1,721,174 research outputs found
When an optimal control of hemostasis is fundamental: a case report of patient with simultaneous acquired FVIII deficiency and venous thromboembolism
No full textContinuous infusion of rFVIII:a good choice for mild hemophiliac patient undergoing major oncologic surgery and reconstructive plastic surgery
No full textPractical use of intermittent pneumatic compression as thromboprophylaxis in neurosurgery
No full textMost patients undergoing neurosurgery are considered at increased risk for venous thromboembolism (VTE). Several studies have demonstrate that intracranial surgery, malignancy, leg weakness, prolonged procedures and advanced age can to increase VTE. Use of thromboprophylaxis is recommended to avoid this risk. Low molecular weight heparin (LMWH), low dose unfractionated heparin (LDUH), intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) are commonly used as VTE prophylaxis. This article wants to show the practical use of IPC in neurosurgery, following the guidelines developed by American College of Chest Physicians (ACCP) and used by the most important medical societies such as American Association of Neurological Surgeons (AANS) and European Association of Neurosurgical Societies (EANS). Several studies have demonstrated that IPC use is effective as LMWH, safe and economic
PdFVIII/VWF may be an alternative treatment for old medical patient with acquired haemophilia A and systemic vascular disease?
No full textAcquired Haemophilia is a severe, rare and potentially life-threatening bleeding that affects both males and females with an incidence of 1.5. cases/million/year. Mucocutaneous haemorrhages or haematomas are the typical expression of this disease as a consequence of a decrease in FVIII activity and the presence of a FVIII inhibitor, which differs from congenital haemophilia. We report a case of a 71. year-old-man who presented with spontaneous haematomas and severe anaemia and suffered from vascular disease. At admission, all haemostatic and laboratory data were diagnostic for idiopathic AHA. Treatment with by-passing agents such as rFVIIa was contraindicated because of the risk of thromboembolic events. Despite the fact that administration of FVIII concentrates in AHA is recommended only in patients with an inhibitor titre. <. 5.0. BU, the physicians decided to use pdFVIII/vWF with corticosteroids in this patient. One month later, the FVIII was within the normal range and the inhibitors had disappeared. In our case, pdFVIII/vWF resulted in a safe and effective alternative for the treatment of acquired haemophilia A in a patient at high thromboembolic risk. © 2012 Elsevier Ltd
Intracranial haemorrhage in children and adults with haemophilia A and B: A literature review of the last 20 years
No full textIntracranial haemorrhage (ICH) is the most serious event in haemophiliacs, resulting in high rates of mortality and disability. Although the use of a prophylaxis regimen has improved outcomes, the mortality caused by ICH is still around 20%. ICH is more frequent at two different ages: in childhood (mostly in children aged ≤2 years) and in adulthood (with known risk factors such as hypertension and age ≥60 years). Our review shows how ICH remains one of the worst problems of patients with haemophilia. Greater attention to risk factors and early symptoms, together with an appropriate early prophylaxis, may reduce the risk of severe intracranial haemorrhagic events
Savings without changing: How to use the MyPKfit® device to improve treatment strategies in a cohort of patients with haemophilia A
No full textBackground: The real goal on haemophilia treatment is to combine efficacy, safety, improvement in quality of life and cost-savings. Sometimes the choice for reaching this result is to switch the patients to an extended half-life (EHL) drug. In case of haemophilia A this goal is not always achieved due to the less pharmacokinetic (PK) differences among EHL and standard concentrates. A better and regular use of available tools, as MyPKfit®, can then optimize the treatment without distorting therapy or changing concentrate. Methods: We now report our experience with a population of severe or moderate haemophilia A patients treated with octocog-alfa (Advate® –Shire Takeda) and in which a tailored prophylaxis with MyPKfit® has been assessed. Results: PK evaluations of 14 patients were carried out. A Bayesian curve and a tailored prophylaxis were assessed individually employing PK data. The weekly frequency of infusions was reduced in three severe patients, it was increased in four while it remained the same in the others five patients. The annual consumption of concentrate was reduced in 81.8% of patients. A subsequent economic evaluation carried out for each of the twelve severe haemophilia A patients included in this analysis, in which we have compared the standard and the PK-driven prophylaxis, showed that an optimized treatment can lead to an annual average saving of € 20,525 (−15.8%). Conclusions: The use of MyPKfit® for a tailored prophylaxis may lead to a more rational use of available resources through an easy correction of the treatment strategies without distorting the individual patient therapy
Three cases of successful immune tolerance induction rescue (ITI-R) with three different recombinnt FVIII (rFVIII) in haemophilia A patients and high-titer inhibitors
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Population pharmacokinetics of different clotting factor concentrates in fifty-six patients with severe hemophilia A: a single center experience
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