Coronary Artery Disease: Role of Antithrombotic Therapy *
Hau C. Kwaan, Meyer M. Samama in Clinical Thrombosis, 2019
Recent evidence from our laboratory has shown that thrombosis occurring in the setting of plaque disruption is a dynamic process of coagulation combined with platelet aggregation and disaggregation. The equilibrium is shifted one way or the other by the relative balance between pro- and antithrombotic tendencies (i.e., the depth of injury). Disaggregating platelets may break free, resulting in downstream microemboli suggested by some to have a role in ischemic sudden death. Even when such microembolism occurs, rethrombosis is common due to persistence of a thrombogenic substrate and abnormal hemorheology.13 It appears likely that in the acute coronary syndromes multiple cycles of thrombotic occlusion and spontaneous thrombolysis may occur, with vasoconstriction also acting to promote arterial occlusion.14 Thus, plaque rupture with thrombosis results in a clinical spectrum which may manifest as worsening angina pectoris, unstable angina, myocardial infarction, or ischemic sudden death, depending, as we have suggested, upon the degree of obstruction caused by the thrombus, the duration of obstruction, and the suddenness of the obstruction.15
Venous Thromboembolic Disease
James M. Rippe in Lifestyle Medicine, 2019
Distal thrombosis of the extremities that have occurred with or without a potentially modifiable risk factor does not uniformly require anticoagulation. The decision to treat these patients with anticoagulation should be based on an evaluation of the patient’s symptoms, the risk of adverse bleeding events, and risk of recurrence or progression of clot conferred by their medical history. An approach to patients with distal DVT includes performing serial duplex ultrasounds of the lower extremities for a period of two weeks off of anticoagulation. An absence of symptoms or clot progression over this surveillance interval suggests that the patient is at low risk for embolization or clot propagation. Candidates most likely to benefit from such a treatment plan will have a good cardiopulmonary reserve, small distal clot, and no concurrent pulmonary embolism.81 Current guidelines recognize that shared decision making may result in a higher value being placed on definitive therapy rather than a period of uncertainty, and this cohort of patients is likely at low risk of serious bleeding events with anticoagulation.82
Musculoskeletal trauma
Ian Greaves, Keith Porter, Chris Wright in Trauma Care Pre-Hospital Manual, 2018
Splinting limbs has a number of benefits: Anatomical or near anatomical reduction is usually the most comfortable position for the limb.Ongoing blood loss from fracture sites (including open fractures) is reduced.Relocation of the periosteum prevents the release of ongoing inflammatory mediators, which contribute to ongoing pain, neurological damage and help to drive coagulopathy.The risk of fat embolism is reduced.Packaging of the patient for transport is facilitated.
Ischemia of the fingers after carpal tunnel syndrome treatment
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Niels H. Bosma, Tjeerd R. de Jong
After two weeks the patient complained mainly of an intense cold-intolerance of the affected fingers. The marbled aspect of the fingers was unchanged. However, closer inspection of the nails showed massive splinter hemorrhages in the ulnar three digits (Figure 2). An angiography was performed to rule out an active cause of micro-embolism. This showed a curved aspect of the ulnar artery at the level of the distal radio-ulnar joint (DRUJ) (Figure 3(A)). No aneurysmatic changes or vascular wall irregularities were identified, but decreased contrast filling of the digital arteries of the ulnar three fingers was obvious (Figure 3(B)). Some sudden stops distally in the digital arteries confirmed the assumption of microembolic occlusion by steroid particles. A carpal tunnel release was performed several months after the event. With cold intolerance as the only lasting complaint, the patient was discharged from further follow-up.
Diagnostic approach to neuropsychiatric lupus erythematosus: what should we do?
Published in Postgraduate Medicine, 2018
Enrico Maria Zardi, Chiara Giorgi, Domenico Maria Zardi
Another important diagnostic property of TCDS is the ability to detect the presence of right to left shunting through the individuation of paradoxical embolism due to a patent foramen ovale. To detect or exclude microembolic signals in the cerebral arteries an ultrasound contrast medium is injected in the upper limb veins; in patients with right to left shunt, it will give typical artifacts in middle cerebral artery Doppler tracing while, in patients without, any signal will be recorded. According to some authors, the presence of cerebral microembolism has been related to the appearance of some neurologic manifestations in NPSLE [95,96]. An interesting study showed encouraging values of sensitivity (68.7%) and specificity (86%) in detecting cerebral micrombolism in NPSLE patients by means of TCDS [96]; in other studies the values of sensitivity were lower, ranging from 20% to 36% [80,95,97].
Liquid biopsy markers for stroke diagnosis
Published in Expert Review of Molecular Diagnostics, 2020
Harshani Wijerathne, Malgorzata A. Witek, Alison E. Baird, Steven A. Soper
The main cause for AIS is fatty deposits on vessel walls called atherosclerosis. Cerebral thrombosis is a thrombus or a blood clot that will develop overlying the fatty plaque within the blood vessel while cerebral embolism is a blood clot that forms at another location in the circulatory system (Table 1). These are usually formed in heart and large arteries of the upper chest and neck. These blood clots break loose, enter the bloodstream, and move to the brain’s vessels until they reach one that is too small to let it pass creating an obstruction for blood flow. Irregular heartbeat, which is called atrial fibrillation, is one of main reasons of embolism that causes these clots to form in the heart [11]. Additional causes of AIS are small vessel disease and less frequent etiologies such as arterial dissection, other vasculopathies, cardiac diseases (e.g. mechanical heart valve with superimposed thrombus) and hypercoagulable disorders. Symptoms for AIS and ICH include trouble with speaking and understanding, experience of confusion, and slur of words. Also, sudden numbness, weakness, or paralysis in the face, legs or arms can develop, which usually takes place in only one side of the body and face. Patients may also have blurred or blackened vision in one or sometimes both eyes.
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