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Source: Journal of Thrombosis and Thrombolysis
Condition: Thrombosis

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Total 309 results found since Jan 2013.

Decision-making about the use of non-vitamin K oral anticoagulant therapies for patients with atrial fibrillation
Abstract Until recently, vitamin K antagonists, warfarin being the most commonly used agent in the United States, have been the only oral anticoagulant therapies available to prevent stroke in patients with atrial fibrillation (AF). In the last 5 years four new, non-vitamin K oral anticoagulants, the so-called NOACs or novel oral anticoagulants, have come to market and been approved by the Federal Drug Administration. Despite comparable if not superior efficacy in preventing AF-related stroke, and generally lower risks of major hemorrhage, particularly intracranial bleeding, the uptake of these agents has been s...
Source: Journal of Thrombosis and Thrombolysis - February 1, 2016 Category: Hematology Source Type: research

Repeated early thrombolysis in cervical spinal cord ischemia
We report the first case of an MRI-verified cervical spinal ischemia treated by thrombolysis and review the literature. A 72-year old woman with right-sided motor hemiparesis and trunk ataxia was treated by intravenous thrombolysis with full recovery. Three days later she developed again a severe right-sided sensorimotor hemiparesis and a second off-label intravenous thrombolysis was repeated. Magnetic resonance imaging revealed a right-sided posterior-lateral cervical spinal ischemia. Spinal ischemia may clinically present with a cerebral-stroke-like picture challenging diagnostic and therapeutic procedure. Systemic throm...
Source: Journal of Thrombosis and Thrombolysis - January 13, 2016 Category: Hematology Source Type: research

Platelet reactivity in patients undergoing transcatheter aortic valve implantation
In conclusion, patients undergoing TAVI for severe aortic stenosis and treated with DAPT have high rates of residual platelet reactivity during the peri-procedural period and up to 1-month thereafter. These findings may have clinical implications for the anti-platelet management of TAVI patients.
Source: Journal of Thrombosis and Thrombolysis - December 22, 2015 Category: Hematology Source Type: research

High residual platelet reactivity (HRPR) for adenosine diphosphate (ADP) stimuli is a determinant factor for long-term outcomes in acute ischemic stroke with anti-platelet agents: The meaning of HRPR after ADP might be more prominent in large atherosclerotic infarction than other subtypes of AIS
In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70 % or greater according to OPA after 10 µM ...
Source: Journal of Thrombosis and Thrombolysis - December 17, 2015 Category: Hematology Source Type: research

PON1 Q192R genetic variant and response to clopidogrel and prasugrel: pharmacokinetics, pharmacodynamics, and a meta-analysis of clinical outcomes
Abstract Clopidogrel and prasugrel are antiplatelet therapies commonly used to treat patients with cardiovascular disease. They are both pro-drugs requiring biotransformation into active metabolites. It has been proposed that a genetic variant Q192R (rs662 A>G) in PON1 significantly alters the biotransformation of clopidogrel and affects clinical outcomes; however, this assertion has limited support. The relationship between this variant and clinical outcomes with prasugrel has not been studied. We genotyped PON1 Q192R in 275 healthy subjects treated with clopidogrel or prasugrel and 2922 patients with an ACS u...
Source: Journal of Thrombosis and Thrombolysis - November 16, 2015 Category: Hematology Source Type: research

The changing characteristics of atrial fibrillation patients treated with warfarin
Abstract It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2D...
Source: Journal of Thrombosis and Thrombolysis - September 27, 2015 Category: Hematology Source Type: research

The effect of dabigatran and rivaroxaban on platelet reactivity and inflammatory markers
Abstract The new oral anticoagulants (NOACs) reduce stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF), but dabigatran may increase risk of coronary ischemic events for unclear reasons. Thus, this study assessed the effects of dabigatran and rivaroxaban on platelet reactivity and inflammatory markers in patients with non-valvular AF. Patients with non-valvular AF planned to begin treatment with NOACs were included. Seventeen patients were prescribed dabigatran and ten rivaroxaban. Platelet function (as assessed by multiple-electrode aggregometry, Impact-R shear-induced platelet de...
Source: Journal of Thrombosis and Thrombolysis - August 23, 2015 Category: Hematology Source Type: research

Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation
Abstract Atrial fibrillation and obesity are two major growing epidemics in the United States and globally. Obese people are at the increased risk of developing atrial fibrillation. The contribution of obesity as an independent risk factor for stroke in the setting of atrial fibrillation remains unclear. We tested the hypothesis that non-valvular atrial fibrillation (NVAF) patients with increased body mass index (BMI) would be at increased risk for the development of left atrial appendage thrombus (LAAT). Consecutive, anticoagulation naïve patients with NVAF referred for a transesophageal echocardiogram (TEE) bet...
Source: Journal of Thrombosis and Thrombolysis - August 18, 2015 Category: Hematology Source Type: research

Preferences for anticoagulation therapy in atrial fibrillation: the patients’ view
The objective of this study was to assess AF patients’ preferences with regard to the attributes of these different treatment options. We conducted a multicenter study among randomly selected physicians. Preferences were assessed by computer-assisted telephone interviews. We used a discrete-choice-experiment (DCE) with four convenience-related treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/dose adjustment: yes/no; frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: <1 km/>15 km). Preferences measur...
Source: Journal of Thrombosis and Thrombolysis - August 11, 2015 Category: Hematology Source Type: research

Adequacy of preadmission oral anticoagulation with vitamin K antagonists and ischemic stroke severity and outcome in patients with atrial fibrillation
In conclusion, optimally anticoagulated patients with AF have more favorable functional outcome after stroke and a trend for less severe stroke whereas patients with subtherapeutic anticoagulation have similar stroke severity and outcome with those on no treatment.
Source: Journal of Thrombosis and Thrombolysis - August 8, 2015 Category: Hematology Source Type: research

Real life anticoagulation treatment of patients with atrial fibrillation in Germany: extent and causes of anticoagulant under-use
Abstract Oral anticoagulation (OAC) with either new oral anticoagulants (NOACs) or Vitamin-K antagonists (VKAs) is recommended by guidelines for patients with atrial fibrillation (AF) and a moderate to high risk of stroke. Based on a claims-based data set the aim of this study was to quantify the stroke-risk dependent OAC utilization profile of German AF patients and possible causes of OAC under-use. Our claims-based data set was derived from two German statutory health insurance funds for the years 2007–2010. All prevalent AF-patients in the period 2007–2009 were included. The OAC-need in 2010 was assumed wh...
Source: Journal of Thrombosis and Thrombolysis - May 29, 2015 Category: Hematology Source Type: research

The impact of frequency of patient self-testing of prothrombin time on time in target range within VA Cooperative Study #481: The Home INR Study (THINRS), a randomized, controlled trial
In conclusion, more frequent PST improved TTR and reduced the proportion of poorly managed patients.
Source: Journal of Thrombosis and Thrombolysis - May 29, 2015 Category: Hematology Source Type: research

Standardized use of novel oral anticoagulants plasma level thresholds in a new thrombolysis decision making protocol
Abstract Acute ischemic stroke (AIS) patients receiving non-vitamin-K antagonist oral anticoagulants (NOAC) are commonly excluded from thrombolytic therapy, as interpretation of coagulation tests remains unclear. We aimed to investigate the applicability of a novel institutional protocol for thrombolysis based on current expert recommendations and NOAC specific coagulation assessment. We included hospitalized AIS patients receiving NOAC for at least 24 h and consecutive AIS patients not receiving NOAC into a prospective study. We performed standard coagulation tests and specific tests for dabigatran, rivaroxaban ...
Source: Journal of Thrombosis and Thrombolysis - May 23, 2015 Category: Hematology Source Type: research

Tissue plasminogen activator for acute ischemic stroke: calculation of dose based on estimated patient weight can increase the risk of cerebral bleeding
Abstract A dose of 0.9 mg/kg of intravenous tissue plasminogen activator (t-PA) has proven to be beneficial in the treatment of acute ischemic stroke (AIS). Dosing of t-PA based on estimated patient weight (PW) increases the likelihood of errors. Our objectives were to evaluate the accuracy of estimated PW and assess the effectiveness and safety of the actual applied dose (AAD) of t-PA. We performed a prospective single-center study of AIS patients treated with t-PA from May 2010 to December 2011. Dose was calculated according to estimated PW. Patients were weighed during the 24 h following treatment with t-PA. ...
Source: Journal of Thrombosis and Thrombolysis - May 21, 2015 Category: Hematology Source Type: research

Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection
This study demonstrated that patients admitted to our hospital were prescribed appropriate therapy the majority of the time; however, 34 % were prescribed inadequate antithrombotic therapy compared to current practice guidelines given their CHA2DS2VASc score. The development of an institution-specific guideline stratifying appropriate use of anticoagulation in this population may increase adherence to national guideline recommendations.
Source: Journal of Thrombosis and Thrombolysis - May 8, 2015 Category: Hematology Source Type: research