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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

90 patients with acute stroke and a concomitant cardiac embolism source or a symptomatic high-grade stenosis of an extra-or intracranial vessel received in a mulitcenter, randomized, controlled study either Enoxaparin 1 mg/kg BW s.c. b.i.d. or i.v. heparin aPTT-adjusted daily for 8 +/- 2 days as secondary prophylaxis. There were no significant differences between the two groups regarding cerebral and systemic embolic events, bleeding complications, length of hospital stay, number of diagnostic and therapeutic measures and outcome after three months. This suggests that Enoxaparin, which is easier to administer and monitor, is a safe drug in patients with acute cerebral events.
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PMID:Treatment with anticoagulants in cerebral events (TRACE). 1504 29

Mild hypothermia has been shown to provide protective effects in patients with ischemia (e.g. acute stroke and heart attack), but traditional methods for inducing, maintaining, and reversing hypothermia are slow, difficult to administer and control, and uncomfortable for patients. An innovative method produces mild, wholebody hypothermia (32 degrees C to 34 degrees C) by use of an endovascular heat exchanger placed into the inferior vena cava. A closed-loop system accurately changes core body temperature with average cool-down rates of 4.8 degrees C per hour, tight-target temperature control of +/- 0.1 degree C, and average rewarm rates of 1.9 degrees C per hour. By enhancing the mixing of blood in the vicinity of the heat exchanger, the disposable, small-diameter catheter efficiently exchanges heat between the closed-loop circulating fluid and the blood stream in response to body temperature. A control algorithm adapts to body physiology and thermal mass to mitigate temperature excursions. Flexible, bellow-shaped segments along the length of the catheter allow precise maneuvering within blood vessels. Heparin, covalently bonded to the catheter, helps control thrombogenicity. This novel design has potential clinical applications in cerebrovascular surgery, acute stroke, acute myocardial infarction, cardiac arrest, and fever control.
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PMID:A novel system for mild hypothermia. 1517 68

In the general population, mild renal impairment is associated with increases risk for coronary artery disease and stroke, suggesting that cardiovascular disease begins to develop early in the natural history of renal dysfunction. Patients with renal failure are known to be at increased risk of death following acute myocardial infarction or congestive heart failure.In such sense, anticoagulation in addition to antiplatelet inhibitor drugs became the standard of care, particularly, among high risk unstable angina patients associated with a scarce side effects.The Nadroparin calcium Versus Enoxaparin (NaVe) Study will evaluate in a head to head basis the anti Xa activity reached by nadroparine or enoxaparine, both low molecular weight heparins, in patients at high risk for ischemic episodes, and renal insufficiency to eventually be undergone to angiographic diagnosis studies, and in consequence proposing the best anticoagulant strategies for these patients before being invasively treated.Patients will be randomly assigned to one of the two groups: Group 1: thirty patients will be given with subcutaneous enoxaparine injections into the abdominal wall in a dose of 0,85 mg/kg every 12 hours for a maximum of 48 hours. A saline infusion dose will be given in between. Total number of injections: 6. Group 2:Thirty patients will be receiving subcutaneous injections into the abdominal wall in a doses of 30% less in relationship with his / her body weight every 8 hours for a maximum of 48 hours.In order to achieve the goal of the study, the antiXa activity will be measure using venous blood samples taken as follows: Group 1:*Within 3rd and 4 hour of the second doses of HBPM for enoxaparine.*Within 11 th and 12 th hour next to fourth doses of enoxaparine. Group 2: *Within 3rd and 4 th hour next to 3rd doses of HBPM for the nadroparine.*Within 7th and 8th hour next to 4th doses HBPM for the nadroparine.The primary end point is to analyze during the in-hospital stay phase the stability of the anti Xa activity within the therapeutic ranges which will be estimated between 0.5 to 1.0 IU during the first 48 hours.
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PMID:Nadroparine calcium or enoxaparine in acute coronary syndrome patients suffering renal insufficiency: The nadroparin versus enoxaparin (NaVe) study design. 1518 95

Prosthetic valve thrombosis (PVT) is a life-threatening disease, the treatment strategies for which remain controversial. Transesophageal echocardiography (TEE) is the diagnostic technique of choice. Prosthetic valve obstruction is defined as limited leaflet motion; obstructive and non-obstructive PVT are separated by abnormal or normal leaflet motion. TEE is limited in differentiating thrombus from pannus ('tissue ingrowth'), and sterile thrombi from infected vegetations. Clinical aspects are helpful. The estimated incidence of PVT is 2-4% per year based on autopsy and surgical findings. The true incidence should be higher, as TEE reveals almost as many obstructive as non-obstructive PVT, of which 50% are asymptomatic. The prevalence of asymptomatic non-obstructive PVT in the early postoperative period may reach 10%. Three therapeutic approaches are available for PVT. Surgical mortality may reach 69%, depending on NYHA class and need for emergency surgery. Thrombolysis represents an alternative to surgery, with 84% success and low complication rates (stroke 9%, mortality 5%). In non-obstructive PVT patients in NYHA class I or II, thrombolysis success was higher (92%), without severe complications. No other clinical predictor of success could be confirmed. Besides classical contraindications there are no absolute contraindications (large thrombi, pregnancy, early postoperative period) for thrombolysis. Long-term streptokinase protocols have been used with regular TEE monitoring. Heparin may be an initial treatment for non-obstructive PVT, but thrombolysis is superior in this subset. If thrombi are > 5 mm in size, heparin therapy is unsuccessful and unsafe. TEE monitoring is mandatory during heparin treatment, as thrombi may increase in size and become obstructive. Thrombolysis is recommended as first-line treatment if there are no contraindications. Heparin may be used initially for small non-obstructive thrombi, particularly if thrombolysis is contraindicated. Surgery should be reserved for patients in whom thrombolysis is either contraindicated or has been ineffective, independent of NYHA class.
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PMID:Management of prosthetic valve thrombosis. 1522 76

Heparin is indicated to replace warfarin in patients with valve disease requiring antithrombotic treatment. Its use in thus necessary for short periods during which warfarin is contraindicated, but the thromboembolic risk persists. These circumstances, which are common in patients with mechanical prostheses, include: hemorrhagic risk or event complicating an existing thromboembolic risk (heart or extracardiac surgery, severe hemorrhage, end of pregnancy); when an unstable situation develops and imposes the rapid diminution or interruption of anticoagulants (stroke, infectious endocarditis); when immediate efficacy is required, rather than the delayed action of warfarin (onset of atrial fibrillation); and when warfarin is contraindicated (early pregnancy). Regardless of whether unfractionated or low molecular-weight heparin (LMWH) is used, therapeutic doses must be prescribed: continuously perfused intravenous and subcutaneous injections (t.i.d.) with repeated biological monitoring for the former, or subcutaneous injections (b.i.d.) with initial biological controls preferred and repeated in elderly subjects or those suffering from renal insufficiency. International guidelines have specified the respective roles of heparin in general, and each preparation individually with an ever-increasing use of LMWH, the efficacy of which has been proven in the majority of common thromboembolic pathologies and in pregnant women.
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PMID:Role of heparin in the antithrombotic treatment of valvulopathies. 1522 78

A 75-year-old man was admitted to our hospital with dysesthesia of the right lip, dysphagia and gait disturbance. He presented with right Wallenberg syndrome and brain MR image showed a fresh infarction in the right lateral medulla. Therapy with heparin and ozagrel sodium was started. For a time his symptom improved a little, but after 8 days he developed re-infarction, thrombocytopenia and DIC, while being treated with heparin for cerebral infarction. Heparin was discontinued, and these symptoms improved quickly. The clinical course and the positive anti-platelet factor 4-heparin complex antibody suggested that these symptoms were caused by heparin-induced thrombocytopenia (HIT). HIT should be included as a differential diagnosis for progression of ischemic stroke under heparin therapy.
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PMID:[A case of heparin-induced thrombocytopenia that worsened preexisting cerebral infarction]. 1551 11

The optimal pharmacological antithrombotic treatment for interventional coronary procedures is a controversial subject. The ISAR-REACT trial investigated the necessity of a IIb/IIIa glycoprotein inhibitor in procedures not considered at high risk, that is to say excluding acute coronary syndromes, and concluded that there was no additional gain with this treatment compared with placebo when the patient was pre-treated with 600 mg of clopidogrel. The REPLACE-2 trial proposed an alternative to a treatment with NFH and IIb/IIIa glycoprotein inhibitor with the use of a direct antithrombin, bivalirudine. Heparin therapy of acute coronary syndromes and the eventual ensuing interventional coronary procedure may employ NFH or LMWH. New large scale trials (SYNERGY and phase A of the so-called A to Z trial) compared the two approaches and are reported later on. If facilitated angioplasty is a seductive concept, the best antithrombotic association remains to be determined (BRAVE trial). Bitherapy with a platelet inhibitor and an antithrombotic, ximegalatran, was tested in the ESTEEM trial and in the post-infarct period. Bitherapy with platelet inhibitors clopidogrel and aspirin versus clopidogrel alone was tested in patients with "ischaemic" stroke but does not seem to be more effective than monotherapy. In pulmonary embolism, the fondaparinux seems to be an alternative to NFH. Finally, the concept of resistance to platelet inhibitors is in vogue and is the subject of some interesting trials.
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PMID:[The best of thrombosis in 2004]. 1571 67

The Kunitz-type proteinase inhibitor, tissue factor pathway inhibitor (TFPI), is the only endogenous inhibitor of the tissue factor (TF)-mediated coagulation pathway that plays a dominant role in normal haemostasis. TFPI exerts its action by binding to factor Xa (FXa) forming a TFPI-FXa complex that then, in a second step, binds and effectively inhibits the TF-factor VIIa (FVIIa) complex. Both full-length TFPI and chemically modified forms (e.g., truncated, glycosylated or phosphorylated TFPI variants) exert various pharmacological effects. The anticoagulant and antiplatelet actions of TFPI, its potency in inhibiting thrombin and FXa generation, as well as its favourable antithrombotic effectiveness seen in different animal models of venous and arterial thrombosis make this inhibitor a promising agent that could be potentially useful in several clinical indications. The inhibitory action of TFPI is accelerated by heparin. Heparin, as well as low molecular weight heparin (LMWH) derivatives, release TFPI from the vascular endothelium, an effect which seems to contribute mainly to the antithrombotic effectiveness of these drugs. The clinical relevance of TFPI is still undefined. Based on the beneficial actions in animal studies, as well as on the results obtained in first clinical investigations, TFPI is expected to be effective in the treatment of various diseases, such as disseminated intravascular coagulation, sepsis, coronary syndromes, stroke and acute respiratory distress syndrome (ARD). Further clinical trials should clarify the role of TFPI and more importantly define its potential usefulness as a prophylactic and/or therapeutic agent.
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PMID:Recombinant TFPI and variants: potential implications in the treatment of cardiovascular disorders. 1599 20

(1) In the acute phase of ischaemic stroke, antiplatelet or anticoagulant treatments reduce the risk of recurrence and pulmonary embolism, but carry a risk of haemorrhagic transformation. (2) Aspirin has been tested in several placebo-controlled trials and has a positive risk-benefit balance, preventing about 5 deaths per 1000 patients with ischaemic stroke. Aspirin must be given as soon as computed tomography has ruled out intracerebral haemorrhage, unless thrombolytic treatment is planned. (3) Heparin has as many potential benefits as risks: it tends to be beneficial at low doses but harmful at high doses. Low-dose heparin therapy appears to be justified, especially for patients with emboligenic heart disease, tight carotid stenosis, or at risk of pulmonary embolism. Higher-dose heparin is only warranted for the rare patient with a high thrombotic risk. (4) Some thrombolytic drugs can reduce the frequency and severity of complications, but their use carries a high immediate risk of aggravation or death by haemorrhagic transformation. Alteplase has a somewhat positive risk-benefit balance in certain highly specific situations: for example, in some patients with persistent ischaemic stroke who are treated within three hours of onset, and without signs of severe stroke or risk factors for bleeding (high blood pressure, aspirin use). (5) Clinical trials have shown that routine use of "neuroprotective" treatments (calcium channel blockers, haemodilution, parenteral magnesium, oxygen therapy) does not reduce the risk of death or disability. (6) Arterial hypertension frequently occurs in the immediate aftermath of stroke, and then generally subsides. Few clinical trials have evaluated the use of antihypertensive drugs in this setting and there is little evidence of benefit. One trial showed that a sudden drop in blood pressure led to neurological aggravation. Antihypertensive drugs should only be used in stroke patients with severe hypertension or cardiac complications. (7) Cerebral oedema is an important cause of death after stroke: treatments (especially mannitol, mechanical ventilation and neurosurgery) have been poorly evaluated. (8) Other treatments recommended only for patients with persistent complications include oxygen therapy, antibiotics, paracetamol, insulin, and anticonvulsants. (9) A controversial meta-analysis suggested that management by a specialised multidisciplinary team reduced the mid-term risk of death and disability in comparison with management in a non specialised unit.
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PMID:Ischaemic stroke: acute-phase drug therapy. Mostly aspirin and heparin. 1610 99

Myocardial infarction and other arterial thrombosis are commonly maintained to be rare in hemophilia patients. This, in general, seems true but the occurrence of a thrombotic event in hemophilia B is not exceptional. A thorough search of the literature has yielded 13 patients with myocardial infarction and 1 patient with a cerebrovascular accident. There were three fatalities. In five cases MI occurred after infusion of Prothrombin Complex Concentrates. In three additional patients the event occurred after infusion of plasma, Feiba or cryoprecipitate supernatant. Four patients had an antero-lateral infarction. Two had a non-Q infarction and one each showed a multiple or a posterior-inferior form. Several therapeutic coronary procedures (GABG and PTCA) were carried out in hemophilia B patients without undue complication providing adequate level of FIX were maintained. Heparin prophilaxis was used in all patients but one. The analysis of the literature indicates that (1) MI may occur in hemophilia B patients and (2) that invasive coronary artery therapeutic procedures may be carried out without complications.
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PMID:Myocardial infarction, other arterial thrombosis and invasive coronary procedures, in hemaophilia B: a critical evaluation of reported cases. 1613 95


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