Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid.

The optimal management of menorrhagia among women with abnormal laboratory haemostasis is uncertain. In a crossover study, 116 women with menorrhagia [pictorial blood assessment chart (PBAC) score >100], negative gynaecological evaluation and abnormal laboratory haemostasis were randomly assigned to either intranasal desmopressin (IN-DDAVP) or tranexamic acid (TA) therapy for two menstrual cycles. The subjects then crossed over to the second study drug for two additional cycles.

Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia.

Background: Effective ways to prevent arthropathy in severe hemophilia are unknown.

Methods: We randomly assigned young boys with severe hemophilia A to regular infusions of recombinant factor VIII (prophylaxis) or to an enhanced episodic infusion schedule of at least three doses totaling a minimum of 80 IU of factor VIII per kilogram of body weight at the time of a joint hemorrhage. The primary outcome was the incidence of bone or cartilage damage as detected in index joints (ankles, knees, and elbows) by radiography or magnetic resonance imaging (MRI).

Demographics of hemophilia in developing countries.

Demographic datasets pertaining to populations are extremely valuable tools in healthcare planning. They are vital in setting priorities, allocation of resources, measurement of outcomes, and comparison of alternate approaches. Countries with emerging economies especially need information regarding targeted populations when initiating programs designed to deliver care to persons with chronic conditions such as hemophilia.

Elevated factor VII as a risk factor for recurrent fetal loss. Relationship to factor VII gene polymorphisms.

Haemostatic abnormalities can be detected in a portion of the women who have recurrent fetal loss. We measured factor VII coagulant activity (FVII:C) in 65 women with 3 or more fetal losses (recurrent cases), 31 women with one 2nd or 3rd trimester loss (late loss cases), and 81 women with only live births (controls). FVII:C was greater than 2 standard deviations above the mean for controls in 9 recurrent cases (13.

Prevalence and risk factors for heart disease among males with hemophilia.

There have been conflicting reports in the literature about the protective effect of hemophilia on the occurrence of ischemic heart disease (IHD). Circulatory disease has been reported as the second most common cause of death in persons with hemophilia in the United States. In addition to diabetes and hypertension, high levels of FVIII, as may occur during factor concentrate infusions, may increase IHD risk in this population.

HIV Infection and thrombocytopenia.

Thrombocytopenia is a common complication of HIV infection. The low platelet count can be caused by multiple mechanisms including immune-mediated destruction, decreased platelet production, effects of drugs on progenitors, or by the development of a form of thrombotic thrombocytopenic purpura (TTP). Bleeding problems associated with the thrombocytopenia can be accentuated by the presence of platelet dysfunction produced by drugs used to treat HIV/AIDs or its complications.

Human parvovirus B19 in young male patients with hemophilia A: associations with treatment product exposure and joint range-of-motion limitation.

Background: To evaluate the risk of human parvovirus B19 (B19) transmission in recombinant antihemophilic factor, the seroprevalence among 798 two- to seven-year-old boys with hemophilia was compared. Also, data collected on joints were used to assess relations between B19 serostatus and joint range-of-motion (ROM) limitation.

Study Design And Methods: Staff at US hemophilia treatment centers collected data on product exposures and ROM of 10 joints and provided blood specimens as part of blood safety surveillance.

Relationship of venous thromboembolism and myocardial infarction with the renin-angiotensin system in African-Americans.

Genetic polymorphisms/mutations associated with venous thrombosis have largely been confined to the genes that encode for proteins in either the coagulant or the anticoagulant pathway. Although genetic alterations in the renin-angiotensin system have been reported to have a role in myocardial infarction and hypertension, there is recent evidence to suggest that there may also be an association with venous thrombosis. To extend our earlier observation of an association between the ACE DD genotype in African-American males and venous thrombosis, other genes in the renin-angiotensin pathway were investigated for possible disease association and were compared with African-Americans with myocardial infarction.