Thromboses

Compared to streptokinase, urokinase has been less extensively studied because of its high cost, ie, about 10 times that of a comparable treatment with streptokinase. In addition to the indications described for streptokinase, urokinase is indicated for use in patients with prior streptokinase treatment, or prior Streptococcal infection. Urokinase is commonly used at a loading dose of 4400 units /kg, with a maintenance intravenous infusion dose of 4400 units/kg/h for thromboses other than acute myocardial infarction. In the latter case, a much larger dose, ie, 0.5—2.0 million units/h or a bolus dose of 1.0 million units followed by a 60-min infusion with 1.0 million units, has been found optimal (106). An intracoronary dose of 2000 units/min for two hours was used in one comparative study with intracoronary streptokinase (107). In this study, urokinase exhibited efficacy equivalent to streptokinase with fewer side effects. Other studies with intracoronary urokinase have adrninistered doses ranging from 2,000 to 24,000 units/min with a reperfusion efficacy of 60—89% (108—112). In another urokinase trial, 2.0 million units were adrninistered intravenously, resulting in a thrombolytic efficacy of 60% (113). Effectiveness in terms of reduction in mortaUty rate has not been deterrnined because of the small number of patients studied. 

Basic aspects of the proteins of the blood coagulation system and of fibrinolysis are described in this chapter. Some fundamental aspects of platelet biology are also presented. Hemorrhagic and thrombotic states can cause serious medical emergencies, and thromboses in the coronary and cerebral arteries are major causes of death in many parts of the world. Rational management of these conditions requires a clear understanding of the bases of blood clotting and fibrinolysis. 

Patients with homocystinuria are at risk for cerebrovascular and cardiovascular disease and thromboses 676 Prognosis is more favorable in the pyridoxine-responsive patients 677 Homocystinuria can occur when homocysteine is not remethylated back to form methionine 677... 

Patients with homocystinuria are at risk for cerebrovascular and cardiovascular disease and thromboses. 

Tamoxifen and raloxifene reduce the rates of invasive breast cancer in women at high risk for developing the disease. Rates of endometrial cancer and deep vein thromboses are higher in patients receiving tamoxifen but overall quality of life is similar between the two agents. 

Micro-Thromboses Platelets and leucocytes, like other cells, are known to carry surplus negative charge, and can be electrophoretically deposited at (or around) the anode10 owing to the positive electrode potential. These microthromboses in capillaries in or near the treatment site will result in decreased blood flow and may contribute to a local dystrophy of the tissue. A more pronounced version of this effect can be seen sometimes as electrocoagulation and vascular occlusion (i.e., shut, closed or obstructed vasculature) of the tumor tissue. In other words, ECT cuts off the blood supply to the tumor and causes the tumor cell necrosis. 

Drugs that decrease the coagulability of blood, such as coumarins andhep-arin (A), are employed for the prophylaxis of thromboses. In addition, attempts are directed at inhibiting the aggregation of blood platelets, which are prominently involved in intra-arterial thrombogenesis (p. 148). For the therapy of thrombosis, drugs are used that dissolve the fibrin meshwork->fibrino-lytics (p. 146). 

Cost-minimisation analysis are performed when the clinical outcomes (e.g. efficacy and safety) of the comparator groups are virtually identical and for all practical purposes can be considered to be equal. Because no decision can be made based on differences in the clinical endpoints, decisions are based on the incremental costs of the treatment pathways. Such was the case in a study that assessed the cost-effectiveness of treating proximal deep vein thromboses (DVT) at home with low molecular weight heparin versus standard heparin in hospital therapy. A cost-minimisation approach was chosen for this analysis because the results from a comparative clinical trial confirmed that there were no statistically significant differences in safety or efficacy between the two treatment groups. The study authors concluded that for patients with acute proximal DVTs, treatment at home with low molecular weight heparin was less costly than hospital treatment with standard heparin. ... 

Warfarin is used as an anticoagulant for preventing and treating deep venous thromboses and pulmonary embolism. Synonyms of this drug are cumadin, panwarfm, sofrain, wamerin, and others. 

Resistance Increased resistance to the drug is frequently encountered in fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies. Ml, cancer, and postoperative states. 

Cardiovascular effects Too vigorous a diuresis, as evidenced by rapid and excessive weight loss, may induce an acute hypotensive episode. In elderly cardiac patients, avoid rapid contraction of plasma volume and the resultant hemoconcentration to prevent thromboembolic episodes, such as cerebral vascular thromboses and pulmonary emboli. 

Intravascular thrombosis As with other immunosuppressive therapies, arterial or venous thromboses of allografts and other vascular beds have been reported. 

First, the protocol may induce the detection of extra cases - cases that would have gone undetected if no protocol were used in the usual care of patients. These cases may be detected earlier than they would have been in usual care. In the prophylaxis example above, repeated testing of all patients is likely to increase the number of deep vein thromboses that are detected, especially if, in usual care, patients are only tested when they develop clinical signs of deep vein thromboses. This extra or early detection may also reduce the average costs for each case detected, because subclinical cases or those detected early may be less costly to treat than clinically detected cases. However, because these two potential biases - more cases, each of which may cost less -work in opposite directions, the total costs of care for patients in the trial may or may not exceed those that would occur in usual care. 

Digital necrosis. An 18-year-old woman, with a history of severe anorexia nervosa of 5 years duration, who acknowledged regular use of tobacco and cannabis, was hospitalized for necrosis of the left index and thumb that had occurred shortly after left radial artery puncture for blood gas analysis. Acrocyanosis of the four limbs had been present since the onset of anorexia nervosa. Arteriography of the upper limbs showed major spasm of the left radial and cubital arteries and thromboses in the left interdigital arteries of the left index and thumb. The distal portions of the arteries were then on the left and on the right. The necrotic lesions healed after intravenous administration of ilomedine and interruption of tobacco and cannabis. Acrocyanosis of the four limbs persisted . 

The rare earth elements are physiologically inert and therefore present no danger to the environment. The tro pharmaceutical applications vhich go back to the thirties are based primarily on the anions or corresponding salts rather than on the effect of the rare earth metals ceriumoxalate as treatmoit for seasickness and Nd-isonikotinate as treatment for thromboses. 

Material of the catheter Number of implantations Number of thromboses... 

At present, the binary water-soluble preparation of heparin and proteolytic enzymes is being applied for the treatment of thromboses. For instance, injection into the bloodstream of heparin-plasmin complex or a heparin-plasmin-streptokinase preparation leads to the total dissolution of the thrombus, while if introduced separately, heparin and streptokinase do not display the lytic action at all, and plasmin, alone or together with streptokinase, dissolves the thrombus only partially 132>. The treatment of acute thrombophlebitis with trypsin resulted in a full dissolution of the thrombus and in an increase of antithrombin III in the blood 133). Administration of trypsin together with heparin has an effect similar in efficiency to the action of the heparin-plasmin complex 134>. The use of a mix of heparin and urokinase for improving tbrom-boresistance of polymeric materials was also described 13S). These substances were immobilized by preliminary coating of the surface of a polymer with a graphite layer and subsequent adsorption of heparin and the enzyme. 

Tisman G. Thromboses after estrogen hormone replacement, progesterone or tamoxifen therapy in patients with elevated blood levels of homocysteine. Am J Hematol 2001 68(2) 135. 

Yarrow possesses diaphoretic, antipyretic, hypotensive, astringent, diuretic, and urinary antiseptic properties. Traditionally, it has been used for fevers, common colds, essential hypertension, amenorrhea, dysentery, diarrhea, and specifically for thrombotic conditions with hypertension, including cerebral and coronary thromboses. 

Tochilin V.P., I. Voronkov, and A.V. Mazaev. 1982. Use ofimmobilized streptokinase (streptodecase) for treating thromboses. 

Hepatic venous thrombosis, also known as Budd-Chiari syndrome, is caused by hypercoagulable disorders precipitated by pregnancy, infection, and birth control medication. An acute painful abdomen, sudden enlargement of the liver, and the presence of ascites make up a triad of clinical symptoms that are important in the diagnosis of this syndrome. Myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal dyspnea were previously thought to be responsible. Factor V Leiden and prothrombin 20210 mutations are also known to be responsible, Other intraabdominal thromboses include portal vein thrombosis, mesenteric vein thrombosis and renal vein thrombosis. 

Some white cells and mural thrombus were also observed. It that there were no stent thromboses nor significant differ-... 

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