http://www.expertoentrombosis.com 2009-10-13T16:34:56Z

Thrombus healing in sudden cardiac death victims may depend on the presence of plaque ruptures or erosions, and, in some patients, call for different treatment approaches, according to research published online Oct. 7 in the Journal of the American College of Cardiology.

We have retrospectively analysed data of 440 consecutive patients with acute PE. Collected data included age, gender, medical history, blood pressure, pulse rate and D-dimer concentration. The variables associated with SAE in the first 10 days in univariate analysis (p<0.15) have been included in a multivariate logistic regression model (backward conditional, p out >0.10).

Catheter ablation provides curative treatment for atrial fibrillation (AF). Data on anticoagulation after the procedure are sparse. We investigated real-life antithrombotic treatment after AF ablation and examined its adherence to current recommendations.

In patients receiving GP IIb/IIIa inhibitors or thienopyridines, fondaparinux reduces major bleeding and improves net clinical outcome compared with enoxaparin.

Our data show that markers of inflammation, such as hs-CRP, fibrinogen, and factor VIII, are at higher levels in patients with idiopathic compared to secondary VTE, supporting the hypothesis that idiopathic VTE and arterial thromboembolism share common risk factors.

In conclusion, this prospective, population-based study suggests elevated CRP is independently associated with increased risk of VTE.

The authors concluded that obese patients have a higher risk for long-term cardiovascular thrombotic events following PCI with drug-eluting stents than patients with normal weight.

In patients with STEMI undergoing primary PCI with contemporary anticoagulation regimens, a 600-mg loading dose of clopidogrel may safely reduce 30-day ischemic adverse event rates compared with a 300-mg loading dose.

Prophylaxis against venous thromboembolism has been mandated by the government, payers, and patient groups. Controversies remain with regard to the ideal agent, timing and duration of administration.

Catching a superbug often tops the list of worries harboured by people going into hospital, but there is a far more serious threat to their welfare that rarely receives the attention that it deserves. Over the past year at least 25,000 NHS inpatients have died from blood clots — five times the number killed by MRSA and Clostridium difficilecombined.

A review in The Lancet Neurology concludes that although very elderly people – those aged over 80 – are particularly susceptible to stroke, they receive fewer vascular prevention interventions than younger people. Emerging data show that the drugs can be very effective in the very elderly in routine clinical practice, the authors point out.

When adjusted, the HR for subsequent CV events was not different between patients with and without pulmonary embolism (HR=1.39; 95% CI, 0.83-2.3), according to the researchers. The HR was greatly increased, however, for patients with unprovoked pulmonary embolism vs. patients with provoked pulmonary embolism (HR=2.18; 95% CI, 1.1-4.5) and patients without pulmonary embolism (HR=2.62; 95% CI, 1.4-4.9).

Beginning next week, heparin shipped to hospitals and pharmacies will be about 10% less potent than that currently available, a change that is likely to have clinical implications when the drug is administered as a bolus IV dose, the FDA said today. The loss in potency is the result of new manufacturing controls -- including a new reference standard for the drug's unit dose -- adopted by United States Pharmacopeia (USP), a nonprofit standards-setting organization.

According to the researchers, 83 patients died during the follow-up period, with nine of them having hemorrhagic complications. Patients spent a median of 14% of their time below, 71% of their time within and 15% of their time above the intended therapeutic range. Ninety-four patients experienced bleeding complications during follow-up, with 37 patients having major complications and 57 patients having minor complications.

The study included nearly 57,000 patients at a mean age 52 years with lateral malleolar, bimalleolar or trimalleolar fractures treated by open reduction internal fixation. The majority of those studied were women. To draw their conclusions, researchers studied: fracture pattern, if the fractures were open or closed, age, gender, patient ethnicity, type of insurance utilized and presence of comorbidities, such as peripheral vascular disease (PVD) or diabetes mellitus.

Speaking at the Venous Disease Coalition (VDC) Annual Meeting, Dr. Garth Graham from the Office of Minority Health at the Department of Health and Human Services followed up on last year’s Surgeon General’s Call to Action by focusing attention on the African-American population which is at significantly increased risk of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). African-Americans have a significantly higher risk of developing potentially deadly DVT and PE compared with other ethnic populations in the U.S., according to data presented by Dr. Graham.

Based on a U.S. model of health care economics, the strategy of using enoxaparin instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI is cost effective according to commonly used benchmarks.

We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%–10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayed-type hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7–15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9–26.3) and female sex (OR 3.0, 95% CI 1.1–8.8).

Of 132 subjects randomized, the majority had either a mechanical heart valve (58%) or atrial fibrillation (35%), with similar frequency in each group. Magnitude and direction of INR variation was comparable in the two groups. The vitamin K-directed therapy group achieved target INR more rapidly, being in target range at 90-day follow-up in 75% versus 58% of cases in the dosage-adjustment group (p = 0.04). There was a trend in the same direction at each follow-up point (15, 30, and 60 days). There was also a trend toward less bleeding and use of parenteral vitamin K in the dietary therapy group (1 [1.5%] vs. 7 [11%]; p = 0.06).

Our results suggest that lupus anticoagulant is a major risk factor for arterial thrombotic events in young women, and the presence of other cardiovascular risk factors increases the risk even further.