Atrial thrombosis

Hodkinson, J., Couper-Smith, J., Kew, M.C. Inferior vena cava and right atrial thrombosis complicating an amebic hepatic abscess. Amer. J. Gastroenterol. 1988 83 786 - 788... 

Williams and Aronsohn (1956) showed that mice fed low protein diets developed two types of lesions (1) myocardial necrosis and fibrosis, and (2) deposits of mineral ceroid. Williams (1960) found that mice fed high fat, low protein diets developed cardiovascular disease characterized more by small areas of myocardial fibrosis than frank necrosis. Choline supplementation of the diet produced more severe lesions. Carroll et a/. (1965) described atrial thrombosis and atrial and ventricular myocardial necrosis in mice fed high fat low protein diets. These workers also described the presence of fat droplets within the lesions in oil red O stained sections. They reported similar lesions (necrosis) in the hearts of older control mice. Thomas et a/. (1968)... 

Nicolosi GL, Channel PA, Zanuttini D. Large right atrial thrombosis. Rare complication during permanent transvenous endocardial pacing. Br Heart J 1980 43 199 201. 

Recognized complications of PN are pneumothorax, subcutaneous emphysema, arrythmias, massive hematoma during an attempt to place a central line in the subclavian vein, right atrial thrombosis, and embolism (82). Hepatic complications are seen in about 15% of patients depending on the duration and mode of application of PN (83), and metabolic bone disease may also occur (84,85). 

Derumeaux G, Habib G, Schleifer DM et al (1995) Standard orthotopic heart transplantation versus total orthotopic heart transplantation. A transesophageal echocardiography study of the incidence of left atrial thrombosis. Circulation 9211 196-201... 

Anticoagulant drugs include heparin and warfarin (Coumadin ) —agents used to prevent deep vein thrombosis. They are also used to prevent formation of emboli due to atrial fibrillation, valvular heart disease, and other cardiac disorders. Heparin, which is not absorbed by the gastrointestinal tract, is available only by injection its effect is immediate. 

Prophylaxis and treatment Prophylaxis and treatment of venous thrombosis and its extension pulmonary embolism peripheral arterial embolism atrial fibrillation with embolization. 

Treatment of venous thrombosis, pulmonary embolism, peripheral arterial embolism, atrial fibrillation with embolism Intermittently Initially, 10,000 units, then 50-70 units/kg (5000-10,000 units) q4 6h. IV Infusion Loading dose 80 units/kg, then 18 units/kg/hr, with adjustments based on aPTT. Range 10-30 units/kg/hr. 

Prevention of venous thrombosis, pulmonary embolism, peripheral arterial embolism, atrial fibrillation with embolism Subcutaneous 5000 units q8-12h. 

It is indicated in the prophylaxis and treatment of deep vein thrombosis in major surgery and pulmonary embolism, treatment of atrial fibrillation with embolisation, prophylaxis and treatment of peripheral arterial embolism. 

A major focus of drug development has been to develop orally active anticoagulants that do not require monitoring. Rivaroxiban is the first oral factor Xa inhibitor to reach phase III clinical trials. The safety and efficacy of rivaroxiban appears to be at least equivalent, and possibly superior, to LMW heparins for prevention of deep vein thrombosis no routine monitoring is required. This drug is also in clinical trials for treatment of deep vein thrombosis and prevention of stroke in atrial fibrillation. 

The increased risk of thromboembolism associated with atrial fibrillation and with the placement of mechanical heart valves has long been recognized. Similarly, prolonged bed rest, high-risk surgical procedures, and the presence of cancer are clearly associated with an increased incidence of deep venous thrombosis and embolism. Antiphospholipid antibody syndrome is another important acquired risk factor. Drugs may function as synergistic risk factors in concert with inherited risk factors. 

The book is comprised of five sections with part I covering systemic and endoluminal therapy with an incisive overview of hemostasis and thrombosis part II covers local therapy with several chapters devoted to drug-eluting stents and restenosis therapies part III covers cell therapy and therapeutic angiogenesis and includes chapters on cell transplantation and clinical trials in cellular therapy part IV covers adjunctive pharmacotherapy with chapters devoted to various patient populations including those with heart failure, diabetes, atrial fibrillation, peripheral artery disease,... 

Patients in atrial fibrillation who have a TIA or stroke without other clear etiology should be given anticoagulation therapy if there are no contraindications (European Atrial Fibrillation Trial Study Group 1993, 1995). Recent studies have shown that warfarin is as safe as aspirin in elderly patients with atrial fibrillation (Rash et al. 2007 Mant et al. 2007). Patients with presumed cardioembolic TIA or stroke secondary to other causes should certainly receive antithrombotic therapy. Also they may benefit from anticoagulation in certain circumstances, such as intracardiac mural thrombosis after myocardial infarction, although there have been no randomized trials in situations other than non-valvular atrial fibrillation. 

There has also been considerable interest in the use of statins in other clinical indications, including cancer [75], neurological disorders [76], osteoporosis [77], atrial fibrillation [78], asthma [79], angiogenesis [80], immunomodulatory effects [81], coagulation and thrombosis [82,83]. Whether these effects can all be attributed to the cholesterol-lowering activity or are a consequence of depletion of other isoprenoid species remains to be determined. 

INR 2.0-3.0 Treatment of deep vein thrombosis pulmonary embolism systemic embolism prevention of venous thromboembolism in myocardial infarction mitral stenosis with embolism transient ischaemic attacks atrial fibrillation. 

Central venous catheters are reluctantly used as blood access for hemodialysis because of safety concerns and frequent complications, for example sepsis, thrombosis, and vessel stenosis. Nevertheless, 20% or more of all patients rely on atrial catheters for chronic dialysis because of lack of other access. Potentially fatal risks related to central venous catheters include air embolism (1), severe blood loss (2), and electric shock (3). These specific risks have been substantially eliminated by the inherent design and implantation of Dialock (Biolink Corporation, USA). Dialock is a subcutaneous device consisting of a titanium housing with two passages with integrated valves connected to two silicone catheters. The system is implanted subcutaneously below the clavicle. The tips of the catheters are placed in the right atrium. The port is accessed percutaneously with needle cannulas. 

Heparin is an anticoagulant that inhibits reactions that lead to clotting. It is indicated in prophylaxis and treatment of venous thrombosis and its extensions, pulmonary embolism (PE), peripheral arterial embolism, and atrial fibrillation with embolization diagnosis and treatment of acute and chronic consumption coagulopathies (DIC) and prevention of postoperative deep venous thrombosis. 

Warfarin (initially 10 to 15 mg p.o. for three days) is indicated as an anticoagnlant in pntmonary emboli, deep-vein thrombosis (DVT), myocardial infarction (Ml), rhenmatic heart disease with heart valve damage, and atrial arrhythmias. 

The anticlotting drugs are used in the treatment of myocardial infarction and other acute coronary syndromes, atrial fibrillation, ischemic stroke, and deep vein thrombosis (DVT). The anticoagulant and thrombolytic drugs ate effective in treatment of both venous and arterial thrombosis. Antiplatelet dmgs are used primarily for treatment of arterial disease. 

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