Atherothrombosis describes the occurrence of both
atherosclerosis and thrombosis in an artery, a
common feature of peripheral arterial disease.1
It is estimated that 1 in 16 U.S. residents who were
at least 40 years of age in 2000 (approximately 8.5
million persons) had peripheral arterial disease.
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review
The term thrombophilia describes a range of conditions in which there is
an increased tendency, frequently recurrent, for thrombus formation in the
venous as well as in the arterial vascular systems. Thrombophilia is caused
by inherited or acquired conditions and may cause symptoms related to the
place in which the thrombosis occurred, the extent of thrombosis, and
whether embolization occurred in other organs.
The most commonly used screening tests are the PT, aPTT, and platelet count. The PT assesses the factors I (fibrinogen), II (prothrombin), V, VII and X (Fig. 59-6). The PT measures the time for clot formation of the citrated plasma after recalcification and addition of thromboplastin, a mixture of TF and phospholipids. The sensitivity of the assay varies by the source of thromboplastin.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study...
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Anticoagulant properties of drotrecogin alfa (activated) during hemofiltration in patients with severe sepsis...
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài:
Pigmented villonodular synovitis of the knee in a patient on oral anticoagulation therapy: a case report
Tuyển tập các báo cáo nghiên cứu khoa học ngành y học tạp chí Medical Sciences dành cho các bạn sinh viên ngành y tham khảo đề tài: Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome...
Research objectives: To analyse of obstetric history and characteristics of anticardiolipin antibody and lupus anticoagulant in pregnant women with a history of RPL; assess the effectiveness of treatment pregnancy in women with a history of RPL by antiphospholipid syndrome by coordinating regimen low doses of aspirin and low molecular weight heparin.
Dental Care of Medically Complex Patients Routine dental care (e.g., extraction, scaling and cleaning, tooth restoration, and root canal) is remarkably safe. The most common concerns regarding care of dental patients with medical disease are fear of excessive bleeding for patients on anticoagulants, infection of the heart valves and prosthetic devices from hematogenous seeding of oral flora, and cardiovascular complications resulting from vasopressors used with local anesthetics during dental treatment. Experience confirms that the risks of any of these complications are very low.
Drug Interactions Not Mediated by Changes in Drug Disposition Drugs may act on separate components of a common process to generate effects greater than either has alone. Antithrombotic therapy with combinations of antiplatelet agents (glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel) and anticoagulants (warfarin, heparins) are often used in the treatment of vascular disease, although such combinations carry an increased risk of bleeding.
Table 111-3 Long-Term Treatment with Vitamin K Antagonists for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
First episode of DVT or PE secondary to a transient (reversible) risk factor
Recommendation applies to both proximal and calf vein thrombosis
idiopathic DVT or PE
anticoagulant therapy after 6–12 months may be considered
First episode of DVT
or PE with a documented thrombophilic abnormality
anticoagulant therapy after 6–12 months may be con...
Mixing studies are used to evaluate a prolonged aPTT or, less commonly PT, to distinguish between a factor deficiency and an inhibitor. In this assay, normal plasma and patient plasma are mixed in a 50:50 ratio, and the aPTT or PT is determined immediately and after incubation at 37oC for varying times, typically 30, 60, and/or 120 min. With isolated factor deficiencies, the aPTT will correct with mixing and stay corrected with incubation. With aPTT prolongation due to a lupus anticoagulant, the mixing and incubation will show no correction.
Withholding further diagnostic testing and anticoagulant treatment in those patients with an unlikely clinical probability and a normal D-dimer level, which constitutes 30–50% of all referred patients, is safe. The remaining patients need to undergo (repeated) compression ultrasonography. An alternative approach is to perform a whole-leg imaging test on the day of referral. The advantage of this approach is that it eliminates the need for a repeat test (and may even obviate the probability assessment and D-dimer testing).
Differential Diagnosis The differential diagnosis between DIC and severe liver disease is challenging and requires serial measurements of the laboratory parameters of DIC. Patients with severe liver disease are at risk for bleeding and manifest laboratory features including thrombocytopenia (due to platelet sequestration, portal hypertension, or hypersplenism), decreased synthesis of coagulation factors and natural anticoagulants, and elevated levels of FDP due to reduced hepatic clearance. However, in contrast to DIC, these laboratory parameters in liver disease do not change rapidly.
Coagulation Disorders Associated with Liver Failure The liver is central to hemostasis because it is the site of synthesis and clearance of most procoagulant and natural anticoagulant proteins and of essential components of the fibrinolytic system. Liver failure is associated with a high risk of bleeding due to deficient synthesis of procoagulant factors and enhanced fibrinolysis. Thrombocytopenia is common in patients with liver disease and may be due to congestive splenomegaly (hypersplenism), or immune-mediated shortened platelet life span (primary biliary cirrhosis).
Patients recovering from tetanus should be actively immunized (see below) because immunity is not induced by the small amount of toxin required to produce disease.
Like all patients receiving ventilatory support, patients with tetanus require attention to hydration; nutrition; physiotherapy; prophylactic anticoagulation; bowel, bladder, and renal function; decubitus ulcer prevention; and treatment of intercurrent infection.