PubMed · 3848124
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M G Huisse. 1985. [Thrombopathies].. https://pubmed.ncbi.nlm.nih.gov/3848124/
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A pharmacy-managed protocol for warfarin use in orthopedic surgery patients was studied. In 1990 a protocol designed to accommodate either protocol- or physician-determined dosing of warfarin for orthopedic antithrombotic prophylaxis (OAP) was implemented at a community hospital. A "protocol" group consisting of patients treated entirely under the protocol-determined dosing option was prospectively identified over a two-year period. A "physician" group consisting of patients treated by physicians in the 10 months immediately preceding implementation of the protocol was also identified. The ability of the protocol to achieve laboratory-test and clinical goals was assessed by comparing the two groups. The proportion of patients who received OAP increased from 89% for the physician group to 98% for the protocol group. Mean prothrombin times (PTs) were significantly higher in the protocol group only on postoperative day 2; 66% of all PTs beyond post-operative day 1 in the protocol group were within the targeted range, which reflected an International Normalized Ratio of 1.6-3.2. The frequencies of clinically apparent postoperative thrombotic events and bleeding episodes were low in each group and comparable to literature values. Analysis of protocol-group patients with PTs of > 20 seconds indicated that lower weight, female sex, and blood loss during surgery were associated with an elevated PT. The protocol was revised to provide for a lower initial warfarin dose in elderly women. A pharmacy-managed protocol for dosing warfarin achieved therapeutic goals and promoted nearly universal use of OAP in patients undergoing high-risk orthopedic surgery.
In many diabetic patients, disturbances of components of the coagulation/fibrinolysis system have been observed. These disturbances have been studied extensively due to their interrelations with the development of atherosclerotic vascular lesions. A thrombophilia (increased tendency to form thrombi) is regarded as a part of the presently widely discussed Metabolic Syndrome. In diabetic patients, increases of the fibrinogen concentration, of the factor VII activity and of the von Willebrand factor, of the concentration and activity of the plasminogen activator inhibitor as well as a raised platelet reactivity have been measured. Probably, further disturbances exist in the complexly regulated subsystems of hemostasis. Not only the hyperglycemia, but also dyslipidemias and a number of other factors do modify the individual situation. First of all, the therapeutic approach to reduce the atherosclerotic risk in the diabetic patients focuses on the optimization of these factors. In this context, a fat-modified diet, physical activity and eumetabolisation in a broader sense are especially important. In high-risk patients, especially within the framework of the secondary prevention of atherosclerotic lesions, the use of fibrates and of inhibitors of platelet aggregation are to be taken into consideration.
Resistance to activated protein C is a recently discovered genetic defect with a high prevalence in adult patients with thromboembolic disease. It is an autosomal dominant disorder and is ten times more common in these patients than antithrombin III-, protein C- and protein S deficiency together. In spite of this high prevalence among adults with thromboembolic disease no clinical manifestation in infancy so far has been reported. We describe a 4-year-old boy with a complex cardiac malformation and inherited resistance to activated protein C, who developed multiple thromboses after cardiac catheterization in early infancy. Conclusion. Resistance to activated protein C can cause thrombosis in infants and children if additional risk factors for the development of thrombosis are present.