Description
Thrombotic and bleeding disorders affect at least 10 million people in the US alone. There has also been a great deal of concern over travel-related deep vein thrombosis and therefore much more interest and research into the field of blood clotting. This new and concise practical guide will cover all the essentials one needs to know when managing thrombotic and bleeding disorders. The field of haematology is undergoing major advances in thrombosis research, including significant additions to recommended treatment protocols. The Essential Guide to Coagulation will distil the most clinically, up-to-date and relevant material from the literature for all those working in the field. Faced with a bleeding patient, it may be difficult to discern whether blood loss is due to a local factor or secondary to an underlying haemostatic defect. There are a range of simple and specialized laboratory texts which can be performed to further define the cause of bleeding in a patient. Since the first edition there have been many developments in the field including many new anticoagulant drugs. These new classes of “direct thrombin inhibitors” slow the coagulation cascade by directly binding to thrombin, a clotting factor essential in the clotting process. If thrombin is blocked, clot formation is delayed. A key component of this guide will be the latest treatment strategies available for patients. List of contributors, x Preface, xii Abbreviations, xiii PART 1: GENERAL HEMOSTASIS 1 Schematic presentation of the hemostatic system, 3 Nils Egberg 2 Proposals for sampling instructions, 6 Margareta Blombck and Nils Egberg Points to note prior to sampling, 6 Sampling time and patient preparation, 7 Referrals for coagulation analyses, 8 Sampling, 8 Technique, 9 For DNA investigation (genetic analyses), 10 3 Laboratory investigations, 11 Jovan P. Antovic, Liselotte Onelv, and Nils Egberg Nomenclature, 11 Reference intervals for laboratory investigations, 13 Screening analyses, 13 Special analyses, 20 Markers of coagulation activation (hypercoagulation markers), 29 DNA analyses, 29 Global hemostatic assays and bedside methods, 31 Useful components in research studies, 32 Platelet-activating predictors, 35 PART 2: BLEEDING DISORDERS 4 Hereditary bleeding disorders, 41 Margareta Holmstrm and Lars Gran Lundberg General remarks about hemophilia A and B, 41 General remarks about von Willebrand disease, 42 Factor concentrates used for treatment of hemophilia A and B and VWD in Sweden in 2012, 43 Treatment strategy in severe forms of hemophilia and VWD, 44 Recommendations for desired initial plasma concentrations at different types of bleedings, 45 Surgery in patients with bleeding disorders, 47 Tooth extraction in a hemophilia patient, 47 Caution in patients with bleeding disorders, 48 Treatment principles for different types of bleeding disorders (severe, moderate, and milder forms of hemostatic defects), 49 Rare bleeding disorders, 51 Blood sampling in bleeding disorders, 54 Bleeding risk charts, 54 5 Critical bleeding, 56 Maria Bruzelius, Anna gren, and Hans Johnsson Introduction, 56 Defi nition of massive bleeding, 56 Transfusion coagulopathy, 56 Recommendations to obtain optimal hemostasis, 57 Choice of plasma, 58 Local procedures, 59 Additional treatment, 59 Fibrinogen concentrate, 59 Prothrombin-complex concentrate (PCC), 59 Recombinant factor VIIa, 59 Concentrates of other coagulation factors, 60 Cryoprecipitates, 60 Tranexamic acid, 60 Desmopressin, 60 Local hemostatic drugs, 60 Complicating factors, 61 Ongoing treatment with antiplatelet, and anticoagulant drugs, 61 6 Investigation of increased bleeding tendency, 62 Margareta Holmstrm and Lars Gran Lundberg Introduction, 62 Diagnosis, 62 Reasons for pathologic screening analyses and further actions, 64 Causes of thrombocytopenia, 64 Causes of prolonged activated partial thromboplastin time, 65 Causes of elevated PT(INR), 66 Investigation of bleeding tendency: practical aspects, 66 PART 3: THROMBOEMBOLIC DISORDERS 7 Venous thrombosis and pulmonary embolism, 71 Anders Carlsson Introduction, 71 Venous thrombosis, 72 Pulmonary embolism, 75 Primary prophylaxis against VTE, 91 8 Investigations of thromboembolic tendency, 94 Margareta Holmstrm Introduction, 94 Venous thromboembolism, 95 Arterial thromboembolism, 96 Disseminated intravascular coagulation, 96 9 Heart disease, 97 Hkan Wallen and Rickard Linder Ischemic heart disease, 97 Atrial fi brillation, 102 Cardiac valve prosthesis, 103 New oral anticoagulants in the treatment of heart disease, 104 10 Antiplatelet drug therapy and reversal of its effects, 105 Hkan Wallen, Hans Johnsson, and Bo-Michael Bellander Introduction, 105 ASA, 105 ADP (P2Y12) receptor antagonists, 106 GPIIb/IIIa receptor antagonists, 106 Phosphodiesterase inhibitors and other antiplatelet compounds, 108 Combined antithrombotic treatment, 108 Benefi t-risk assessment, 108 Platelet transfusion, 109 11 New oral anticoagulants: Focus on currently approved oral factor Xa and Thrombin inhibitors, 111 Rickard E. Malmstrm and Hans Johnsson Clinical pharmacology of NOACs, 111 Possibility of and need for therapeutic monitoring of NOACs, 114 Clinical aspects of NOACs, 114 Results of clinical trials, 116 Some characteristics of the individual NOACs, 118 Considerations to be taken when using NOACs in some emergency situations 12 Stroke and transient ischemic attack, 121 Nils Wahlgren and Mia von Euler Antithrombotic secondary stroke prevention, 121 Atrial fi brillation and TIA or stroke, 122 Thrombolysis in stroke, 122 Cerebral venous thrombosis and dissection of precerebral arteries, 123 Recurrent TIA, 124 Prophylactic treatment against DVT and PE, 124 13 Peripheral artery surgery, 125 Jesper Swedenborg Prophylaxis against reocclusion in peripheral vascular surgery or percutaneous transluminal angioplasty (PTA), 125 Peri- and postoperative treatment, 125 Thrombolysis in acute ischemia, 126 PART 4: SPECIAL HEMOSTASIS 14 Hemostasis in obstetrics and gynecology, 129 Katarina Bremme Introduction, 129 Thrombosis during pregnancy, 131 Heart disease: treatment of women with mechanical heart valve prostheses, 139 Thromboprophylaxis in obstetrics and gynecology, 140 Blood sampling in children of women with severe forms of thrombophilia, 148 Obstetric epidural/spinal analgesia (anesthesia), 148 Complications during pregnancy, 150 Postpartum bleeding, 155 Thromboprophylaxis in legal and spontaneous abortions, 156 Thromboprophylaxis in gynecologic surgery, 156 Investigation prior to artifi cial insemination (IVF), 160 Investigation in repeated miscarriages, 160 Investigation in menorrhagia (for treatment see Chapter 4), 161 15 Hemostasis in children, 162 Susanna Ranta and Pia Petrini Introduction, 162 Bleeding disorders in children, 166 Thromboembolic disorders in children, 172 16 Emergency conditions associated with coagulation: DIC, HIT and TTP/HUS, 182 Jovan P. Antovic and Margareta Holmstrm Disseminated intravascular coagulation, 182 Heparin-induced thrombocytopenia, 188 Thrombotic microangiopathies, 190 Index, 191
