1,721,039 research outputs found
Central Retinal Vein Occlusion and Prothrombotic Factors
No full textRetinal vein occlusion (RVO) is an important cause of visual loss.
Known risk factors are hypertension, diabetes mellitus, hyperlipidaemia, open angle glaucoma and abnormalities of haemostatic factors and blood viscosity.
The aim of our study was to identify any relationships between RVO and fibrinolytic-coagulative pattern in patients affected either by metabolic disorders or not
Methods: 50 patients (22 male, 28 female) affected by RVO underwent a study of metabolic, coagulative and fibrinolytic parameters.
All patients were not submitted to any previous ocular theraphy before the episode of RVO.
After a complete ophtalmologic evaluation, blood was collected to perform various laboratory tests:
Enzymatic-colorimetric: glicaemia, total-cholesterol (TC), HDL-cholesterol (HDL-C), Tryglicerides (TG), Antitrombin III (ATIII), Protein C and S (PC, PS), Alpha-2-antiplasmin (A2P), Plasminogen (PL). ELISA: D-dimer (DD), tissue plasminogen activator and inhibitor (t-PA, PAI-1), thrombin activable fibrinolysis inhibitor (TAFI), Soluble P and E selectin (sP-sel, sE-sel), vonWillebrand factor (vWF), fragment 1+2 (F1+2), lipoprotein (a) [lp(a)]. Coagulative: Protein C resistance (APCR), Factor VII and VIII (VII, VIII). HPLC: Homocysteine.
Our data show a decreased fibrinolytic power in 43/50 subjects (86%) (ELT 318±36 min, PAP 107±19 ug/l).
PAI-1 was 21.4±4.2 UI/l in the general population with differences between diabetic and dyslipidaemic subjects and not-metabolic patients.
1 patients suffered from low ATIII levels (60%), none had PC, PS deficiency or APCR.
2 not-metabolic subjects had increased Lp (a) and impairment of fibrinolysis.
Hyper Hc (21.6±3.1umol/l) was detected in 4 subjects
TAFI and sP-sel were increased in patients (4) with type IIa hyperlipidemia.
sE-sel and vWF were particularly increased in dysmetabolic subjects (diabetes and Hyper TG or low HDL-C).
A prothrombotic state involving defects in coagulative and fibrinolytic factors has been previously associated with the onset of RVO.
Our data show that a fibrinolytic impairment is the most common feature in such patients regardless dysmetabolic or not associated diseases.
Moreover mechanisms leading to fybrinolysis alterations vary between subjects in order to associated metabolic conditions.
Defects in anticoagulant natural proteins or platelet hyperactivity are very rare conditions detected in our population.
Such data suggest that the fibrinolytic system may be an important target of acute treatment and profilaxys in RVO affected patients
Pharmacogenetics of statins therapy
No full textCardiovascular disease has become the global leading cause of death worldwide, representing the most frequent cause of morbidity and mortality in the developed world. Statins, the most widely prescribed cholesterol-lowering drugs, are considered to be first-line therapeutics for the prevention of coronary heart disease and atherosclerosis. Meta-analyses from several primary and secondary intervention studies have clearly shown that cholesterol-lowering medication, significantly reduces cardiovascular events, mortality, and morbidity, but considerable interindividual variation exists in response to statin therapy. Pharmacogenomics can provide important insights into statins therapy through elucidation of the genetic (or genomic) contribution to variable response for these drugs. The search for genetic polymorphisms may enable us to identify novel determinants of drug responsiveness by means of the study of three candidate genes groups: (1) genes encoding proteins involved in metabolism or drug transport, or both, that influence drug pharmacokinetics; (2) genes encoding proteins involved in mechanism of action and/or metabolic pathways on which drugs operate (that influence pharmacodynamics); (3) genes encoding proteins involved in the underlying disease condition or intermediate phenotype. This review briefly summarizes the recent pharmacogenomic and pharmacogenetic patents and the potential contributions of genetic variations in candidate genes related to lipid and lipoprotein metabolism and statins efficacy. © 2007 Bentham Science Publishers Ltd
New generation analysis of thrombin generation in retinal vein thrombosis
Full text linkPurpose
To investigate potential mechanisms involved in retinal vein occlusion (RVO) we evaluated thrombin generation and soluble CD40 ligand (sCD40L) with respect to other known thrombophilic factors.
Methods
68 patients affected by RVO (28 central, 40 branch) and 60 healthy controls were evaluated for endogenous thrombin potential (ETP) by a chromogenic method and sCD40L by ELISA technique. Polymerase chain reaction (PCR) was employed for genetic polymorphisms and coagulative/chromogenic methods for othe coagulation factors.
Results
Independently of genetic polymorphisms ETP was increased in patients with CRVO whereas sCD40L was higher in the whole cohort.
Conclusions
Our data indicate an involvement of global coagulative activation in CRVO patients as suggested by ETP
A fatal unsuspected case of acquired A hemophilia. Misleading role of therapy with acetylsalicylic acid?
No full textSafety of long-term simvastatin discontinuation
No full textcomment and reference to personal data concerning the pro-atherothrombotic rebound of simvastatin stoppin
MEDICAL TREATMENT OF CRVO
No full textPurpose:
A disorder of fibrinolytic power is a risk factor for both venous and arterial thrombosis. An hypofibrinolytic state has been described as a common feature in Central Retinal Vein Occlusion (CRVO) affected subjects. Aim of our study was to evaluate the efficacy of a thrombotic-risk assessement related therapy either in acute phase treatment or secondary prophylaxis in CRVO affected patients.
Methods:
Phase A: 60 subjects (28 female, 22 male) were respectively treated with ASA 325 mg/die (19), heparin 12500 to 25000 U/die (16) , and mesoglycan 100 mg/die (25) for one month. Phase B: 35 subjects were treated with ASA 325 mg/die for 6 months and 29 patients with mesoglycan 100 mg/die. The development of new thrombotic events was assessed by fundoscopy at one and six months.
Results:
In phase A 5/19 (26%) subjects in the ASA, 6/16 (37%) in the heparin and 2/25 (8%) (p< 0.001) in the mesoglycan group experienced a new thrombotic event. In phase B 13/35 (37%) in the ASA and 3/29 (10%) (p< 0.001) in the mesoglycan group showed new thrombotic signs.
Conclusions:
Our data suggest that a profibrinolytic treatment in thrombotic risk-profile selected subjects is safe and effective for the therapy and prophylaxis of CRVO when compared to other antithrombotic agents
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Report of two cases of subconjunctival haemorrhage as first sign of post‐pregnancy acquired haemophilia a (AHA)
No full textPurpose: To show that subconjunctival haemorrhage may be the first sign of post-pregnancy acquired A haemophilia (AHA), a potentially fatal bleeding disorder.
Methods: Case reports.
Results: Two thirty-year-old caucasic women at first pregnancy presented slight pain without visual loss 2 weeks after uncomplicated spontaneous full-term delivery. The only clinical findings were a subconjunctival bleeding for both and a small haematoma in the first case. The clinical history was negative for spontaneous bleeding also in infantile age and at previous surgery and no bleeding tendency was observed in the main relatives. The first patient was lost on follow-up and admitted to urgent haemathologic evaluation due to large multiple cutaneous hematomas, a massive deep muscle haematoma, asthenia and dyspnea. In the second case quick routine coagulation labs were performed immediately after the subconjunctival bleeding. In both cases PTT ratio was increased. An extensive study of blood coagulation suggested the presence of a circulating inhibitor against factor VIII [1,2], confirming the diagnosis of AHA. First case was treated with a bypassing agent, however the eradication was obtained only with immunosuppressive therapy. Second case was initially placed in close follow-up, since the post-pregnancy form is often self-limiting, however an immunosuppressive therapy was set after clinical progression due to the appearance of spontaneous hematoma.
Conclusions: AHA is a relevant acquired bleeding disorder that can be fatal if not quickly recognized and treated even when the initial clinical signs are minor [3], how it can happen in post-pregancy mainly in the first month [4]. Since it may present as spontaneous subconjunctival haemorrhage, routine hemathological and coagulation labs should be performed to exclude this serious condition or once identified, allow for proper clinical management
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