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Common Clotting Pathway

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162. 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

163. 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

164. 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

165. Inferior Vena Cava Filters for Prevention of Pulmonary Embolism

occur, some of which may be fatal (five cohort studies, two case reports). These include filter migration to the heart, nonfatal IVC thrombosis, fatal IVC thrombosis, errant placement of the filter into the common iliac vein, wrong positioning of the filter, pneumothorax, hemopericardium, and the inability to perform a transvenous ablation of a cardiac accessory pathway due to the filter. A subset of studies reported that physicians ultimately removed more than two thirds of the retrievable filters (...) March 12, 2015 The summary of evidence in this document is derived directly from these evidence sources, and portions are extracted verbatim. EVIDENCE OVERVIEW Clinical background Blood clots or deep venous thrombosis (DVT) form in the lower extremities and can occur under a number of different circumstances. Temporary circumstances are prolonged immobility, recent surgery, trauma, pregnancy, or estrogen therapy. Longer term situations include people who have cancer, or people who have an inherited

2015 Oregon Health Evidence Review Commission

166. Colorectal cancer: diagnosis and management

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 25This guideline replaces TA93. This guideline is the basis of QS20. Introduction Introduction Recommendations on surgery and colonic stents in acute large bowel obstruction and on stage I rectal cancer in sections 1.2.2 and 1.2.4 were added in December 2014. The addendum contains details of the methods and evidence used to update these recommendations. Colorectal cancer is one of the most common cancers in the UK after breast and lung cancer (...) , with approximately 40,000 new cases registered each year. Occurrence of colorectal cancer is strongly related to age, with almost three-quarters of cases occurring in people aged 65 or over. Colorectal cancer is the second most common cause of cancer death in the UK. Around half of people diagnosed with colorectal cancer survive for at least 5 years after diagnosis. Recommendations about medicines The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

167. Generalised anxiety disorder and panic disorder in adults: management

] or [2018] [2018] indicates the recommendation was amended in the June 2018 update to bring it in line with current best practice or other NICE guidance, or added to give a link to existing guidance. [1] Common mental health disorders: identification and pathways to care (2011) NICE guideline CG123. [2] American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (fourth edition). Washington DC: American Psychiatric Association. This guideline uses DSM-IV criteria (...) 'pure' GAD, in which no comorbidities are present, and the more typical presentation of GAD comorbid with other anxiety and depressive disorders in which GAD is the primary diagnosis. NICE is developing a guideline on case identification and referral for common mental health disorders that will provide further guidance on the identification and treatment of comorbid conditions [1] . GAD is a common disorder, of which the central feature is excessive worry about a number of different events

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

168. 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

169. New Zealand Guideline for the Management of Gonorrhoea

is intended as a reference document. There is some intentional overlap between sections because it is anticipated that different professional groups will consult the sections relevant to their disciplines. Version 2014-09-10 12 New Zealand Guideline for the Management of Gonorrhoea Introduction Commonly known as ‘the clap’ – most likely after the Parisian district ‘Les Clapiers’, which housed prostitutes in the Middle Ages – N. gonorrhoeae infection (that is, gonorrhoea) is a common and treatable (...) , gonorrhoea is the second most common bacterial STI after chlamydia. The primary sites of infection are the urethra, rectum, pharynx and conjunctiva in both genders and the endocervix in the female. In infants, the conjunctiva is the most common site of infection. N. gonorrhoeae has traditionally been detected by culture, before measurement of antibiotic susceptibilities. This method is highly specific for N. gonorrhoeae but is time consuming and subjective, and it relies on organism viability, which

2014 New Zealand Sexual Health Society

170. Mixing Studies in Patients With Prolonged Activated Partial Thromboplastin Time or Prothrombin Time. (PubMed)

in both the intrinsic and extrinsic as well as the common pathways. An ICA >11% had 100% (95% CI, 59%-100%) sensitivity, 53% (95% CI, 35%-70%) specificity, and 77% (95% CI, 62%-92%) accuracy in predicting the presence of lupus anticoagulant in patients with prolonged aPTT.Normalization of the aPTT and PT in a mixing study was associated with low clotting factor activity. The ICA may be helpful in predicting the presence of a lupus anticoagulant. As anesthesiologists take ownership of the perioperative (...) Mixing Studies in Patients With Prolonged Activated Partial Thromboplastin Time or Prothrombin Time. Patients presenting for surgery may have isolated or combined prolonged activated partial thromboplastin time (aPTT) and/or prothrombin time (PT). In patients not receiving anticoagulants or with no identifiable cause for abnormal clot formation, a mixing study is performed. The index of circulating anticoagulant (ICA) has been used to predict the presence of an inhibitor, usually a lupus

2019 Anesthesia and Analgesia

171. 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

172. Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review. (PubMed)

Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review. The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one (...) specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care

2019 Seminars In Thrombosis And Hemostasis

173. 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

174. A synthetic heparin mimetic that allosterically inhibits factor XIa and reduces thrombosis in vivo without enhanced risk of bleeding. (PubMed)

could be rapidly reversed by common antidotes, such as protamine. SCI preferentially prolonged plasma clotting initiated with recalcification, rather than thromboplastin, alluding to its intrinsic pathway-based mechanism. Human blood thromboelastography indicated good ex vivo anticoagulation properties of SCI. Rat tail bleeding and maximum-dose-tolerated studies indicated that no major bleeding or toxicity concerns for SCI suggesting a potentially safer anticoagulation outcome. FeCl3 -induced (...) A synthetic heparin mimetic that allosterically inhibits factor XIa and reduces thrombosis in vivo without enhanced risk of bleeding. Human factor XIa (FXIa) is an actively pursued target for development of safer anticoagulants. Our long-standing hypothesis has been that allosterism originating from heparin-binding site(s) on coagulation enzymes is a promising approach to yield safer agents.To develop a synthetic heparin mimetic as an inhibitor of FXIa so as to reduce clot formation in vivo

2019 Journal of Thrombosis and Haemostasis

175. 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

176. 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

177. 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

178. 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

179. 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

180. 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

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