ISSN:1424-8832    

DOI:10.1159/000217474

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Traditional risk factors, e.g. hyperlipidemia, cigarette consumption, blood pressure, family history, and diabetes, predict < 50% of all future cardiovascular events. This paper reviews the use of novel hemostatic and thrombotic markers, such as intrinsic fibrinolysis and systemic micro-inflammation, for the prediction of the risk of arterial thrombotic disease. It has been hypothesized that relative abnormalities in the hemostatic and thrombotic systems are common on a population basis, and that they predispose certain individuals to clinically pathologic thrombosis. Abnormal levels of fibrinolytic parameters have been shown to predict future cardiovascular events, and tissue-type plasminogen activator antigen appears to be the most useful of these markers. Low-grade chronic inflammation may play an important role in athero-genesis. Of the newer inflammatory parameters, C-reactive protein has been the best studied and evidence suggests that elevated levels of C-reactive protein can predict the future risk of both myocardial infarction and stroke, both in healthy individuals and in patients with known coronary artery disease. Results from clinical trials to evaluate whether modification of novel risk factors results in a net clinical benefit are limited at present. However, novel markers will probably provide new directions in both thrombosis research and disease prevention.

ISSN:1424-8832    

DOI:10.1159/000217475

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The aim of the study is to determine if a novel thrombophilia mechanism (factor V Leiden) that is associated with resistance to activated protein C (APC) is in itself a risk factor for the development of ischemic stroke (IS). Sixty-six controls and 66 patients with IS were included in an unmatched case-control study. In the group of patients selected for this study, other causes of IS were ruled out. APC resistance was considered if activated partial thromboplastin time (aPTT) measured in the presence of APC was less than 2.2 times prolonged when compared to aPTT in the absence of APC (APC ratio < 2.2). Digestion with a restriction enzyme of a previously amplified exon 10 of the gene that encodes for factor V was used to detect the presence of the factor V mutation. We identified 5 patients (prevalence: 7.5%) with APC resistance (mean age: 31 years, range: 6-52 years). Mutation in factor V gene was confirmed in three of them. In the control group we detected 3 (4.5%) low APC ratios, all of them carrying specific factor V mutation. We cannot conclude a significant association between APC resistance and IS [odds ratio: 1.72; χ2 Mantel and Haenszel was 0.53 (p = 0.4673) and exact Fisher’s test p = 0.3589] but these 5 young adults suffered an episode of IS having APC resistance as the only prothrombotic condition. In conclusion, these results cannot prove a statistical association between APC resistance and IS. Further studies must be done in order to confirm that there is no relationship between APC resistance and IS in young adults when major risk factors are exclud

ISSN:1424-8832    

DOI:10.1159/000217428

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Arterial thrombosis in the acute coronary syndromes is precipitated by plaque disruption. This occurs in lesions with a large lipid core, a thin fibrous cap, macrophages infiltrating the fibrous cap, and a lipid core with a high tissue-factor content. This results in acute platelet deposition and rapid growth of mural thrombus which unfavorably influences the rheology of blood flow to produce more thrombus, and propagates additional thrombosis by the high thrombogenicity of the mural thrombus overlying the disrupted culprit arterial lesion. Acute therapy in the hospital and subacute therapy beyond the hospital phase for as long as 1.5-3 months with aspirin plus anti-coagulation, such as low-molecular-weight heparin, or oral anticoagulation, reduces thrombotic occlusion, myocardial infarction, death, and need for coronary revascularization.

ISSN:1424-8832    

DOI:10.1159/000217477

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Endotoxin infusion (lipopolysaccharide from Escherichia coli 120 μg kg–1 i.v.) was titrated to produce hypercoagulability in rabbits and the effects of prostacyclin (PGI2) treatment (continuous infusion of 6 ng kg–1 min–1 i.v.) on coagulation variables, cardiorespiratory variables, and fibrin deposition in the microcirculation of vital organs were studied. PGI2 infusion did not influence the concentration of soluble fibrin, throm-belastographic variables, or systemic platelet aggregability. Fibrin deposition in the microcirculation of the liver and the lungs was reduced to 50% of that observed in untreated animals (p < 0.01). The antiplatelet properties of PGI2 were unable to reduce experimental endotoxin-induced systemic procoagulant turnover but improved organ perfusion during the initial phase of disseminated intravascular coagu

ISSN:1424-8832    

DOI:10.1159/000217429

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Thrombosis is responsible for most acute manifestations of coronary artery disease, including unstable angina and non-Q-wave myocardial infarction (MI). Antiplatelet therapy plays a major role in reducing the risk of ischaemic events in such patients. Since thrombin generation is key in the pathogenesis of thrombosis, recent studies have focussed on thrombin inhibition in the management of acute ischaemia. Heparin is the most widely used anticoagulant for acute management of thrombosis and is the treatment of choice in the prevention and treatment of venous thrombo-embolism. Heparin given in therapeutic doses intravenously has been shown to be more effective than aspirin at reducing the risk of death or MI in patients with unstable angina. Low-molecular-weight heparins (LMWHs) have improved pharmacologic and pharmacokinetic properties over standard heparin that may result in greater efficiency and safety. LMWH may be given in fixed doses subcutaneously without monitoring, resulting in greater clinical utility and cost-effectiveness compared with standard heparin. A number of LMWHs – dalteparin, enoxaparin and nadroparin – have been evaluated in unstable angina. In a small open trial, nadroparin reduced the risk of ischaemic outcomes compared with aspirin alone or a combination of aspirin and standard heparin. Dalteparin has been evaluated in two large clinical trials in the management of unstable angina. The Low-Molecular-Weight Heparin (Fragmin) During Instability in Coronary Artery Disease (FRISC) trial showed that dalteparin resulted in a 63% reduction in risk of death or acute MI compared with aspirin alone. The Fragmin in Unstable Coronary Artery Disease (FRIC) trial showed that dalteparin was as effective as intravenous heparin. Enoxaparin resulted in a statistically significant 16% reduction in the combined outcome of death, MI and recurrence of angina in comparison with standard heparin in the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) trial. There is accumulating evidence that LMWHs are safe and effective alternatives to standard heparin in unstable coronary artery disease and that they offer practical and therapeutic advanta

ISSN:1424-8832    

DOI:10.1159/000217478

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In the last few years, several assays have been developed that permit the evaluation, with a high degree of sensitivity, of the level of activation of the coagulation system. Some of these tests have been used in cancer patients, in an attempt to monitor the risks of tumour progression and the development of thromboembolic complications. Even though coagulation activation markers are often abnormally elevated, the results available so far do not indicate that they are useful in the clinical management of individual cancer patients.

ISSN:1424-8832    

DOI:10.1159/000217479

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Patients with cancer are at increased risk for venous and arterial thromboembolism and the principal interventions in such patients – surgical operation, chemotherapy or venous catheterization – heighten this risk. Thromboprophylaxis is indicated in cancer patients undergoing surgical operation and there is also evidence that thrombopropylaxis appears beneficial during chemotherapy, particularly for breast cancer, and possibly for ovarian and pancreatic carcinoma. Low-molecular-weight heparins (LMWHs) have shown promise as a thromboprophylactic agent in oncology patients, and offer significant benefits over standard heparin because of their improved safety profile and ease of use. There is emerging evidence that LMWHs may also favourably influence survival, possibly as a result of direct anti-tumour effe

ISSN:1424-8832    

DOI:10.1159/000217480

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

This study assessed the effects of the angiotensin-converting enzyme (ACE) inhibitor cilazapril on the main haemostatic variables in 22 patients, of either sex, with newly diagnosed uncomplicated essential hypertension. In the patients and in 10 control subjects, plasma levels of thrombomodulin, β-thromboglobulin, D-dimer, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) had previously been measured. Only the levels of t-PA and PAI-1 were found to be higher than in controls. All these haemostatic evaluations were carried out after 6 and 12 months of treatment with an ACE inhibitor, cilazapril, 5 mg/day. This treatment significantly lowered the mean arterial pressure in the whole group from 133 to 106 mm Hg (after 6 months) and to 105 mm Hg (after 12 months), p < 0.05. No significant difference in any haemostatic parameters was observed after 6 and 12 months of treatment. The present study confirmed that treatment with cilazapril for 12 months lowers daytime ambulatory mean arterial pressure in patients with essential hypertension, without any significant increase in the tendency of blood to clot

ISSN:1424-8832    

DOI:10.1159/000217431

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Cancer patients are in a hypercoagulable state. The pathogenesis of thrombosis in malignancy is multifactorial with mechanisms including release of procoagulants by tumour cells, comorbid predisposing factors (bed rest, infection, surgery, etc.) and anti-cancer drugs. Cancer patients with established venous thromboembolism are more likely to develop recurrent venous thromboembolism during treatment with oral anticoagulants. This paper reviews the use of heparin for the treatment of thrombotic disorders in cancer patients. Treatment of acute venous thrombosis comprises initial heparin administration, which for a cancer patient should last for at least 5 days, followed by administration of oral anticoagulants. Low-molecular-weight heparins (LMWHs) have been shown to be as safe and effective as standard heparin for the treatment of acute deep vein thrombosis. Recent meta-analyses have revealed lower mortality rates with LMWH than with standard heparin, indicating that LMWH may exert an inhibitory effect on tumour growth that is not observed with standard heparin.

ISSN:1424-8832    

DOI:10.1159/000217481

出版商:S. Karger AG    

年代:1997

数据来源: Karger