Thrombophilia defines inherited and acquired conditions associated with an increased thrombotic risk, which predispose to venous thromboembolism (VTE), cardiopulmonary bypass (CPB) and stroke. Thromboembolic events have long been treated with the most commonly used anticoagulant drug, heparin that is rapidly replaced by low molecular weight heparin (LMWH). A variety of point-of-care (POC) coagulation platforms have been commercially available for many years now, providing more control over the patient’s anticoagulation management such as heparin and warfarin. While the measurement for anticoagulation by POC devices has relied mainly on the clotting time tests, innovative platelet function tests, and factor-specific assays based on enzymatic or immunoassay principles are becoming available, driven by the development of new anticoagulant drugs, as well as the failure of clotting time tests to precisely detect the thrombophilic events. This review focuses on current advances in the development of POC coagulation monitoring techniques and assesses their future prospects in management of thrombophilic events.
1. Introduction
Thrombosis is generally described as a complication in adults, whilst age is a potential risk factor with a 10-fold increased risk of thrombosis for every 20 years of age. Thrombophilia can be tested in adults who notice un-triggered thrombotic events and have family history of thromboembolism in adults less than 45 years of age. The thrombophilic disorders have long been treated with the conventional anticoagulant drugs, warfarin that is a vitamin K antagonist and heparin (unfractionated heparin UFH) that was replaced with recent, more predictable drugs such as low molecular weight heparins (LMWHs or f...
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...drugs for which current tests are unsuitable, within its potential as an anticoagulant monitoring POC device (Wehling et al., 2011). Another optical method established for measuring heparin therapy is focused on the electrostatic interaction along negatively charged heparin and positive charged nano-particles. As a result of this interaction is the incresed aggregation of nano-particles resulting in a change in color from red to blue and is visible in solution (Chandler et al., 2012).
To sum up, the rapid, turn-around measurement of clotting status in all clinical scenarios, involving operating theatres, emergency rooms, and inpatient and outpatient settings in the management of perioperative anticoagulation to the treatment of thrombosis and the prophylactic management of a variety of thrombophilic conditions, are now facilitated by a wide range of POC devices.
According to an article by Timsit, J., et al. an estimated 5 million central venous catheters are inserted in patients each year. CBIs, most of which are associated with central venous catheters, account for more than 11% of all health-care associated infections. Additionally, more than 250,000 central-line associated blood stream infections also occur annually, with an estimated mortality rate of 12-25%. For patients within the intensive care unit, the numbers were even higher. Each episode significantly increases the patient’s hospital stay, as well as increasing costs from $4,000 to $56,000 per episode.
...ulation respectively. In terms of assessment, hemophilia is suspected in children with excessive bleeding, easy bruising, spontaneous hematuria, and epistaxis (Ignatavicius & Workman, 2009). A low prothrombin and bleeding and low factor VIII in indicative of hemophilia A while an extended thromboplastin time and low factor IX is indicative of hemophilia B. Hemophilia is a lifelong disease and treatment regimens are aimed at reducing the signs and symptoms associated with it. Type A and B are managed with supplementation plasma concentrate Factor VIII and factor IX respectively, liver transplant, and gene therapy (Colbert, 2009).
Coumadin, whose generic name is Warfarin, and is manufactured by Bristol-Myers Squibb Company, is an anticoagulant medication. It is more commonly known as a “blood thinner”; however it does not actually thin the blood. An anticoagulant helps your body control how fast your blood clots and it prevents clots from forming during certain medical conditions. Medications such as Coumadin may prevent an already present clot from getting any larger and may also prevent a piece of the clot from breaking off and traveling to your heart, brain or lungs. Anticoagulants do not dissolve blood clots but with time, clots may dissolve on their own. (Cleveland Clinic, 2014)
(14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51.
Pinkerton, C. (2009). New technology enhances expertise of vascular access team. Canadian Nurse, 105(2), 21-22.
“Chronic diseases and illnesses are the leading causes of death and disability in the United States” (CDC.gov, 2014). These types of illnesses are the most common health problems that people in this country face today and they are also the most preventable (CDC.gov, 2014). Every year the cost to help care for and manage people with these types of illnesses increases and there is less being done about educating people about prevention. Venous Thromboembolism is one such chronic disease that is very deadly but also very preventable if the right precautions are taken. This paper will aim to educate about the disease, courses and costs of treatment, clinical microsystems that are involved and what barriers if any exist to achieving generative relationships among the various clinical microsystems involved.
After a thorough examination, J.P. was diagnosed with a deep vein thrombosis (DVT). “DVT develops most often in the legs but can occur also in the upper arms…” (Ignatavicius & Workman, 2013). Due t...
According the American Association of Blood Banks (AABB), there are several standards available for this procedure. These standards are vital to help intervene when blood transfusion is needed. It provides clinical recommendations to educate and aware nurses the recent advances and technological innovations in planning and management of transfusion medicine. The standards are updated so nurses can be in compliance with best practices of how to manage blood transfusion to assure the proper approach to patient care. The standards are updated as new clinical trials are performed and show different techniques. There are other associations which enforce the same standards but have some clinical variations. (AABB, 2010)
Essential IV information management and application of patient care technology is an essential that I consider most important to my practice. My nursing skill and technology is challenged every day while working. The new technology, change in procedures, and new equipment are essential to working in the Cardiac Catheterization Lab. One must adapt and change daily in order to keep up and stay educated. New physicians join and we must learn their technique styles and equipment needs while still maintaining exceptional patient care.
More research should be done on new oral anticoagulants with different study population and similar patients that are seen in everyday clinical practice as well as attempt to define the best pharmacodynamic monitoring tools. Research should be conducted to outline monitoring protocol including timing relative to dosing and frequency as well as therapeutic targets. Using these strategies, future trials could enhance further the efficacy and safety of these new agents and could extend their use to new indications.
Atkinson, R. P.; & DeLemos, C. (2000). Acute Ischemic Stroke Management. Thrombosis Research. 98:3; 97-111.
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
There have been an incidents of prolonged hospital stay due to central line infections putting patients at risk for mortality, morbidity, and increase in medical cost. When central lines are placed at bedside or in interventional radiology, the inserter is required to document the steps and sterile procedure that took place in the electronic health record. Furthermore, with weekly and as needed dressing changes, nurses are required to use central line bundles and document what was used (ex: Chloraprep, biopatch, tegaderm, etc.) to track how the dressing was done. From these documented records, staff can gather data and measure the compliance of sterile procedure. Additionally, if a patient with a central line develops a fever without an unknown cause physician will order blood culture from the central line if catheter-related infection is suspected. If the test comes back positive, the team will initiate antibiotics immediately. By integrating electronic health records it can assist in CLABSI prevention strategies, raise the standard for best practices, and essentially reduce central line infections. With the quarterly results of CLABSI in our unit, CVC committee have re-educated the staff on appropriate dressing changes using sterile technique, transitioned to a different end
The liver plays central role in each of these phases of clotting process, as it synthesizes the majority of coagulation factors and proteins involved in fibrinolysis as well as thrombopoietin., which is responsible for platelet production from megakaryocytes. In cirrhosis, liver is badly get damaged. So the production of coagulation factors and proteins is impaired. Many pathological processes associated with cirrhosis, such as portal hypertension and endothelial dysfunction as well as co-morbid conditions, may also alter the coagulation process. Consequently, patients with liver disease as in cirrhosis, have a disturbed balance of procoagulant and anti- coagulant factors which deviates from the normal coagulation cascade.
patient is going into DIC when in fact she is not. By checking a slide to verify the platelet