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Common Clotting Pathway

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121. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Pharmacogenetics-guided Warfarin Dosing

that are interrogated in warfarin response tests. However, homozygosity for rare coding mutations in VKORC1 are a known cause of combined de?ciency of vitamin K- dependent clotting factors-2 (VKCFD2), which is a rare and potentially fatal bleeding disorder that can be reversed by oral administration of vitamin K. 29 Linkinggeneticvariabilitytovariabilityindrug-related phenotypes Common variants in CYP2C9, VKORC1, and CYP4F2 account for up to 18%, 30%, and 11% respectively, of the variance in sta- ble warfarin dose (...) trial.Lancet385, 2280–2287 (2015). 13. Wajih, N., Hutson, S.M., Owen, J. & Wallin, R. Increased production of functional recombinant human clotting factor IX by baby hamster kidney cells engineered to overexpress VKORC1, the vitamin K 2,3- epoxide-reducing enzyme of the vitamin K cycle. J.Biol. Chem.280, 31603–31607 (2005). 14. Wadelius, M.etal. Common VKORC1 and GGCX polymorphisms associated with warfarin dose.PharmacogenomicsJ5, 262–270 (2005). 15. Yuan, H.Y.etal. A novel functional VKORC1 promoter

2016 Clinical Pharmacogenetics Implementation Consortium

122. Clinical practice guideline on Perioperative Care in Major Abdominal Surgery

of the strategies and actions related to patient care from the moment the decision to operate surgically is made until the patient leaves the hospital. It includes a wide range of procedures and practices that are aimed at reducing surgical stress, preventing complications, accelerating patient recovery, and improving the patient’s experience. The CPG on Perioperative Care in MAS answers clinical questions regarding some of these care interventions, in order to offer a series of common directives based

2016 GuiaSalud

123. Cerebrovascular Disease

of the proximal common carotid and distal internal carotid arteries (ICAs), tandem vascular lesions, near occlusion, and heavily calcified vessels. Computed Tomography CT technology continues to improve since its introduction in the early 1970s with improved radiation dose reduction techniques such as iterative reconstruction and tube current modulation as well as reduced scan times secondary to multislice CT technology. CT is used across the spectrum of cerebrovascular diseases. Noncontrast CT (NCCT (...) (DWI), apparent diffusion coefficient (ADC) map, and fluid-attenuated inversion recovery (FLAIR) to evaluate for infarct. Currently, the most common clinical MRI scanners have field strengths of 1.5T and 3T. Increasing field strength leads to increased signal-to-noise ratio, increased susceptibility effects, and increased chemical shift artifact. MRI may be unable to be performed in patients with claustrophobia, morbid obesity, or presence of cardiac device or metal within the patient. Caution

2016 American College of Radiology

124. Guidelines for adult stroke rehabilitation and recovery

). Apathy is mani- fested in >50% of survivors at 1 year after stroke 5 ; fatigue is a common and debilitating symptom in chronic stroke 6 ; daily physical activity of community-living stroke survivors is low 7 ; and depressive symptomology is high. 8 By 4 years after onset, >30% of stroke survivors report persistent participation restrictions (eg, difficulty with autonomy, engagement, or ful- filling societal roles). 9 The Rehabilitation Program Organization of Poststroke Rehabilitation Care (Levels (...) after stroke can be classified as early (beginning within the first few days of stroke) or late. A seizure is most likely to arise during the first 24 hours after stroke onset, is usually partial at onset, and has a variable ten- dency to secondarily generalize. A poststroke seizure is more common with ICH 189 or when the stroke involves cerebral cortex 190 ; seizures in patients with lacunar stroke are rare. 191 Estimates of the percentage of patients having a seizure dur- ing the first few days

2016 American Academy of Neurology

125. Telemedicine quality and outcomes in stroke

of stroke care in the United States began in the early 2000s with the funding of the pilot Coverdell stroke registries and the establishment and rapid expansion of the Get With The Guidelines–Stroke program, which now represents one of the largest ongoing clinical quality registries in the world. , The effort to establish a comprehensive system to monitor and to improve stroke care was accompanied by the establishment of common stroke performance measures. The Stroke Performance Measure Consensus Group (...) hemorrhage. Other less common complications of intravenous tPA that should be recorded are angioedema and systemic hemorrhage. Intracranial Hemorrhage Most publications report symptomatic hemorrhagic intracranial complications but do not use a consistent definition. The National Institute of Neurological Disorders and Stroke, ECASS (European Cooperative Acute Stroke Study), Get With The Guidelines–Stroke registry, and SITS-MOST (Safe Implementation of Thrombolysis in Stroke–Monitoring Study) define

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2016 American Academy of Neurology

126. The diagnosis and management of primary autoimmune haemolytic anaemia

investigation. A clotted sample is also required for investigation of suspected PCH or DIIHA. 3. What type of AIHA is present? Typical serological characteristics of AIHA subtypes are shown in table IV. Although the autoantibody specificity can sometimes be identified, specificity does not help predict the clinical outcome (Issitt, 1985). Warm AIHA. Is caused by autoantibodies (usually IgG) that bind red cells optimally in vitro at 37°C. When tested with anti-C3 and anti-IgG reagents, the DAT would (...) IgG antibody which binds to red cells at low temperature and causes complement mediated lysis as the temperature is raised. The DAT is usually positive to C3 only. There may be agglutination, spherocytes or erythrophagocytosis by neutrophils on blood film. Reticulocytopenia is common early in PCH evolving into reticulocytosis with recovery. PCH can be diagnosed in patients with AIHA and a positive Donath-Landsteiner test. The test can be technically difficult (Sokol et al, 1999) and false negative

2016 British Committee for Standards in Haematology

127. PAR-1 Antagonists: An Emerging Antiplatelet Drug Class

., the legs), resulting in poor peripheral circulation, pain, and difficulty walking. One of the mainstays of therapy in preventing or reducing thrombosis in the event of plaque rupture involves using antiplatelet drugs to prevent platelet aggregation — the early stage of the blood-clotting process. 4-6 The Technology Because there are multiple signaling pathways involved in platelet aggregation, multiple antiplatelet drug classes currently exist to reduce platelet activity. 7 These classes include (...) pathways involved in platelet aggregation, multiple antiplatelet drug classes currently exist to reduce platelet activity. 7 Ischemic heart disease (IHD; otherwise known as coronary artery disease, or CAD) is a type of cardiovascular disease that accounts for a large portion of the morbidity and mortality associated with cardiovascular disease. 2 This condition is characterized by the narrowing of the blood vessels that supply oxygen and nutrients to the heart. More than 90% of myocardial infarctions

2016 CADTH - Issues in Emerging Health Technologies

128. Rapid blood test helps exclude pulmonary embolism for low risk patients

at the accuracy of a simple blood test called a D-dimer added to the usual diagnostic pathway and a clinical prediction rule. The test is already used to indicate the likelihood of related blood clots in the legs. Findings from four studies suggest that a negative D-dimer result effectively rules out the diagnosis, particularly for patients with few risk factors. A positive result is less reliable and may pick up people without the condition, especially in over 65’s. People who test positive will still need (...) diagnostic imaging. Overall a change in the management pathway for suspected pulmonary embolism (PE) have potential to be cost saving and provide better care. Commissioners, will be interested in the overall pathway costs but unfortunately these were not researched here. Share your views on the research. Why was this study needed? In the UK, 47,734 cases of PE were reported between 2014 and 2015. Emergency admissions for PE increased by 30% between 2008 and 2012. A pulmonary embolism is a blockage

2018 NIHR Dissemination Centre

129. Arsenic trioxide for treating acute promyelocytic leukaemia

interruption, repeated for 5 weeks. Treatment with arsenic trioxide must be temporarily stopped before the scheduled end of therapy if a toxicity grade 3 or greater on the National Cancer Institute Common T oxicity Criteria is observed and judged to be possibly related to arsenic trioxide treatment. Treatment may be resumed at 50% of the preceding daily dose after the toxic event is resolved or after recovery to baseline status of the abnormality that prompted the interruption. Price Price £2,920 for 10 (...) or bleeding (which can sometimes be catastrophic at presentation because of severely disordered blood clotting), fatigue, feeling weak or breathless, bone or joint pain and sleeping problems. A patient group explained that these symptoms affect mobility and daily living such that they may impair education and employment. Current treatments also have high toxicity. For example, the long-term effects of chemotherapy can include a risk of secondary cancers and loss of fertility in younger people

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

130. BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups

progression is faster (Khunti et al. 2009). In the UK, people of black African and African-Caribbean origin are 3 times more likely to have type 2 diabetes than the white population (DH 2001). Type 2 diabetes is also more common among Chinese people (DH 2001). In addition, people from all of these groups are more at risk of stroke (National Obesity Observatory 2011). BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups (PH46) © NICE 2018. All rights reserved (...) . Subject to Notice of rights ( conditions#notice-of-rights). Page 17 of 51Type 2 diabetes is also more prevalent among black Caribbean, Indian, Pakistani and Bangladeshi men aged 35–54 than the general UK population. With the exception of black African men, it is also more prevalent among those aged 55 and over from these groups (NHS Information Centre 2005). Among women, type 2 diabetes is more common among Indian, Pakistani and Bangladeshi groups (aged 35 and over

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

131. Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline

DVT is defined as thrombus involving the iliac and/or common femoral veins, with or without extension to the inferior vena cava; it represents about one-quarter of all cases of DVT. 2,3 The natural history of iliofemoral DVT is associated with a higher risk of adverse outcomes relative to femoropopliteal or distal DVT, with examples of such outcomes including severe leg pain and swelling, limb ischemia and increased risk of recurrent venous thromboem- bolism and post-thrombotic syndrome. 4,5 (...) , are resource intensive and have their own potential complications. Scope This guideline is intended to assist Canadian pri- mary care physicians in the assessment and man- agement of patients with iliofemoral DVT. We include guidance as to which patients may bene- fit from early triage and transfer to tertiary care institutions for clot removal and reduction, a crit- ical aspect in the management of this condition. Methods This consensus guideline provides recommenda - tions on the diagnosis and management

2015 CPG Infobase

132. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

not routinely offer thrombophilia testing to first-degree relatives of people with a history of DVT or PE and thrombophilia. [2012] [2012] T erms used in this guideline D-dimer test D-dimer test D-dimer is a product formed in the body when a blood clot (such as those found in DVT or PE) is broken down. A laboratory or point-of-care test can be done to assess the concentration of D-dimer in a person's blood. The threshold for a positive result varies with the type of D-dimer test used and is determined (...) DVT is sometimes referred to as 'above-knee DVT' . Pulmonary embolism Pulmonary embolism A blood clot that breaks off from the deep veins and travels round the circulation to block the pulmonary arteries, causing severe respiratory dysfunction. Renal impairment Renal impairment Reduced renal function that may be acute or chronic. An estimated glomerular filtration rate of less than 90 ml/min/1.73 m 2 indicates a degree of renal impairment in chronic kidney disease. (For NICE guidance

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

133. Ectopic pregnancy and miscarriage: diagnosis and initial management

there is significant concern about the degree of pain or bleeding, directly to A&E. 1.3.2 Be aware that atypical presentation for ectopic pregnancy is common. 1.3.3 Be aware that ectopic pregnancy can present with a variety of symptoms. Even if a symptom is less common, it may still be significant. Symptoms of ectopic pregnancy include: common symptoms: abdominal or pelvic pain amenorrhoea or missed period vaginal bleeding with or without clots other reported symptoms: breast tenderness gastrointestinal symptoms (...) of 39they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests. Using ultrasound for diagnosis Offer women who attend an early pregnancy assessment service (or out

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

134. Acute upper gastrointestinal bleeding in over 16s: management

and support for patients and carers 11 More information 12 Update information 13 Acute upper gastrointestinal bleeding in over 16s: management (CG141) © NICE 2018. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 3 of 13This guideline is the basis of QS38. Introduction Introduction Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has (...) not significantly improved over the past 50 years. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the guideline therefore focuses on hospital care. The most common causes are peptic ulcer and oesophago- gastric varices. Endoscopy is the primary diagnostic investigation in patients

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

135. Epilepsies: diagnosis and management

of ketogenic diet (see about this guideline for details). Epilepsy is a common neurological disorder characterised by recurring seizures. Different types of epilepsy have different causes. Accurate estimates of incidence and prevalence are difficult to achieve because identifying people who may have epilepsy is difficult. Epilepsy has been estimated to affect between 362,000 and 415,000 people in England. In addition, there will be further individuals, estimated to be 5–30%, so amounting to up to another

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

136. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

Improvement ( ). The SSC bundles that are based on previous guidelines have been adopted by the U.S.-based National Quality Forum and have also been adapted by the U.S. healthcare system’s regulatory agencies for public reporting. To align with emerging evidence and U.S. national efforts, the SSC bundles were revised in 2015. While specifics vary widely among different programs, a common theme is the drive toward improvement in compliance with sepsis bundles and practice guidelines such as SSC ( ). A meta

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2016 European Respiratory Society

138. Topics in Integrative, Alternative, and Complementary Therapies (PDQ®): Health Professional Version

that silymarin functions as an antioxidant, stabilizes cellular membranes, stimulates detoxification pathways, stimulates regeneration of liver tissue, inhibits the growth of certain cancer cell lines, exerts direct cytotoxic activity toward certain cancer cell lines, and may increase the efficacy of certain chemotherapy agents. Refer to the PDQ summary on for more information. Mistletoe Extracts Mistletoe is a semiparasitic plant that has been used for centuries to treat numerous human ailments. It is used (...) affected by St. John's wort are CYP3A4, CYP2C9, and CYP2D6. In one study in humans, effects on systemic concentrations of drugs via the CYP3A4 pathway were evident in as few as 14 days.[ ] Clinically, this means that the concomitant use of St. John's wort with other drugs could cause lower concentrations of drugs that are needed to have therapeutic effects. With respect to cancer and its treatment, St. John's wort has been shown to decrease concentrations of irinotecan in patients receiving treatment

2018 PDQ - NCI's Comprehensive Cancer Database

139. Propofol-induced death in children: at a Univ. Hospital

and urticaria ¦ If you notice any sign of other possible adverse effects (side effects), please ask your doctor or a pharmacist. Med Check TIP If you have any questions on this leaflet, please ask your doctor or pharmacist. Please keep medicines out of reach of children. What is this medicine? Atrial fibrillation is a common arrhythmia (irregular heart beat). If you have atrial fibrillation, blood easily clots inside the heart, and a fragment of the blood clot travels from the heart to brain or other parts (...) concentration-dependently as tested by activated partial thromboplastin time (aPTT), ecarin clotting time (ECT), and thrombin time (TT) mentioned later in detail [1]. However, monitoring by these tests was not required in clinical use of the new oral anticoagulants for their approval [1]. In August 2011, five months after the release of dabigatran, five deaths due to serious bleeding after dabigatran use were reported, and the warning was issued in the form of a blue letter[2]; (note 2). Immediately after

2015 Med Check - The Informed Prescriber

140. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis

of IE, although peripheral stigmata of IE are increasingly uncommon elsewhere, as patients generally present at an early stage of the disease. However, vascular and immunological phenomena such as splinter haemorrhages, Roth spots and glomerulonephritis remain common. Emboli to the brain, lung or spleen occur in 30% of patients and are often the presenting feature. In a febrile patient, diagnostic suspicion may be strengthened by laboratory signs of infection, such as elevated C-reactive protein (...) (CRP) or erythrocyte sedimentation rate (ESR), leucocytosis, anaemia and microscopic haematuria. However, these signs lack specificity and have not been integrated into current diagnostic criteria. Atypical presentation is common in elderly or immunocompromised patients, in whom fever is less common than in younger individuals. A high index of suspicion and low threshold for investigation are therefore essential in these and other high-risk groups, such as those with CHD or prosthetic valves

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2015 European Society of Cardiology

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