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Between a rock and a hard place: anticoagulation management for ECMO.
Med Klin Intensivmed Notfmed
July 2024
Department of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, NC, USA.
Anticoagulation is an essential component of optimal extracorporeal membrane oxygenation (ECMO) management. Unfractionated heparin is still the anticoagulant of choice in most centers due to longstanding familiarity with the agent. Disadvantages include alterations in drug responses due to its capability to bind multiple heparin-binding proteins that compete with antithrombin and the potential for heparin-induced thrombocytopenia.
View Article and Find Full Text PDFHigh risk and low prevalence diseases: Acute limb ischemia.
Am J Emerg Med
December 2023
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA. Electronic address:
Introduction: Acute limb ischemia is a rare but serious condition that carries with it a high rate of morbidity and mortality.
Objective: This review highlights the pearls and pitfalls of acute limb ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion: Acute limb ischemia is defined as a sudden decrease in limb perfusion resulting in cessation of blood flow and nutrient and oxygen delivery to the tissues.
Long-term assist device patients admitted to ICU: Tips and pitfalls.
J Intensive Med
April 2023
Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen 32545, Germany.
Left ventricular assist device (LVAD) therapy is well-established in the treatment of end-stage cardiac failure. Indications are bridge to transplant (BTT), bridge to candidacy (BTC), bridge to recovery (BTR), and destination therapy (DT). The durability and adverse event (AE) rate of LVADs have improved over the years.
View Article and Find Full Text PDFGenotyping genetic variants of for precision antiplatelet dosing: state of the art and future perspectives.
Expert Opin Drug Metab Toxicol
December 2022
Faculty of Medical Sciences, Department of Pharmacology and Toxicology, University of Kragujevac, Svetozara Markovica 69, 34 000 Kragujevac, Serbia.
Article Synopsis
- Clopidogrel, an antiplatelet drug, is significantly influenced by genetic variations, known as polymorphisms, affecting its effectiveness in patients.
- The review discusses the link between genetic testing and clopidogrel treatment, highlighting recommendations and potential challenges in implementing these tests in clinical settings.
- Evidence indicates that specific genetic markers (LOF alleles) result in less effective clopidogrel activation, increasing the risk of treatment failure, while genetic testing can help identify patients who will benefit most from this therapy.
Lessons Learned from Managing Antithrombotic Therapy in Children Supported with Pediatric Ventricular Assist Devices.
ASAIO J
November 2022
From the Pediatric Advanced Cardiac Therapies Program, Pediatric Advanced Cardiac Therapies Program, Lucile Packard Children's Hospital, Palo Alto, California.
Article Synopsis
- Pediatric ventricular assist devices (VADs) face significant risks of complications like stroke and bleeding, which are leading causes of death and disability in these patients.
- Recent developments in antithrombotic strategies, especially with drugs like bivalirudin, have shown promise in reducing neurologic events, particularly for smaller pediatric VADs.
- The report aims to highlight current antithrombotic regimens linked to low complication rates and share 10 key lessons learned from 20 years of experience in managing pediatric VADs, focusing on methods to minimize clotting and bleeding risks beyond just the medication used.
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