Recombinant activated factor VII in controlling bleeding in non-hemophiliac patients

There have been recent reports on the successful use of recombinant factor Vila [rFVIIa] in non-hemophiliac patients who have experienced heavy blood loss due to trauma with extensive organ damage and who have received multiple blood transfusions with hemostatic changes without success. The timing of administration, dosage, mortality, units of blood transfusion saved, risk of thrombotic events, and the risk/benefit ratio are still poorly defined. We conducted a retrospective review of all medical records of patients who received rFVIIa between January 2003 and March 2008. Data collection included demographic characteristics, diagnosis, indications, comorbidities, and amount of blood products used with rFVIIa, dose of rFVIIa, mortality, and adverse events. We identified 45 patients, 27 [60%] males and 18 [40%] females, with a median age of 52 years. The median dose of rFVIIa was 40 micro g/kg [range, 20-120 micro g/kg]. Five [11.1%] patients needed a second dose of rFVIIa [dose range of 20-85 micro g/kg] whereas three patients [6.7%] needed a third dose of rFVIIa [dose range of 40-60 micro g/kg]. There was a marked and significant reduction in transfusion requirements for packed red blood cells [P=.0078]. Overall transfusion requirements significantly decreased after the infusion of rFVIIa [P=.0323]. Nineteen patients [42.2%] died and thrombosis was documented in 3 patients [6.7%].Use of rFVIIa should be based on sound clinical evidence to balance the risks, benefits, and cost if used among non-hemophiliacs. Prospective randomized studies are needed to investigate the efficacy and cost-effectiveness of rFVIIa for this indication and to allow a final assessment of the importance of this treatment

Practices and perceptions of physicians to prescribing elastic compression stockings in a single center in Saudi Arabia

To assess Saudi physicians' attitudes, practices, and perceptions towards use of elastic compression stockings [ECS] and knowledge of effective treatment in patients with deep vein thrombosis [DVT]. In January 2009, we surveyed 38 physicians from King Saud University, Riyadh, Kingdom of Saudi Arabia who are involved in the management and treatment of patients with DVT. Thirty [78.9%] of 38 respondents have prescribed ECS in their practices wherein only 6 [20%] prescribed ECS to patients only if venous signs and symptoms are present. Not all respondents perceived benefit from use ECS. Common perceived benefits included control of edema [70%], prevention of DVT recurrence [56.7%] and control of symptoms [46.7%]. The main reasons for patient non-compliance were discomfort [66.7%], hard to put on [16.7%], appearance [13.3%], no help [10%], and makes leg worse [3.3%]. The prescription of ECS in our institution needs to be systematically examined. Physicians involved in the management of DVT need to be further acquainted with the benefit of ECS. Although some of our respondents do prescribe ECS, they need to be further instructed on the timing of initiation of ECS, duration of therapy, and even compression strength

Pregnancy-associated venous thromboembolism Part I - Deep vein thrombus diagnosis and treatment

Venous thromboembolic VTE complications are leading causes of maternal mortality in the developed world. Over the past 20 years, there has been an increase in the incidence of deep venous thrombosis DVT in pregnant women, and this increase may be explained by the risk factors including older age, cesarean section, history of VTE, and presence of thrombophilia. To reduce the incidence of VTE in pregnancy and improve the outcomes, a wider understanding of the risk factors, and a better identification of women at risk of the thrombosis, with objective diagnosis and provide the optimal effective and safe treatment. Deep venous thrombosis and pulmonary embolism, considered manifestations of the same disease, are often preventable and usually treatable. Nevertheless, VTE remains a substantial problem despite the dramatic decline in pregnancy-related mortality in industrialized countries over the past century. While diagnosis and management of VTE in pregnancy are challenging, and many diagnostic tests are less accurate in pregnant than non-pregnant patients, and the available options are suboptimal. This is a review in 2 parts, in part I, we address the following questions: In pregnant women, who developed DVT; how to diagnose, and the treatment once the diagnosis is confirmed. For each of these problems, the relevant background is briefly summarized, approaches recommended, and the suggested practical and relatively safe diagnostic management approaches. Part II, we address pregnant women with pulmonary embolism, how to diagnose and treat