deamino-arginine-vasopressin and Heart-Diseases

Acquired von Willebrand disease (aVWD) occurs in association with a variety of underlying disorders, most frequently in lymphoproliferative and myeloproliferative disorders, other malignancies, and cardiovascular disease. aVWD is a complex and heterogeneous defect with a multifactorial etiology and the pathophysiologic mechanisms remain unclear in many cases. Assays for anti-factor VIII (FVIII)/von Willebrand factor (VWF) activities often yield negative results although antibodies may be present in autoimmune disease and some lymphoproliferative disorders. Functional assays of VWF in patients' plasma and particularly in heart valve disease, VWF multimer analysis are important for aVWD diagnosis. In patients with normal partial thromboplastin times and normal VWF activity, the diagnosis of aVWD is based on clinical suspicion and a careful bleeding history, which should prompt the clinician to initiate further laboratory investigations. Management of bleeding in aVWD relies mainly on desmopressin, FVIII/VWF concentrates and high-dose intravenous immunoglobulin. The half-life of VWF may be very short, and in bleeding episodes high doses of FVIII/VWF concentrates at short intervals may be necessary even when high-dose intravenous immunoglobulin was applied before. Since the optimal treatment strategy has not yet been defined for aVWD of different etiology, controlled multicenter trials aiming at the development of standardized treatment protocols are urgently needed.

Topics: Antibody Specificity; Autoantibodies; Autoantigens; Autoimmune Diseases; Deamino Arginine Vasopressin; Heart Diseases; Hemorrhage; Humans; Immunoglobulin G; Immunoglobulin M; Immunoglobulins, Intravenous; Immunosuppressive Agents; Lymphoproliferative Disorders; Neoplasms; von Willebrand Diseases; von Willebrand Factor

To review the use of systemic hemostatic medications for reducing bleeding and transfusion requirements with cardiac surgery.. Articles were obtained through computerized searches involving MEDLINE (from 1966 to September 2000). Additionally, several textbooks containing information on the diagnosis and management of bleeding associated with cardiac surgery were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references.. Due to the large number of randomized investigations involving systemic hemostatic medications for reducing bleeding associated with cardiac surgery, the article selection process focused on recent randomized controlled trials, metaanalyses and pharmacoeconomic evaluations.. The primary outcomes extracted from the literature were blood loss and associated transfusion requirements, although other outcome measures such as mortality were extracted when available.. Although the majority of investigations for reducing cardiac bleeding and transfusion requirements have involved aprotinin, evidence from recent meta-analyses and randomized trials indicates that the synthetic antifibrinolytic agents, aminocaproic acid and tranexamic acid, have similar clinical efficacy. Additionally, aminocaproic acid (and to a lesser extent tranexamic acid) is much less costly. More comparative information of hemostatic agents is needed retative to other outcomes (eg., reoperation rates, myocardial infarction, stroke). There is insufficient evidence to recommend the use of desmopressin for reducing bleeding and transfusion requirements in cardiac surgery, although certain subsets of patients may benefit from its use.. Of the medications that have been used to reduce bleeding and transfusion requirements with cardiac surgery, the antifibrinolytic agents have the best evidence supporting their use. Aminocaproic acid is the least costly therapy based on medication costs and transfusion requirements.

Topics: Aminocaproates; Antifibrinolytic Agents; Aprotinin; Blood Loss, Surgical; Critical Care; Deamino Arginine Vasopressin; Heart Diseases; Hemostatics; Humans; Meta-Analysis as Topic; Randomized Controlled Trials as Topic

Prothrombin complex concentrates are frequently used to rapidly reverse anticoagulation with vitamin K antagonists associated with life-threatening bleeding. We report a patient receiving warfarin who presented to the emergency department with an international normalization ratio greater than 12.8 in cardiac tamponade and received prothrombin complex concentrate for rapid reversal of anticoagulation. On correction of the tamponade, the patient developed a massive and fatal right-sided ventricular thrombus. Thrombogenic complications of treatment with prothrombin complex concentrate have been reported before. Caution should be used when using prothrombin complex concentrates for reversal of anticoagulation.

Topics: Aged; Blood Coagulation Factors; Cardiac Tamponade; Coagulants; Deamino Arginine Vasopressin; Drug Synergism; Fatal Outcome; Heart Diseases; Heart Ventricles; Hemostatics; Humans; International Normalized Ratio; Male; Pericardial Effusion; Prothrombin Time; Thrombosis