11/23. Rescue in situ thrombolysis for acute coronary thromboembolism in an angiographically normal coronary artery.Coronary thromboembolism in an angiographically normal coronary artery is extremely uncommon. There are few instances where normal coronary arteries have been documented just prior to an episode of acute thromboembolic insult. We now report such a case of acute coronary thromboembolism in a patient with widely patent coronary vessels documented just prior to the event during preoperative screening angiogram with successful in situ revascularization.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
12/23. Heparin-induced thrombocytopenia: clinical manifestations and management strategies.thrombocytopenia is a relatively frequent and usually benign clinical complication of heparin therapy. However, some patients receiving heparin and heparin-based products experience an immune-mediated reaction due to the development of heparin-induced antibodies. This reaction leads to a highly specific and paradoxical form of thrombocytopenia, known as type II heparin-induced thrombocytopenia (HIT). Unlike other types of drug-induced thrombocytopenia, HIT promotes thrombosis rather than bleeding; therefore HIT should be suspected in patients who experience thrombotic events despite adequate anticoagulation therapy. Early identification and treatment of HIT can prevent more serious complications associated with this disorder (e.g., exacerbation of venous thromboembolism, limb gangrene, and skin necrosis). Both arterial and venous thrombosis can arise from a single episode of HIT. Routine assessment of platelet counts is necessary with heparin therapy, as a decreased platelet level is usually the only indication of HIT. Although compared with unfractionated heparin, low-molecular-weight heparin therapy is less likely to result in HIT, the use of these agents is contraindicated in HIT patients. Concomitant warfarin therapy is not contraindicated in such patients but must be carefully monitored. Treatment with a direct thrombin inhibitor, such as lepirudin or argatroban, is an effective strategy in reversing the thrombocytopenia associated with HIT and reducing its complications. This article discusses the clinical syndrome of HIT, including pathophysiology, diagnostic criteria, clinical presentations, and current available management strategies in the context of 2 case studies.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
13/23. Thyrotoxic atrial fibrillation.atrial fibrillation is the most common cardiac complication of hyperthyroidism and occurs in 15% of patients with hyperthyroidism. It is associated with a higher risk of thromboembolism that often involves the central nervous system. Oral anticoagulation is important in the majority of these patients to prevent thromboembolic complications. These patients require adjustment in the dose of various rate-controlling agents because of increased clearance associated with hyperthyroidism and a decrease in warfarin dosage because of increased clearance of vitamin k-dependent clotting factors. The management of thyrotoxic atrial fibrillation is summarized in this clinical review.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
14/23. Massive subchorionic hematoma associated with enoxaparin.BACKGROUND: The use of low-molecular-weight heparins is increasing for the prevention of thromboembolism in pregnancy. Subchorionic hematoma as a complication of anticoagulation therapy is rarely reported. CASE: A persistent, massive subchorionic hematoma was diagnosed in a pregnant patient with atrial fibrillation and mitral stenosis. enoxaparin was administered to maintain her trough anti-Xa level 0.5 units/mL or higher. The patient's peak anti-Xa levels never exceeded 1.05 units/mL. The patient underwent cesarean delivery at 34 6/7 weeks of gestation for preterm premature rupture of membranes. CONCLUSION: Subchorionic hematoma is a potentially serious complication that can occur in pregnant patients receiving enoxaparin for the prevention of thromboembolism.- - - - - - - - - - ranking = 0.33333333333333keywords = thromboembolism (Clic here for more details about this article) |
15/23. Anticoagulation in atrial fibrillation.Thromboembolic complications are a major problem in patients with atrial fibrillation. This vignette presents the probabilities of thromboembolism in the various etiologies of atrial fibrillation and prophylactic management with anticoagulants.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
16/23. Renal infarction.A 43-year-old woman complaining of left flank pain was found to have renal infarction. New-onset atrial fibrillation suggested thromboembolism, which was confirmed by retrograde urogram and intravenous pyelogram. The patient was treated with heparin and was discharged on coumadin after evaluation of her cardiac disease.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
17/23. thrombocytopenia and low-dose heparin.We present two cases in which thrombocytopenia developed during low-dose heparin therapy. They seem to represent the spectrum of heparin-associated thrombocytopenia described by Carreras. Because of the increasing use of low-dose heparin for thromboembolism prophylaxis, and because patient reexposure to heparin is not uncommon, the identification of even a modest fall in platelet count in association with heparin therapy is important.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
18/23. Anticoagulation and atrial fibrillation. Putting the results of clinical trials into practice.The thromboembolic risk of atrial fibrillation varies with the underlying cause, associated heart disease, and history of previous embolism. Decisions regarding warfarin anticoagulation therapy require a careful assessment of relative risks of thromboembolism and bleeding. Anticoagulation is strongly indicated for valvular atrial fibrillation and to prevent recurrent stroke in patients with atrial fibrillation and previous stroke or transient ischemic attack. Several randomized trials have consistently shown a reduction of the risk with the use of warfarin in nonvalvular atrial fibrillation, and anticoagulation is recommended. With a careful selection of patients, the risk of major bleeding on warfarin therapy is 2% to 4% per year. aspirin therapy is less efficacious but also less risky than warfarin. patients younger than 60 with lone atrial fibrillation do not require anticoagulation.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
19/23. Embolic stroke after unanticoagulated cardioversion despite prior exclusion of atrial thrombi by transoesophageal echocardiography.Recent studies in patients with atrial fibrillation, not on anticoagulation, suggest that if transoesophageal echocardiography (TEE) excludes the presence of thrombi, early cardioversion can be performed safely without the need for anticoagulation before the procedure. Immediately after successful cardioversion, however, left atrium or left atrial appendage stunning may be present, potentially carrying a risk for de novo thrombus formation. Furthermore, the presence of spontaneous contrast is considered as a contraindication for unanticoagulated cardioversion since it has been associated with postcardioversion thromboembolism. We present a case in which stroke developed in relation to unanticoagulated cardioversion regardless of careful prior evaluation with TEE.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
20/23. The Maze procedure: surgical therapy for refractory atrial fibrillation.Although atrial fibrillation is well tolerated by most patients, in some patients the consequences may be severe. The Maze procedure is a new open-heart operation that creates a carefully designed maze of incisions in the atrial myocardium; this maze then acts as an electrical conduit to channel atrial impulses from the sinoatrial node to the atrioventricular node. The Maze procedure has been shown to restore sinus rhythm and atrial systole (thus reducing the risk of thromboembolism), improve hemodynamics, alleviate palpitations, and eliminate the need for antiarrhythmic and anticoagulant drugs. We describe our first patient to undergo this operation.- - - - - - - - - - ranking = 0.16666666666667keywords = thromboembolism (Clic here for more details about this article) |
| <- Previous || Next -> |