vitamin-k-semiquinone-radical and Substance-Withdrawal-Syndrome

To evaluate whether the incidence of recurrent venous thromboembolism (VTE) events after therapy differs for patients treated with long-term low-molecular-weight heparin (LMWH) or oral anticoagulant therapy (OAT).. All randomized studies were searched through computerized queries of MEDLINE, the Cochrane Controlled Trials Register, the American Society of Hematology abstract database, and the American Society of Clinical Oncology abstract database.. Eleven studies including 2,907 patients were identified. Seven studies evaluated a period of 3 to 9 months after cessation of the allocated treatment: 5.4% of patients in the LMWH group vs 4% in the arm allocated to OAT had an episode of recurrent symptomatic VTE. Combined analysis showed a nonsignificant trend in lowering recurrent symptomatic VTE in favor of OAT (relative risk [RR], 1.29; 95% confidence interval [CI], 0.82 to 2.02; p = 0.27). By contrast, during active treatment, a statistically significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH over OAT was registered (RR, 0.63; 95% CI, 0.47 to 0.83; p = 0.001). Regarding cancer patients only, 37 of 569 patients (6.5%) in the LMWH group had recurrent symptomatic VTE vs 69 of 546 patients (12.6%) in the OAT group, with a statistically significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH (RR, 0.52; 95% CI, 0.35 to 0.76; p = 0.001).. Despite the significant reduction of the risk of recurrent symptomatic VTE in favor of LMWH over OAT during treatment, patients treated with long-term LMWH do not seem to have more frequently recurrent VTE events compared with OAT after cessation of therapy. The significant difference favoring LMWH over OAT among all patients receiving treatment comes mostly from studies enrolling cancer patients.

Topics: Anticoagulants; Drug Administration Schedule; Drug Therapy, Combination; Follow-Up Studies; Heparin, Low-Molecular-Weight; Humans; Long-Term Care; Pulmonary Embolism; Randomized Controlled Trials as Topic; Secondary Prevention; Substance Withdrawal Syndrome; Venous Thrombosis; Vitamin K

Norplant implant use in Singapore showed a decrease in vitamin K-dependent Factors II, V, VII and reduction in fibrinolytic activity at the end of 5 years of use. Increased platelet numbers and accelerated platelet aggregation were also found throughout the 5 years of Norplant use. It thus appears that unlike the combined pill, prolonged Norplant use does not activate the coagulation system and does not enhance a state of hypercoagulation. On removal of the Norplant implants at the end of 5 years, the significant changes seen in hemostatic function observed with Norplant use remained.

Topics: Blood Coagulation; Blood Coagulation Factors; Blood Platelets; Drug Implants; Female; Hematocrit; Hemostasis; Humans; Levonorgestrel; Partial Thromboplastin Time; Platelet Aggregation; Prothrombin Time; Singapore; Substance Withdrawal Syndrome; Time Factors; Vitamin K

The alcohol withdrawal syndromes are generally self-limited processes from which spontaneous recovery can be anticipated. To achieve this outcome, the various types of withdrawal must be managed in such a way as to prevent the occurrence of life-threatening situations. This begins with a good initial evaluation, followed by the appropriate pharmacologic and behavioral steps to control the severity of withdrawal symptoms and to manage complications. Once the withdrawal process is completed, the patient can then be entered into a long-term treatment program.

Topics: Acute Disease; Alcohol Withdrawal Delirium; Alcoholism; Benzodiazepines; Chloral Hydrate; Ethanol; Folic Acid; Gastrointestinal Hemorrhage; Hallucinations; Humans; Nutrition Disorders; Seizures; Social Support; Substance Withdrawal Syndrome; Thiamine; Vitamin K; Water-Electrolyte Imbalance