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Common Clotting Pathway

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141. Hyperglycaemia in acute coronary syndromes: management

) in a blood vessel, followed by blood clots forming on the plaque. The principles behind the presentation, investigation and management of these syndromes are similar, but there are important distinctions depending on the category of ACS. Hyperglycaemia is common in people admitted to hospital with ACS. Recent studies found that approximately 65% of patients with acute myocardial infarction who were not known to have diabetes had impaired glucose regulation when given a glucose tolerance test (...) of hyperglycaemia in ACS 11 5 Other versions of this guideline 12 5.1 Full guideline 12 5.2 NICE pathway 12 5.3 Information for the public 12 6 Related NICE guidance 13 7 Updating the guideline 15 Appendix A The Guideline Development Group, Short Clinical Guidelines T echnical T eam and NICE project team 16 The Guideline Development Group 16 Short Clinical Guidelines T echnical T eam 16 NICE project team 17 Appendix B The Guideline Review Panel 18 Changes after publication 19 About this guideline 20

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

142. Emicizumab (Hemlibra) - Hemophilia A

underproduction of or dysfunction of FVIII. It accounts for approximately 80% of all cases of haemophilia. Haemophilia A can be classified into severe, moderate or mild haemophilia depending on the % normal level of active clotting factor remaining ( 2 years. It is accepted that the human coagulation cascade reaches maturity at a very young age and that juvenile studies per se are unlikely to contribute any useful data (as agreed as per CHMP Sci Advice July 2015). However, the applicant was asked to identify (...) microangiopathy events: the thromboembolic events did not require treatment with anticoagulation and the thrombotic microangiopathy events started to resolve within 1 week following discontinuation of aPCC. The latter finding argues against mechanistic processes that involve autoantibodies against von Willebrand factor cleaving proteases (i.e., thrombotic thrombocytopenic purpura) or dysregulation of the alternative complement pathway (i.e., atypical haemolytic uremic syndrome), both of which are generally

2018 European Medicines Agency - EPARs

143. Plitidepsin (Aplidin) - Multiple Myeloma

and clotting abnormalities. Approximately 20% of patients are symptom free and are diagnosed by chance (2). The most common criteria used in diagnosis of symptomatic MM are the presence of neoplastic plasma cells comprising greater than 10% of BM cells or presence of a plasmacytoma; paraprotein (M protein) in the serum and/or urine; and evidence of related organ or tissue impairment due to plasma cell disorder. A clinical staging system, developed by Durie and Salmon (3), is useful for predicting survival (...) name: plitidepsin Procedure No. EMEA/H/C/004354/0000 Note Assessment report as adopted by the CHMP with all information of a commercially confidential nature deleted. Assessment report EMA/249101/2018 Page 2/156 Administrative information Name of the medicinal product: Aplidin Applicant: Pharma Mar, S.A. Avenida De Los Reyes 1 POL. IND. La Mina 28770 Colmenar Viejo Madrid SPAIN Active substance: plitidepsin International Non-proprietary Name/Common Name: plitidepsin Pharmaco-therapeutic group (ATC

2018 European Medicines Agency - EPARs

144. Caplacizumab (Cablivi) - thrombotic thrombocytopenic purpura (aTTP)

interval C max _D maximum concentration dose corrected CSR Clinical Study Report CT computed tomography DSMB Data Safety Monitoring Board ECG Electrocardiogram EMA European Medicines Agency FVIII coagulation factor VIII FVIII:C FVIII clotting activity GCP Good Clinical Practice GP HCP Glycoprotein host cell proteins HV healthy volunteer IgG immunoglobulin G INR IPC international normalized ratio in-process control i.v. Intravenous ITT intent-to-treat kDa kiloDalton KM Kaplan-Meier LDH lactate (...) or condition Cablivi is indicated for the treatment of adults experiencing an episode of acquired thrombotic thrombocytopenic purpura (aTTP), in conjunction with plasma exchange and immunosuppression. 2.1.2. Epidemiology Acquired TTP is a life-threatening, autoimmune blood clotting disorder manifested by microvascular occlusions and consequent thrombocytopenia, haemolytic anaemia, and organ ischemia. It is a rare disease with an incidence of 1.2 to 11 cases per million per year (Miller et al., 2004

2018 European Medicines Agency - EPARs

145. Kasabach-Merritt syndrome arising from a vascular fistula. (PubMed)

and consumption of platelets and clotting factors with uncontrolled formation of microthrombi within the vascular lesion. DIC and a microangiopathic hemolytic anemia can subsequently develop. Mechanistic pathways of the Kasabach-Merritt syndrome in the context of a vascular fistula are shared with the more common causes of the syndrome. We speculate that the endothelial dysfunction and injury caused by the flow shear were the pivotal triggers of the aberrant trapping of platelets, the consumptive coagulopathy

2019 American Journal of Emergency Medicine

146. Aquilion PRIME CT scanner for imaging coronary artery disease in adults in whom imaging is difficult

). Sometimes, an area of the plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can largely or completely block blood flow through a coronary artery. The most common symptoms of CAD are shortness of breath and chest pain or discomfort. Chest pain caused by CAD is called angina, which is broadly divided into 2 categories: Stable angina: when the pain is caused by anticipated factors (triggers), such as physical exercise, and usually resolves (...) Aquilion PRIME CT scanner for imaging coronary artery disease in adults in whom imaging is difficult Aquilion PRIME CT scanner for imaging coronary Aquilion PRIME CT scanner for imaging coronary artery disease in adults in whom imaging is artery disease in adults in whom imaging is difficult difficult Medtech innovation briefing Published: 1 March 2016 nice.org.uk/guidance/mib53 pathways Summary Summary The Aquilion PRIME is a CT scanner that can be used for computed tomography coronary

2016 National Institute for Health and Clinical Excellence - Advice

147. ClearWay RX for drug delivery to coronary artery thrombotic lesions

ClearWay RX for drug delivery to coronary artery thrombotic lesions ClearW ClearWa ay RX for drug deliv y RX for drug delivery to coronary artery ery to coronary artery thrombotic lesions thrombotic lesions Medtech innovation briefing Published: 11 March 2016 nice.org.uk/guidance/mib55 pathways Summary Summary The ClearWay RX is a rapid exchange perfusion catheter for localised delivery of diagnostic or therapeutic agents, including drugs such as abciximab to dissolve blood clots in coronary (...) of 21Product Product summary summary and and lik likely ely place place in in ther therap apy y The ClearWay RX is a rapid exchange perfusion balloon catheter, made from expanded polytetrafluoroethylene, for localised delivery of diagnostic or therapeutic agents including drugs. This briefing evaluates its use for delivering abciximab to dissolve blood clots in coronary arteries, following episodes of unstable angina or myocardial infarction. It would replace standard delivery routes for the same drug

2016 National Institute for Health and Clinical Excellence - Advice

148. Somatom Definition Edge CT scanner for imaging coronary artery disease in adults in whom imaging is difficult

arteries (NHS Choices 2014). Over time, the plaque hardens and narrows the coronary arteries, restricting the flow of oxygen-rich blood to the heart (ischaemia). Sometimes, an area of the plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can largely or completely block blood flow through a coronary artery. The most common symptoms of CAD are shortness of breath and chest pain or discomfort. Chest pain caused by CAD is called angina (...) Somatom Definition Edge CT scanner for imaging coronary artery disease in adults in whom imaging is difficult Somatom Definition Edge CT scanner for imaging Somatom Definition Edge CT scanner for imaging coronary artery disease in adults in whom coronary artery disease in adults in whom imaging is difficult imaging is difficult Medtech innovation briefing Published: 1 March 2016 nice.org.uk/guidance/mib54 pathways Summa Summary ry The Somatom Definition Edge is a CT scanner that can be used

2016 National Institute for Health and Clinical Excellence - Advice

149. Reversal of the anticoagulant effect of dabigatran: idarucizumab

Reversal of the anticoagulant effect of dabigatran: idarucizumab Re Rev versal of the anticoagulant effect of ersal of the anticoagulant effect of dabigatr dabigatran: idarucizumab an: idarucizumab Evidence summary Published: 24 May 2016 nice.org.uk/guidance/esnm73 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in May 2016. See summaries of product characteristics (SPCs), British national formulary (BNF) or the MHRA (...) : reversed the anticoagulant effect of dabigatran etexilate (median maximum reversal 100%) normalised dilute thrombin time and ecarin clotting time in 88–98% of people (efficacy analysis; n=68 to 81). Median investigator-reported time to cessation of bleeding was 11.4 hours (n=35; see the evidence review section for more information). Normal intraoperative haemostasis was seen in 92% of people (n=36). Safety Safety Idarucizumab binds specifically to dabigatran and its metabolites and will not reverse

2016 National Institute for Health and Clinical Excellence - Advice

150. ThermoCool SmartTouch catheter for percutaneous radiofrequency ablation in atrial fibrillation

ThermoCool SmartTouch catheter for percutaneous radiofrequency ablation in atrial fibrillation ThermoCool SmartT ThermoCool SmartT ouch catheter for ouch catheter for percutaneous r percutaneous radiofrequency ablation in atrial adiofrequency ablation in atrial fibrillation fibrillation Medtech innovation briefing Published: 23 March 2016 nice.org.uk/guidance/mib61 pathways Summary Summary ThermoCool SmartT ouch is a single-use cardiac ablation catheter with a deflectable distal section (...) the literature review. Introduction Introduction Atrial fibrillation is the irregular and rapid beating of the upper 2 chambers of the heart (the atria), caused by the disruption of the electrical signals that control the heartbeat. In many cases of atrial fibrillation, extra electrical signals start in the area around the opening of the pulmonary veins (the large blood vessels that return blood from the lungs to the left atrium) causing the heart to beat erratically. It is 1 of the most common causes

2016 National Institute for Health and Clinical Excellence - Advice

151. TactiCath Quartz catheter for percutaneous radiofrequency ablation in atrial fibrillation

TactiCath Quartz catheter for percutaneous radiofrequency ablation in atrial fibrillation T T actiCath Quartz catheter for percutaneous actiCath Quartz catheter for percutaneous r radiofrequency ablation in atrial fibrillation adiofrequency ablation in atrial fibrillation Medtech innovation briefing Published: 23 March 2016 nice.org.uk/guidance/mib60 pathways Summary Summary T actiCath Quartz is a single-use cardiac ablation catheter with a deflectable distal section and a contact force sensor (...) is the irregular and rapid beating of the upper 2 chambers of the heart (the atria), caused by the disruption of the electrical signals that control the heartbeat. In many cases of atrial fibrillation, extra electrical signals start in the area around the opening of the pulmonary veins (the large blood vessels that return blood from the lungs to the left atrium) causing the heart to beat erratically. It is 1 of the most common causes of abnormal heart rhythm with an estimated prevalence of 2% in England (Zoni

2016 National Institute for Health and Clinical Excellence - Advice

152. Sickle cell disease

or colonic ischaemia; and splenic infarction. are common and often cause intermittent abdominal pain. Abdominal pain may sometimes have a pulmonary cause (infarction or pneumonia). Acute anaemia due to rapidly falling haemoglobin Acute worsening of anaemia from steady state may be caused by acute splenic sequestration, transient red cell aplasia, or acute hepatic sequestration. Severe haematuria with the passage of clots may rarely cause severe anaemia in adults. Acute splenic sequestration usually (...) Sickle cell disease Sickle cell disease - NICE CKS Clinical Knowledge Summaries Share Sickle cell disease: Summary Sickle cell disease encompasses a group of inherited conditions which have the inheritance of sickle haemoglobin in common. Sickle haemoglobin has an abnormal beta-globin chain that causes it to polymerize when deoxygenated, which distorts the erythrocyte into a sickle shape. The deformed erythrocytes form clusters, which block blood vessels; damage large and small blood vessels

2017 NICE Clinical Knowledge Summaries

153. Cholecystitis - acute

Cholecystitis - acute Cholecystitis - acute - NICE CKS Clinical Knowledge Summaries Share Cholecystitis - acute: Summary Acute cholecystitis is inflammation of the gallbladder, the most common cause of which is gallstones. Approximately 5% of people who present with acute cholecystitis do not have gallstones. Acalculous cholecystitis may affect people admittted to hospital with multiple trauma or acute non-biliary illness. Risk factors for developing gallstones include obesity, increasing age (...) with acute cholecystitis have laparoscopic cholecystectomy within 1 week of diagnosis. See . [ ] Background information Background information Definition What is it? Acute cholecystitis is inflammation of the gallbladder [ ; ]. There are a number of pathological classifications of acute cholecystitis, including oedematous, necrotizing, suppurative, and chronic [ ; ]. Causes What causes it? The most common cause of acute cholecystitis is gallstones, accounting for 90–95% of cases [ ; ; ]. In a minority

2017 NICE Clinical Knowledge Summaries

154. Management of Hepatitis C

REMIT of THE GuIDElINE 1.2.1 o VER ALL o BJEC TIVES The guideline provides evidence based recommendations covering all stages of the patient care pathway; screening, testing, diagnosis, referral, treatment, care and follow up of infants, children and adults with, or exposed to, HCV infection. The remit encompasses prevention of secondary transmission of the virus but specifically excludes primary prevention of HCV infection. Primary prevention of hepatitis C infection is an important public health (...) that there is sufficient evidence/experience of using the medicines to show its safety and efficacy, seeking the necessary information from appropriate sources y record in the patient’s clinical notes the medicine prescribed and, when not following common practice, the reasons for the choice y take responsibility for prescribing the medicine and for overseeing the patient’ s care, including monitoring the effects of the medicine. Non-medical prescribers should ensure that they are familiar with the legislative

2013 SIGN

155. Pentosan polysulfate sodium (Elmiron) - Interstitial Cystitis

pathways of the active substance are described and well understood. The stability results indicate that the active substance manufactured by the proposed supplier is sufficiently stable. The stability results justify the proposed retest period in the proposed container. 2.2.3. Finished Medicinal Product Description of the product and Pharmaceutical development The finished product is presented as immediate release white hard-gelatine capsules (size 2), each containing 100 mg of pentosan polysulfate

2017 European Medicines Agency - EPARs

156. Guidelines for the Provision of Intensive Care Services

Facilities 21 2.2 The Critical Care Team: Staffing Numbers and Work Patterns 24 2.2.1 Consultants 24 2.2.2 Trainee Medical Staff 26 2.2.3 Nurse Staffing 29 2.2.4 Advanced Critical Care Practitioners 32 2.2.5 Physiotherapy 34 2.2.6 Pharmacy 36 2.2.7 Dietetics 39 2.2.8 Occupational Therapy 42 2.2.9 Speech and Language Therapy 45 2.2.10 Practitioner Psychologists 48 CHAPTER THREE: CRITICAL CARE SERVICES – PROCESS 51 3.1 Patient Pathway 52 3.1.1 Admission, Discharge and Handover 52 3.1.2 Critical Care (...) is an introduction which describes the service. Chapter Two describes in detail the structure of the service, including physical facilities and staffing. Chapter Three details the process of the service and focuses on the patient’s pathway. Chapter Four describes the activity of the Critical Care service, including aspects of disease management and prevention as well as specialised critical care. Chapter Five contains other additional key components of the service, ranging from operational delivery networks

2015 Intensive Care Society

157. Guideline on Clinical Genetics Services for Haemophilia

testing and relate to an individual’s understanding of how their genetic information may be used within the family. We have tried to offer guidance for the more common situations based on our understanding of current legislation and good clinical practice. We have recommended the establishment of family genetic files as well as formal genetic family registers in Haemophilia Centres. 1.3 Information and Informed Consent Even before a blood sample is taken for genetic testing it is essential (...) in some of the less common heritable bleeding disorders. 1.7 Required resources Implementation of the recommendations of this report will require additional resources to be invested in haemophilia services. The family files and genetic registers will need to be established to record both factual genetic information and details of clinical consultations with patients and family members. Much of this could be developed with the expertise of genetic counsellors who will bring experience of arrangements

2015 United Kingdom Haemophilia Centre Doctors' Organisation

158. Systematic review of needs for medical devices for ageing populations

elements of service delivery would remain similar, although the availability and cost of different parts of the service could vary widely and be dependent on current skills and infrastructure in each country. It is intended that this report will inform future research, with the aim of improving access to devices of elderly people across the different countries of the Western Pacific Region. To achieve effective clinical management of any health condition, all aspects of the management pathway must (...) rates and the longevity of the population in Japan, which has the world’s highest life expectancy. Consequently, the most common causes of death in Japan have shifted from infectious diseases to malignant neoplasms, heart diseases and cerebrovascular diseases (5). The aged population is also characterized by an overrepresentation of women. In the Western Pacific Region there are approximately 90 men for every 100 women over the age of 60 years. The preponderance of women in the aged population has

2015 ASERNIP-S

159. Cladribine (Mavenclad) - multiple sclerosis

in neurological impairment and severe disability. The present application seeks approval of cladribine for the treatment of adult patients with highly active relapsing remitting multiple sclerosis (RRMS) as defined by clinical or imaging features. During the course of the procedure the target population was revised to adult patients with highly active relapsing MS (RMS). 2.1.2. Epidemiology MS is the most common cause of serious neurological disability in young adults. It is estimated that more than 2.3 (...) concentrations found with therapeutic doses (22 –29 ng/ml in human plasma). As part of general pharmacology studies the effects of cladribine on blood coagulation system (prothrombin time, activated partial thromboplastin, fibrinogen concentration), blood clotting time, ADP-induced platelet aggregation and haemolytic effects were studied using blood of rabbits and in vivo studies in dogs. At concentrations between 0.1 – 100 µM no effect was observed. Safety pharmacology programme The tests included

2017 European Medicines Agency - EPARs

160. Social Determinants of Risk and Outcomes for Cardiovascular Disease

on cardiovascular outcomes. Such interventions might be directed at individual’s underlying abilities to develop and maintain relationships or might be directed at a social milieu rather than at individuals. Finally, the possibility remains that low social support does not lie in the causal pathway. Further investigation of the mechanisms linking low support and CVD may be helpful. The degree to which low social support interacts with other social determinants of cardiovascular health remains somewhat unclear (...) of beliefs and behaviors characteristic of a definable group that is transmitted without biological inheritance. Despite the difficulties, the concept is useful for understanding some differences in prevalence and treatment of illness. Poor control of type 2 diabetes mellitus is particularly common among Mexican American farm workers. Researchers from Stanford University interviewed adult patients with diabetes mellitus at 2 farm worker clinics, 1 in California and 1 in Oregon, and found that many

2015 American Heart Association

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