Seminars in vascular medicine最新文献

{"title":"Prevention of stroke in patients with atrial fibrillation: Current strategies and future directions","authors":"S. Hohnloser, G. Duray, U. Baber, J. Halperin","doi":"10.1093/EURHEARTJ/SUN029","DOIUrl":"https://doi.org/10.1093/EURHEARTJ/SUN029","url":null,"abstract":"The morbidity and mortality associated with atrial fibrillation (AF) are related mainly to ischaemic stroke, and the prevention of thrombo-embolism is an important component of the patient management. The choice of optimum antithrombotic therapy for a given patient depends on the risk of thrombo-embolism, and the assessment of thrombo-embolic risk using validated stratification schemes, such as the CHADS2 score, is a critical step. Improved stratification schemes are needed that take into account the risk of intracerebral haemorrhage, which is the most worrisome complication of anticoagulant therapy. The pattern of AF (paroxysmal, persistent, or permanent) should not influence the selection of antithrombotic treatment. Similarly, successful rhythm control is not a sound basis for withdrawing antithrombotic treatment, and whether this situation differs after successful catheter ablation of AF has not been established. At present, oral vitamin K antagonists alone are recommended for patients with AF at moderate-to-high risk of stroke. A combination of anticoagulant and antiplatelet drugs is necessary in patients with AF undergoing percutaneous coronary intervention and stent implantation, but the optimal therapeutic management of these patients has not been defined. The development of new antithrombotic agents that are easier to use and have a superior benefit-to-risk ratio will extend treatment to a greater proportion of the AF population at risk. The large number of phase III trials currently investigating specific inhibitors of thrombin or factor Xa that do not require laboratory monitoring suggests that this goal is within reach.","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/EURHEARTJ/SUN029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60724331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dear readers","authors":"Daniel S. Schiff","doi":"10.1055/s-2005-922486","DOIUrl":"https://doi.org/10.1055/s-2005-922486","url":null,"abstract":"","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"05 1","pages":"309 - 310"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58053578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparability of D-dimer assays in clinical samples.","authors":"Geneviève Freyburger,&nbsp;Sylvie Labrouche","doi":"10.1055/s-2005-922478","DOIUrl":"https://doi.org/10.1055/s-2005-922478","url":null,"abstract":"<p><p>D-dimers (DD) have shown sufficient proof of their efficiency in the last 10 years to play an important role in hemostasis laboratories for excluding thromboembolic events. Numerous reagents are available on the market but their performances differ. This overview takes stock of the methods used to evaluate the performances of DD assays, the results published in the literature, the technical parameters influencing assay performance, the difficulties caused by the lack of harmonization of DD units, and the attempts to tackle this problem. It raises the issue of the potential optimization of their use with regard to better adaptation to multidisciplinary diagnostic strategies and to target patient populations.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"328-39"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"D-dimer, oral anticoagulation, and venous thromboembolism recurrence.","authors":"Benilde Cosmi,&nbsp;Gualtiero Palareti","doi":"10.1055/s-2005-922481","DOIUrl":"https://doi.org/10.1055/s-2005-922481","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) requires prolonged treatment to prevent late recurrences. However, the optimal duration of vitamin K antagonist (VKA) therapy is still controversial. More recently, D-dimer (D-d) has emerged as a predictive factor for recurrences. D-d has been evaluated both during and after VKA treatment. Some patients with DVT of the lower limbs have persistently high D-d during anticoagulation and this could reflect insufficient anticoagulation despite apparently adequate antithrombotic treatment. Altered D-d during anticoagulation is more frequent in patients with idiopathic or cancer-associated VTE than in those with secondary VTE. In subjects with an unprovoked VTE event, the time spent at near normal international normalization ratio (INR) values (< 1.5) during the first 3 months of treatment is associated with higher D-d during and after VKA treatment and with a higher risk for late recurrences. Moreover, the combination of altered D-d and inherited thrombophilia, and not residual venous obstruction, is associated with a significantly higher hazard ratio for recurrence. Preliminary results of a management study, the PROLONG study, indicate that subjects with normal D-d at 1 month after VKA withdrawal have a low risk of recurrence, and those with altered D-d have a significantly higher risk and deserve prolonged treatment.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"365-70"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"D-dimer levels, constitutional thrombophilia, and venous thrombosis prediction: clinical aspects and implications.","authors":"M M Samama,&nbsp;M H Horellou,&nbsp;I Elalamy,&nbsp;V Mathieux,&nbsp;E Ombandza-Moussa,&nbsp;J Conard","doi":"10.1055/s-2005-922482","DOIUrl":"https://doi.org/10.1055/s-2005-922482","url":null,"abstract":"<p><p>The negative predictive value of D-dimers in the diagnosis of a recent venous thromboembolism (VTE) episode is well established. The plasma level of D-dimer is usually increased in hypercoagulable states. The measurement of D-dimer could be of clinical interest in patients with constitutional thrombophilia as there is no close relationship between the clinical expression and the genotype indicating the existence of a hypercoagulable state. Moreover, the predictive value of D-dimer testing in patients with thrombophilia has been questioned. The review of the literature and results of a recent study of our group are presented. Decreased levels of D-dimer are observed in patients receiving an oral anticoagulant treatment versus untreated patients. In contrast, no significant difference was observed between those with and those without thrombophilia among treated or untreated patients. Patients with constitutional thrombophilia are supposed to have an increased risk of postoperative VTE. The review of the existing literature could not confirm this opinion but this could be due to the fact that most patients receive a prophylactic treatment. Thus, there is an indirect evidence of its efficacy in these patients.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"371-4"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrin D-dimer testing for venous and arterial thrombotic disease.","authors":"Jan Jacques Michiels,&nbsp;Gualtiero Palareti,&nbsp;Philippe de Moerloose","doi":"10.1055/s-2005-922475","DOIUrl":"https://doi.org/10.1055/s-2005-922475","url":null,"abstract":"The present issue of Seminars in Vascular Medicine assembles a series of articles that nicely elucidate the current knowledge on the use of fibrin D-dimer testing for venous and arterial thrombotic disease in vascular medicine. In the first article Dempfle provides relevant background information on D-dimer assays used for thrombosis exclusion. D-dimer antigen assays are heterogeneous concerning epitope specificity and calibration. Dimerized D-domains (D-dimers), D-trimers, and D-tetramers are needed for the branching of fibrin fibrils to cross-linked fibrin during clot formation. Fragment D-dimer is a specific indicator for plasmin proteolysis of cross-linked fibrin as the essential part of a blood clot. Proteolysis of cross-linked fibrin generates various fragments, which contain dimerized D-domains. Proteolytic fragment of cross-linked fibrin also include fibrin fragments formed by elastase or other proteolytic enzymes. The monoclonal antibodies used in D-dimer antigen assays react with epitopes of fibrin compounds containing dimerized D-domains. Three main types of immune assays are available for the measurement of D-dimers. Qualitative latex agglutination assays are insufficiently sensitive for use in the exclusion of venous thrombosis. The whole blood red cell agglutination uses bivalent antibodies against D-dimer antigen and red blood cells. In the presence of sufficient D-dimer antigen the red cells agglutinate. Automated latex-enhanced light-scattering assays use latex particles coated with monoclonal antibodies against D-dimer antigen and are performed on various automatic laboratory analyzers with photometric detection systems. An automated enzyme-linked immunoassay (ELISA) has been developed for the VIDAS analyzer. Fibrin derivatives detected by D-dimer antigen assays are highly heterogeneous. Manufacturers of D-dimer assays use either purified D-dimer, cross-linked fibrin degradation products, or pooled plasma for calibration. The concentration label is based on either the amount of D-dimer present in the solution or the amount of fibrinogen used for the preparation of fibrin degradation products and expressed as D-dimer units (concentration) or fibrinogen equivalent nuts (FEU). Standardization and harmonization of D-dimer assays using standardized preparation for D-dimer concentration are warranted. In the second article Meijer and Kluft discuss the current status of standardization and harmonization of the available quantitative D-dimer methods. The different quantitative D-dimer tests can differ significantly, which is mainly caused by the variety of fibrin degradation products in plasma, the specificity of antibodies against D-dimer antigen, and the calibrator used in the D-dimer assay. Depending on the stage of degradation of cross linked fibrin in various diseases like diffuse intravascular coagulation or venous thrombosis, the patient samples contain various amounts of large and smaller fibrin degradation and D-dimer products.","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"311-4"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25700210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"D-dimer testing in pregnancy.","authors":"Sabine Eichinger","doi":"10.1055/s-2005-922483","DOIUrl":"https://doi.org/10.1055/s-2005-922483","url":null,"abstract":"<p><p>Normal pregnancy is associated with alterations of the hemostatic system toward a hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation, such as D-dimer, indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. Testing for D-dimer in pregnant women could be useful for the diagnosis and prediction of a venous thromboembolic event or pregnancy-related complications and for monitoring antithrombotic treatment. This approach, however, is hampered by the fact that even an uncomplicated pregnancy in healthy women is accompanied by a substantial increase of D-dimer. Thus, prior to clinical application reference values of D-dimer according to gestational age need to be validated. A substantial increase of D-dimer during pregnancy is seen despite thromboprophylaxis with low-molecular-weight heparin (LMWH), indicating that further studies are needed to evaluate monitoring of LMWH during pregnancy and to investigate the optimal beginning and dose of LMWH thromboprophylaxis in pregnant women.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"375-8"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrin D-dimer and cardiovascular risk.","authors":"Gordon D O Lowe","doi":"10.1055/s-2005-922485","DOIUrl":"https://doi.org/10.1055/s-2005-922485","url":null,"abstract":"<p><p>Fibrin D-dimer, the most commonly used clinical assay for detection of coagulation activation and in vivo fibrin formation and lysis in circulating blood, has been associated with risks of cardiovascular diseases in studies published over the past 15 years. This review discusses, in turn, analytic and preanalytic considerations; associations with risk factors; and associations with coronary heart disease, atrial fibrillation, stroke and cerebrovascular disease, peripheral arterial disease, and venous thromboembolism. These associations suggest that activated coagulation and in vivo fibrin formation and lysis may play a role in arterial, intracardiac, and venous thromboembolism. The potential clinical utility of D-dimer in prediction of cardiovascular risk, in indicating patient groups for prophylactic anticoagulation and in monitoring of anticoagulation, requires further study. Harmonization of results from different assays would increase clinical utility.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"387-98"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of qualitative D-dimer assays, clinical probability, and noninvasive imaging tests for the diagnosis of deep vein thrombosis and pulmonary embolism.","authors":"Philip S Wells","doi":"10.1055/s-2005-922479","DOIUrl":"https://doi.org/10.1055/s-2005-922479","url":null,"abstract":"<p><p>Recent advances in the management of patients with suspected venous thromboembolism have both improved diagnostic accuracy as well as made management algorithms safer and more accessible. It is now clear that determination of clinical probability prior to diagnostic testing will improve patient management. D-dimer testing can be employed to decrease the need for imaging tests. Patients at low risk with a negative qualitative D-dimer can avoid imaging tests. Imaging test interpretation benefits from consideration of pretest probability also as this helps clinicians determine when a test may be falsely negative or falsely positive. Diagnostic strategies should include pretest clinical probability, D-dimer assays, and noninvasive imaging tests.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"340-50"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for deep vein thrombosis and pulmonary embolism in outpatients with suspected DVT or PE by the sequential use of clinical score: a sensitive quantitative D-dimer test and noninvasive diagnostic tools.","authors":"Jan Jacques Michiels,&nbsp;Alain Gadisseur,&nbsp;Marc van der Planken,&nbsp;Wilfried Schroyens,&nbsp;Marianne De Maeseneer,&nbsp;Jan T Hermsen,&nbsp;Paul H Trienekens,&nbsp;Henk Hoogsteden,&nbsp;Peter M T Pattynama","doi":"10.1055/s-2005-922480","DOIUrl":"https://doi.org/10.1055/s-2005-922480","url":null,"abstract":"<p><p>The requirement for a safe diagnostic strategy should be based on an overall posttest incidence of venous thromboembolism (VTE) of less than 1% during 3-month follow-up. The negative predictive value (NPV) during 3 months of follow-up is 98.1 to 99% after a normal venogram, 97 to 98% after a normal compression ultrasonography (CUS), and > 99% after serial CUS testing. Serial CUS testing is safe but 100 CUS must be repeated to find one or two CUS positive for deep vein thrombosis (DVT), which is not cost-effective and indicates the need to improve the diagnostic workup of DVT by the use of clinical score assessment and D-dimer testing. The NPV varies from 97.6 to 99.4% for low clinical score followed by a negative SimpiRED test, indicating the need for a first CUS. The NPV is 98.4 to 99.3% for a normal rapid enzyme-linked immunosorbent assay (ELISA) VIDAS D-dimer test result (< 500 ng/mL) irrespective of clinical score. The NPV is more than 99% for a negative CUS followed by either a negative SimpiRED test or an ELISA VIDAS test result of < 1000 ng/mL without the need to repeat a second CUS within 1 week. The sequential use of a sensitive, rapid ELISA D-dimer and clinical score assessment will safely reduce the need for CUS testing by 40 to 60%. Large prospective outcome studies demonstrate that with one negative examination with complete duplex color ultrasonography (CCUS) of the proximal and distal veins of the affected leg with suspected DVT, it is safe to withhold anticoagulant treatment, with a negative predictive value of 99.5%. This may indicates that CCUS is equal to serial CUS or the combined use of clinical score, D-dimer testing, and CUS. Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but not for subsegmental PE. A normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test safely excludes PE. Helical spiral computed tomography (CT) detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with suspected PE and can replace both the ventilation perfusion scan and pulmonary angiography to safely rule in PE and to rule out PE with an NPV of > 99%. The combination of clinical assessment, a rapid ELISA VIDAS D-dimer, followed by CUS will reduce the need for helical spiral CT by 40 to 50%.</p>","PeriodicalId":87139,"journal":{"name":"Seminars in vascular medicine","volume":"5 4","pages":"351-64"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-922480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25699609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}