgical complications. Conclusion. Evidence regarding surgical breast reconstruction options is largely insufficient or of only low or moderate SoE. New high-quality research is needed, especially for timing of IBR and AR in relation to chemotherapy and radiation therapy, for comparisons of implant materials, and for comparisons of anatomic planes of implant placement.
3
Thrombolysis may reduce complications of deep vein thrombosis. National Institute for Health Research, April 2017. http://dx.doi.org/10.3310/signal-000409.