1,721,229 research outputs found
TB-402 for the prevention of venous thromboembolism in orthopaedic surgery: Something new and promising, or not?
No full textEpidemiology of budd-chiari syndrome
No full textBudd-Chiari syndrome (BCS) is a rare but severe liver disorder, with low incidence and prevalence in the general population. The incidence reported in the literature ranges from 0.2 to 4.1 cases per million inhabitants per year, with an estimated prevalence of 2.4-7.7 per million inhabitants in Asian countries and of 1.4-4.0 per million inhabitants in Western countries. A predominance of females was reported in the West (52-69%), while in Asian studies males were more frequently affected (48-70%). Patients with BCS tend to be younger than patients with splanchnic vein thrombosis in other sites or venous thromboembolism, with wide variability reported in different countries (e.g. Pakistan, Nepal, Egypt mid-twenties vs USA, Australia, Italy and Denmark in the late-40s/early-50s). Finally, prevalence of BCS in patients with different risk factors (such as myeloproliferative neoplasm, paroxysmal nocturnal haemoglobinuria, Behçet’s disease or liver diseases) is highly variable
How to manage splanchnic vein thrombosis in patients with liver disease
No full textLiver cirrhosis and splanchnic vein thrombosis (SVT) are strictly correlated. Portal vein thrombosis, the most common location of SVT, is frequently diagnosed in liver cirrhosis (pooled incidence 4.6 per 100 patient-years), and liver cirrhosis is a common risk factor for SVT (reported in 24%-28% of SVT patients). In cirrhosis-associated SVT, anticoagulant treatment reduces mortality rates, thrombosis extension, and major bleeding, and increases the rates of recanalization, compared to no treatment. Achieving vessel recanalization improves the prognosis of cirrhotic patients by reducing liver-related complications (such as variceal bleeding, ascites, hepatic encephalopathy). Anticoagulation should be therefore routinely prescribed to cirrhotic patients with acute SVT unless contraindicated by active bleeding associated with hemodynamic impairment or by excessively high bleeding risk. Of note, early treatment is associated with higher probability of achieving vessel recanalization. The standard treatment consists of low-molecular-weight heparin, followed by oral anticoagulants (eg, vitamin K antagonists or direct oral anticoagulants), if not contraindicated by severe liver dysfunction. Cirrhotic patients with SVT should be treated long-term (especially if candidate for liver transplantation) since liver cirrhosis is a persistent risk factor for recurrent thrombosis. In this review, we discuss the management of SVT in patients with liver cirrhosis, with a focus on the anticoagulant treatment in terms of indications, timing, drugs, duration, and particular scenarios, such as gastroesophageal varices and thrombocytopenia
Timing of anticoagulation for portal vein thrombosis in liver cirrhosis: An Italian internist's perspective
Full text linkApproach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis
No full textSplanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are two manifestations of unusual site venous thromboembolism (VTE). SVT includes thrombosis in the portal, mesenteric or splenic veins, and the Budd–Chiari syndrome. CVT encompasses thrombosis of the dural venous sinuses and thrombosis of the cerebral veins. Unusual site VTE often represents a diagnostic and therapeutic challenge because of the heterogeneity in clinical presentation, the limited evidence available in the literature on the acute and long-term prognosis of these diseases, and the lack of large randomized controlled trials evaluating different treatment options. This narrative review describes the approach to patients with SVT or CVT by examining the diagnostic process, the assessment of potential risk factors and the appropriate anticoagulant treatment
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
Anticoagulant therapy for splanchnic vein thrombosis: recent updates for patients with liver cirrhosis
No full textIntroduction: Liver cirrhosis is accompanied by several hemostatic alterations, which contribute to the current theory of “rebalanced hemostasis.” Splanchnic vein thrombosis (SVT) is a frequent complication of liver cirrhosis (17–26% of the cirrhotic patients), and liver cirrhosis is a common risk factor for SVT (24–28% of SVT cases). Areas covered: This narrative review aims to describe the current state of the art on the anticoagulant treatment of cirrhotic SVT, with a particular focus on the possible role of the direct oral anticoagulants (DOACs) and recent guidelines on this topic. Expert opinion: Early anticoagulant therapy is recommended in cirrhotic patients with acute SVT, to obtain vessel recanalization and decrease the rates of portal hypertension-related complications. Gastroesophageal varices do not represent a contraindication to anticoagulation, if adequate prophylaxis of variceal bleeding is established, and varices band ligation can be safely performed without the need to stop the anticoagulant treatment. The conventional treatment of cirrhotic SVT consisted of low molecular weight heparin, as initial treatment of choice, eventually followed by vitamin K antagonists, but the DOACs can be considered as a reasonable alternative in patients with compensated liver cirrhosis
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