ABC of Antithrombotic Therapy by Edited by Andrew D. Blann Edited by Gregory Y. H. Lip

By Edited by Andrew D. Blann Edited by Gregory Y. H. Lip

Urban clinic, Birmingham, united kingdom. Discusses the motives and effects of blood clots, how antithrombotic treatment works and its makes use of for sufferers. Addresses bleeding hazards, venous thromboembolism, atrial traumatic inflammation, peripheral vascular ailment, middle failure, and anticoagulation. plentiful halftone and colour illustrations. Softcover.

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In IST 300 mg of 28 Vascular death 0 3 6 9 12 15 Annual probability (%) Annual risk of stroke or vascular death among patients in various high risk subgroups Stroke 15% 85% Primary haemorrhage • Intraparenchymal • Subarachnoid Ischaemic stroke 20% 25% 20% Atherosclerotic cerebrovascular disease Penetrating artery disease Cardiogenic embolism ("Lacunes") Hypoperfusion Arteriogenic emboli • Atrial fibrillation • Valve disease • Ventricular thrombi • Many others Management of acute ischaemic stroke The principles of management of patients with ischaemic stroke include slowing the progression of stroke, decreasing the recurrence of stroke, decreasing death and disability, preventing deep vein thrombosis and pulmonary embolism, and suppressing fever, managing hypertension and controlling glucose levels.

Two major randomised trials (the international stroke trial (IST) and the Chinese acute stroke trial (CAST)) have shown that starting daily aspirin promptly ( < 48 hours after the start rather than the end of the hospital stay) in patients with suspected acute ischaemic stroke reduces the immediate risk of further stroke or death in hospital, and the overall risk of death and dependency at six months later. About 10 deaths or recurrent strokes are avoided in every 1000 patients treated with aspirin in the first few weeks after an ischaemic stroke.

Clinical and echocardiographic criteria can help identify the first two of Virchow’s postulates for thrombogenesis—namely, abnormalities of blood flow and vessels, such as valvar heart disease and cardiac impairment. Patients with atrial fibrillation also show abnormalities of haemostatic and platelet markers that are unrelated to aetiology and underlying structural heart disease (and alter with antithrombotic therapy and cardioversion), which point towards the presence of a hypercoagulable state in this common arrhythmia.

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