ABSTRACT
Anemia is a common complication in the clinical course of chronic lymphocytic leukemia. Low hemoglobin levels both correlate with an adverse prognosis and adversely affect the quality of life of chronic lymphocytic leukemia patients. Different physiopathological phenomena may lead to anemia: marrow infiltration, hypersplenism, immune hemolysis or toxicity of chemotherapy. Treatment with human recombinant erythropoietic agents has been shown to be effective for anemia associated with different lymphoproliferative syndromes. This paper analyses the available evidence on erythropoietic agent treatment for chronic lymphocytic leukemia associated anemia. The comparative effect of different dosage schemes, the role of possible response-prediction factors such as the endogenous erythropoietin level and the results achieved using darbopoietin alpha are reviewed.
Subject(s)
Anemia/drug therapy , Erythropoietin/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/blood , Anemia/epidemiology , Anemia/etiology , Anemia/physiopathology , Anemia/psychology , Anemia, Hemolytic, Autoimmune/etiology , Combined Modality Therapy , Darbepoetin alfa , Double-Blind Method , Erythropoietin/administration & dosage , Erythropoietin/analogs & derivatives , Erythropoietin/blood , Humans , Hypersplenism/etiology , Hypersplenism/radiotherapy , Hypersplenism/surgery , Incidence , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Multicenter Studies as Topic , Quality of Life , Randomized Controlled Trials as Topic , Recombinant Proteins , Splenectomy , Splenomegaly/drug therapy , Splenomegaly/etiology , Splenomegaly/radiotherapy , Splenomegaly/surgery , Treatment Outcome , Vidarabine/analogs & derivatives , Vidarabine/therapeutic useABSTRACT
Management of acute coronary syndromes (ACS) has moved rapidly in parallel with our understanding of the pathophysiological basis of the disease. In the eighties, the demonstration of the pivotal role of coronary thrombosis in the etiology of a ACS led to administration of aspirin and unfractionated heparin. In recent years, new medical and invasive therapies have been developed: anti-platelets (thienopyridines and glycoprotein Ilb/IlIa inhibitors), antithrombins (low molecularweight heparins) and most recently, factor Xa inhibitors (pentasaccharides). As new treatments are rapidly added, clinicians are constantly challenged to incorporate new information and guidelines into their practices in a timely fashion.
Subject(s)
Angina, Unstable/drug therapy , Anticoagulants/therapeutic use , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Acute Disease , Angioplasty, Balloon, Coronary , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Disease Management , Electroencephalography , Evidence-Based Medicine , Fibrinolytic Agents/therapeutic use , Humans , Myocardial Infarction/therapy , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , RiskABSTRACT
Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations.
