Vitamin K1 supplementation to improve the stability of anticoagulation therapy with vitamin K antagonists: a dose-finding study.

Background: Poor anticoagulant stability in patients using vitamin K antagonists is a risk factor for both bleeding and thrombosis. In previous studies supplementation with low dose vitamin K(1) was shown to improve the stability of anticoagulant control. We set up a study to confirm earlier reports and to determine the optimal daily dose of vitamin K(1) in preparation of a large study with clinical endpoints.

The new influenza A H1N1 virus: balancing on the interface of humans and animals.

In the spring of 2009, a new human influenza A H1N1 virus emerged in Mexico and the United States. The strain was referred to as "swine flu" as it has strong similarities with current circulating swine influenza viruses, although the first outbreak on a swine farm was recorded more than 2 mo following the first human reports. This new strain, designated as pandemic (H1N1) 2009, has shown the ability to spread amongst the human population and can be found on all continents.

External quality assessment (EQA) for CoaguChek monitors.

Anticoagulant control facilities are being overwhelmed by requests for monitoring and large numbers of patients are not therefore receiving treatment. Procedures designed for point-of-care testing have therefore been developed, the most popular being the CoaguChek. The need for external quality assessment (EQA) of monitors used by patients in self-management has been stressed in a European Commission (EC) Directive.

Influence of dietary vitamin K intake on subtherapeutic oral anticoagulant therapy.

It is unclear what advice should be given to patients using vitamin K antagonists with respect to dietary vitamin K intake. We performed a nested case-control study in patients attending a Dutch anticoagulation clinic, to determine the association between vitamin K intake and subtherapeutic International Normalized Ratio (INR) values and the interaction between usual and recent vitamin K intake. Compared to patients with a normal usual vitamin K intake, those with a high vitamin K intake had a decreased risk of a subtherapeutic INR [Hazard Ratio (HR) 0.

MR spectroscopy of cerebral white matter in type 2 diabetes; no association with clinical variables and cognitive performance.

Introduction: Type 2 diabetes (DM2) is associated with cognitive decline, but the pathogenesis of this important complication remains unclear. We investigated whether abnormalities in neuronal metabolism or membrane integrity in normal appearing cerebral white matter are associated with cognitive impairment in patients with DM2.

Methods: Single voxel proton magnetic resonance spectroscopy (1.

Apoptosis- and necrosis-induced changes in light attenuation measured by optical coherence tomography.

Optical coherence tomography (OCT) was used to determine optical properties of pelleted human fibroblasts in which necrosis or apoptosis had been induced. We analysed the OCT data, including both the scattering properties of the medium and the axial point spread function of the OCT system. The optical attenuation coefficient in necrotic cells decreased from 2.

Optimal level of oral anticoagulant therapy for the prevention of arterial thrombosis in patients with mechanical heart valve prostheses, atrial fibrillation, or myocardial infarction: a prospective study of 4202 patients.

Background: Oral anticoagulant therapy is effective for the prevention of arterial thromboembolism in various patient groups. The increased risk of hemorrhage remains the major drawback to this therapy and is associated with the intensity of anticoagulation. Finding the optimal intensity at which the overall incidence rate of both bleeding and thromboembolic events is minimized represents a way to improve the safety of oral anticoagulant treatment.

The cost-effectiveness of computer-assisted anticoagulant dosage: results from the European Action on Anticoagulation (EAA) multicentre study.

Background: Increased demand for oral anticoagulation has resulted in wider adoption of computer-assisted dosing in anticoagulant clinics. An economic evaluation has been performed to investigate the cost-effectiveness of computer-assisted dosing in comparison with manual dosing in patients on oral anticoagulant therapy.

Methods: A trial-based cost-effectiveness analysis was conducted as part of the EAA randomized study of computer-assisted dosage vs.

Seroprevalence of antibodies against pestiviruses in small ruminants in The Netherlands.

In this study, a serological survey was performed to determine the prevalence of pestivirus (bovine viral diarrhea virus (BVDV) and border disease virus (BDV)) infected small ruminants herds in the Netherlands. After random selection of sheep farms, a sample size was determined to detect a 5% herd prevalence. 13 out of 29 farms were tested seropositive using an ELISA which detects antibodies directed against the non structural protein 3 (NS3) of pestiviruses.

The value of family history as a risk indicator for venous thrombosis.

Background: A positive family history of venous thrombosis may reflect the presence of genetic risk factors. Once a risk factor has been identified, it is not known whether family history is of additional value in predicting an individual's risk. We studied the contribution of family history to the risk of venous thrombosis in relation to known risk factors.

Subtherapeutic oral anticoagulant therapy: frequency and risk factors.

Subtherapeutic anticoagulation levels increase both the risk and severity of thromboembolism. The aim of this study was to determine the cumulative incidence of subtherapeutic international normalised ratios (INRs) and to identify risk factors associated with a low INR. We performed a cohort study in 7,419 patients from a Dutch anticoagulation clinic.

A multicentre randomised assessment of the DAWN AC computer-assisted oral anticoagulant dosage program.

Computer-assisted oral anticoagulant dosage is being increasingly used to meet growing demands for oral anticoagulation. The DAWN AC is one of the most widely used computer-dosage programs. Evidence of its value and that of other computer programs has been based previously only on laboratory evidence of "time in target INR range" (TIR) not on clinical safety in practice.

Influence of haematocrit on international normalised ratio (INR) differences between a whole blood point-of-care coagulation monitor and reference prothrombin time in plasma.

The CoaguChek S system is designed for use in patient self-testing. In this system a whole blood sample without sodium citrate is applied to a test strip containing thromboplastin and iron oxide particles. The detection principle is based on fibrin formation which inhibits and finally stops the movement of the iron oxide particles.

A multicentre randomised clinical endpoint study of PARMA 5 computer-assisted oral anticoagulant dosage.

To meet growing demand for oral anticoagulation worldwide there has been increased dependence on computer-assistance in dosage although the safety and effectiveness of any of the individual computer-assisted dosage programs has not previously been established. This randomised multicentre clinical end-point study assessed a new version of the PARMA 5 program. It compared PARMA 5 safety and effectiveness with manual dosage by experienced medical staff at 19 centres with a known interest in oral anticoagulation.

[The interaction between anticoagulant therapy with vitamin K-antagonists and treatment with antibiotics: a practical recommendation].

--In users of vitamin K-antagonists (VKA), antibiotics can lead to excessive anticoagulation. --It is unclear what the optimal policy is for prevention of an excessive anticoagulant effect during use of antibiotics. --This article describes the increased sensitivity to VKA during use of antibiotics, and also provides a practical recommendation for the correct method for use of antibiotics in combination with VKA treatment.

A Spatial-Spectral Approach for Visualization of Vegetation Stress Resulting from Pipeline Leakage.

Hydrocarbon leakage into the environment has large economic and environmental impact. Traditional methods for investigating seepages and their resulting pollution, such as drilling, are destructive, time consuming and expensive. Remote sensing is an efficient tool that offers a non-destructive investigation method.

An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage.

Background: Increased demand for oral anticoagulants is overwhelming facilities worldwide, resulting in increasing use of computer assistance. A multicenter clinical endpoint study has been performed to compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff at the same centers.

Methods: A randomized study of dosage of two commercial computer-assisted dosage programs (PARMA 5 and DAWN AC) vs.

Current perspective of venous thrombosis in the upper extremity.

Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous thrombosis.

The relationship between maintenance dosages of three vitamin K antagonists: acenocoumarol, warfarin and phenprocoumon.

Introduction: Vitamin K antagonists of the coumarin type are widely used oral anticoagulants.

Objective: We developed a transition algorithm for the maintenance dosages of three frequently used coumarins: warfarin, phenprocoumon and acenocoumarol.

Methods: The study was conducted at the Leiden Anticoagulation Clinic.

Is smaller workspace a limitation for robot performance in laparoscopy?

Purpose: Robot or computer assisted laparoscopic surgeries have overcome several impediments of conventional laparoscopy in pediatric urology. However, in our practice we faced difficulties while performing specific tasks using the da Vinci Surgical System in small cavities. Thus, we objectively evaluated the performance of robot assisted laparoscopic skills in different sizes of workspace.

Prevention of coagulase-negative staphylococcal central venous catheter-related infection using urokinase rinses: a randomized double-blind controlled trial in patients with hematologic malignancies.

Purpose: Fibrin deposition at the intraluminal surface of the indwelling part of the central venous catheter (CVC) surface increases the risk of CVC-related coagulase-negative staphylococci (CoNS) infection. Therefore, repetitive enzymatic dissolution of fibrin by urokinase might reduce the risk of CVC-related infection. We undertook this study to investigate whether three times weekly urokinase rinsing of CVC reduces the incidence or severity of CVC-related infections by CoNS in patients undergoing intensive cytotoxic treatment for hematologic malignancies.

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

Objective: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia).

Design: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry.

Results: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry.

Sensitivity to activated protein C during the menstrual cycle in women with and without factor VLeiden.

Introduction: Activated protein C (APC) resistance is associated with an increased risk of venous thrombosis. High levels of estradiol and progesterone, e.g.