Heparin-dependent antibodies and thrombosis without heparin-induced thrombocytopenia.


:Although heparin-dependent antibodies (HDAs) typically manifest with thrombocytopenia as in heparin-induced thrombocytopenia (HIT), they may also manifest with preserved platelet counts. We describe a 35-year-old woman who developed severe thrombotic complications due to heparinization and unrecognized HDAs. She had received subcutaneous heparin as prophylaxis for deep vein thrombosis during a 5-day hospitalization for postpartum cardiomyopathy. Five days after discharge (day 1), she developed bilateral lower extremity arterial thrombi and underwent heparinization and successful lower extremity thrombectomies. A pulmonary embolus and hepatic and renal infarcts were then found. On days 2-6, the patient experienced a myocardial infarction, ischemic cerebrovascular accident, recurrent lower extremity arterial thrombus, and splenic infarct. On day 7, blood obtained on day 4 was found to be strongly positive for HDAs. In the interim, the patient had been transitioned to warfarin. Her platelet counts were never less than 75% of baseline and were consistently above 200 x 10(3)/mm(3). Hypercoagulability studies were negative. The patient's score on the Naranjo adverse drug reaction probability scale indicated that the relationship between this adverse reaction and heparin was probable. An extensive MEDLINE search located 22 other reports of patients who developed HDAs, sometimes associated with thrombosis, but whose platelet counts did not decrease. As with our patient, many of these case reports described clinicians who overlooked thrombosis due to HDAs because the patients did not have HIT. Clinicians should be cognizant of this possibility and consider a diagnosis of HDAs in patients with ongoing thrombosis who are receiving heparin therapy. It is strongly recommended that heparin be substituted with another anticoagulant in such cases until the presence of HDAs can be definitively ruled out.






Bream-Rouwenhorst HR,Hobbs RA




Has Abstract


2008-11-01 00:00:00














  • Pharmacokinetics of intranasal and intratracheal pentoxifylline in rabbits.

    abstract:STUDY OBJECTIVE:To evaluate the disposition of pentoxifylline and its metabolite, lisofylline, in New Zealand rabbits after two alternative routes of administration, intranasal and intratracheal. DESIGN:Pharmacokinetics study in an animal model. SETTING:University-affiliated animal care facility. SUBJECTS:Twenty New...


    pub_type: 杂志文章


    authors: Adcock KG,Kyle PB,Deaton JS,Olivier JH,Hogan SM

    更新日期:2007-02-01 00:00:00

  • White Paper on Natural Products.

    abstract::The American College of Clinical Pharmacy (ACCP) published an initial white paper on herbal products in 2000. Since then, the global market for natural products has continued to expand, with tens of millions of consumers using such products on an annual basis in the United States alone. However, despite this expansion...


    pub_type: 杂志文章


    authors: Gabay M,Smith JA,Chavez ML,Goldwire M,Walker S,Coon SA,Gosser R,Hume AL,Musselman M,Phillips J,Abe AM

    更新日期:2017-01-01 00:00:00

  • Calcium channel blockers as the treatment of choice for hypertension in renal transplant recipients: fact or fiction.

    abstract::Posttransplantation hypertension has been identified as an independent risk factor for chronic allograft dysfunction and loss. Based on available morbidity and mortality data, posttransplantation hypertension must be identified and managed appropriately. During the past decade, calcium channel blockers have been recom...


    pub_type: 杂志文章,评审


    authors: Baroletti SA,Gabardi S,Magee CC,Milford EL

    更新日期:2003-06-01 00:00:00

  • Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder.

    abstract::In a double-blind, placebo-controlled study of 200 patients with moderate to moderately severe anxiety we compared the anxiolytic efficacy and safety of alprazolam and lorazepam. Dosing was flexible and ranged from 1 to 4.5 mg/day of alprazolam and from 2 to 9 mg/day of lorazepam. The mean daily dose at the end of the...


    pub_type: 临床试验,杂志文章


    authors: Cohn JB,Wilcox CS

    更新日期:1984-03-01 00:00:00

  • The importance of in-hospital statin therapy for patients with acute coronary syndromes.

    abstract::Starting lipid-lowering therapy in the hospital, especially with statins, has become an important component in the management of patients with acute coronary syndromes (ACS). It improves outcomes and increases patient motivation and long-term adherence. In addition, discontinuation of statin therapy in patients with A...


    pub_type: 杂志文章,评审


    authors: Paradiso-Hardy FL,Gordon WL,Jackevicius CA,Kertland HR,Pearson GJ,Pickering JL,Poirier L,Semchuk BM,Verret L

    更新日期:2003-04-01 00:00:00

  • Severe hypoglycemia from Helicobacter pylori triple-drug therapy and insulin detemir drug interaction.

    abstract::Two drugs commonly used in triple-drug therapy for treatment of a Helicobacter pylori infection, clarithromycin and omeprazole, have rarely been associated with hypoglycemia when given alone. No documented interactions between H. pylori treatment with clarithromycin, amoxicillin, and omeprazole and insulin detemir hav...


    pub_type: 杂志文章


    authors: Otsuka SH

    更新日期:2013-04-01 00:00:00

  • Effects of carbamazepine on cyclosporine metabolism in pediatric renal transplant recipients.

    abstract::This study documents a pharmacokinetic interaction between carbamazepine and cyclosporine (CsA) in pediatric renal transplant recipients. Noncompartmental steady-state CsA pharmacokinetics were determined in three pediatric renal transplant recipients who were receiving both CsA and carbamazepine as long-term therapy ...


    pub_type: 临床试验,杂志文章


    authors: Cooney GF,Mochon M,Kaiser B,Dunn SP,Goldsmith B

    更新日期:1995-05-01 00:00:00

  • Endothelin-1 and endothelin receptor antagonists as potential cardiovascular therapeutic agents.

    abstract::Endothelin (ET)-1 is an endothelium-derived peptide with potent vasoconstrictor and proliferative properties. The ET system is activated in several cardiovascular disease states associated with functional and structural vascular changes, including hypertension and heart failure. The two ET receptor subtypes are known ...


    pub_type: 杂志文章,评审


    authors: Ergul A

    更新日期:2002-01-01 00:00:00

  • Impact of High-Dose Acyclovir Cytomegalovirus Prophylaxis Failure in Abdominal Solid Organ Transplant Recipients.

    abstract:STUDY OBJECTIVE:To evaluate the clinical course and long-term impact of high-dose acyclovir (HD-A, 800 mg 4 times/day) cytomegalovirus (CMV) prophylaxis failure in a CMV-seropositive abdominal solid organ transplant population. DESIGN:Retrospective cohort study. SETTING:Tertiary academic medical center. PATIENTS:A t...


    pub_type: 杂志文章


    authors: Siodlak M,Jorgenson MR,Descourouez JL,Leverson GE,Mandelbrot DA,Smith JA,Redfield RR

    更新日期:2018-07-01 00:00:00

  • Itraconazole and fluconazole and certain rare, serious adverse events.

    abstract:STUDY OBJECTIVE:To determine rates of drug-induced, rare, serious adverse events affecting the liver, kidneys, skin, or blood, occurring within 45 days of completing a prescription or refill for itraconazole or fluconazole. DESIGN:Population-based follow-up study SETTING:United Kingdom-based General Practice Research...


    pub_type: 杂志文章


    authors: Bradbury BD,Jick SS

    更新日期:2002-06-01 00:00:00

  • Diflunisal in the treatment of the pain of osteoarthritis. Summary of clinical studies.

    abstract::In comprehensive clinical studies, diflunisal--a new nonsteroidal antiinflammatory drug with a long duration of action--was shown to be highly effective and generally well tolerated in the short- and long-term treatment of the pain of osteoarthritis. In double-blind comparison studies, diflunisal was comparable in eff...


    pub_type: 临床试验,杂志文章


    authors: Umbenhauer ER

    更新日期:1983-03-01 00:00:00

  • Can the frequency and risks of fatal adverse drug events be determined?

    abstract::Death is the ultimate adverse drug event. Despite its importance, the frequency of fatal adverse drug events is unknown. Estimates in the United States are as high as 140,000/year, although this number is heavily disputed. Potential reasons and risks for fatal adverse drug events, as well as epidemiologic designs for ...


    pub_type: 杂志文章,评审


    authors: Kelly WN

    更新日期:2001-05-01 00:00:00

  • Analysis of the analgesic efficacy of acetaminophen 1000 mg, codeine phosphate 60 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg in the relief of postoperative pain.

    abstract::Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. Th...


    pub_type: 临床试验,杂志文章


    authors: Gertzbein SD,Tile M,McMurty RY,Kellam JF,Hunter GA,Keith RG,Harsanyi Z,Luffman J

    更新日期:1986-05-01 00:00:00

  • The biology of thrombin in acute coronary syndromes.

    abstract::Thrombin, a serine protease, is the keystone of the twin processes of hemostasis and thrombosis. Through procoagulant, anticoagulant, and antifibrinolytic mechanisms, thrombin helps maintain vascular integrity in the face of hemorrhage. These same mechanisms, however, allow for the pathologic formation of thrombi in r...


    pub_type: 杂志文章,评审


    authors: Nappi J

    更新日期:2002-06-01 00:00:00

  • Comparison of bivalirudin and argatroban for the management of heparin-induced thrombocytopenia.

    abstract:STUDY OBJECTIVES:To compare the effectiveness of bivalirudin and argatroban in achieving anticoagulation goals and to compare clinical outcomes assessing the safety and efficacy in patients with known or suspected heparin-induced thrombocytopenia (HIT). DESIGN:Single-center, retrospective analysis. SETTING:Large tert...


    pub_type: 杂志文章


    authors: Skrupky LP,Smith JR,Deal EN,Arnold H,Hollands JM,Martinez EJ,Micek ST

    更新日期:2010-12-01 00:00:00

  • Roles of the pharmacist in the use of safe and highly effective long-acting reversible contraception: an opinion of the women's health practice and research network of the American College of Clinical Pharmacy.

    abstract::The U.S. population continues to experience an alarmingly high rate of unintended pregnancies that have an impact on individual families and society alike. Lack of effective contraception accounts for most unintended pregnancies, along with incorrect use of contraceptives. The most common reversible contraceptive meth...


    pub_type: 杂志文章


    authors: Rafie S,McIntosh J,Shealy KM,Borgelt LM,Forinash A,Shrader SP,Koepf ER,McClendon KS,Griffin BL,Horlen C,Karaoui LR,Rowe EL,Lodise NM,Wigle PR

    更新日期:2014-09-01 00:00:00

  • Key articles and guidelines in the management of hypertension: 2008 update.

    abstract::Hypertension remains a major risk factor for cardiovascular disease. The optimal choice of pharmacologic and nonpharmacologic treatment regimens is based on a plethora of published literature. This compilation is the initial update to the Key Articles and Guidelines in the Management of Hypertension authored by member...


    pub_type: 杂志文章


    authors: Gaffney SM,de Denus S,Olson KL,Ripley TL,Robinette B,Summers KM,Spencer AP

    更新日期:2008-08-01 00:00:00

  • Evolution of beta-lactamase inhibitors.

    abstract::After the introduction of penicillin G into therapeutics, bacteria became increasingly resistant to this penicillin and subsequent beta-lactam antibiotics. The major cause of this resistance is beta-lactamase, an enzyme produced by the bacterium, that destroys the antibiotic before it reaches its target within the bac...


    pub_type: 杂志文章


    authors: Jackson D

    更新日期:1991-01-01 00:00:00

  • An Overview of the Treatment of Less Common Non-Lactose-Fermenting Gram-Negative Bacteria.

    abstract::Stenotrophomonas maltophilia, Burkholderia cepacia complex, Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., and Alcaligenes spp. are less-common non-lactose-fermenting bacteria that have emerged as important opportunistic pathogens. Patients at the highest risk for these infections include the immunoc...


    pub_type: 杂志文章,评审


    authors: Spencer HK,Spitznogle SL,Borjan J,Aitken SL

    更新日期:2020-09-01 00:00:00

  • Antifactor Xa levels versus activated partial thromboplastin time for monitoring unfractionated heparin.

    abstract::Intravenous unfractionated heparin (UFH) remains an important therapeutic agent, particularly in the inpatient setting, for anticoagulation. Historically, the activated partial thromboplastin time (aPTT) has been the primary laboratory test used to monitor and adjust UFH. The aPTT test has evolved since the 1950s, and...


    pub_type: 杂志文章,评审


    authors: Vandiver JW,Vondracek TG

    更新日期:2012-06-01 00:00:00

  • Rituximab for the treatment of rheumatoid arthritis.

    abstract::Rituximab has been approved by the United States Food and Drug Administration in combination with methotrexate for the treatment of rheumatoid arthritis in patients who failed to achieve adequate benefit from tumor necrosis factor-alpha inhibitors. Rituximab is a biologic agent that depletes peripheral B cells--an act...


    pub_type: 杂志文章,评审


    authors: Schuna AA

    更新日期:2007-12-01 00:00:00

  • Pharmacokinetics of erlotinib for the treatment of high-grade glioma in a pediatric patient with cystic fibrosis: case report and review of the literature.

    abstract::A 12-year-old girl with cystic fibrosis was diagnosed with a high-grade glioma after radiographic and biopsy results confirmed the primary intracranial lesion. She was treated with single-agent erlotinib during and after daily localized radiation therapy. Pharmacokinetic studies were conducted to assess the effect of ...


    pub_type: 杂志文章


    authors: Christiansen SR,Broniscer A,Panetta JC,Stewart CF

    更新日期:2009-07-01 00:00:00

  • Intravenous amiodarone for conversion of atrial fibrillation: misled by meta-analysis?

    abstract::Therapeutic goals for atrial fibrillation (AF) include ventricular rate control, stroke prevention, conversion to normal sinus rhythm, and maintenance of normal sinus rhythm. The optimal strategy of rate versus rhythm control for acute management of patients with AF is a continuing debate. However, selected patients m...


    pub_type: 杂志文章,评审


    authors: Slavik RS,Zed PJ

    更新日期:2004-06-01 00:00:00

  • Asthma exacerbation after administration of nicotine nasal spray for smoking cessation.

    abstract::A 58-year-old man experienced an asthma exacerbation after administration of nicotine nasal spray for smoking cessation. His medical history was significant for asthma, chronic obstructive pulmonary disease, hypertension, and tobacco use when he was prescribed nicotine nasal spray for smoking cessation in an outpatien...


    pub_type: 杂志文章


    authors: Roth MT,Westman EC

    更新日期:2002-06-01 00:00:00

  • Key articles and guidelines for the prevention of venous thromboembolism.

    abstract::Venous thromboembolism (VTE) is an important medical problem that affects millions of patients each year. With appropriate prophylaxis, many of these thromboembolic events can be prevented. Although strong evidence supporting VTE prophylaxis spans several decades, several large American and global registries have docu...




    authors: Dobesh PP,Wittkowsky AK,Stacy Z,Dager WE,Haines ST,Lopez LM,Nutescu E,Phillips KW,Trujillo TC,Vondracek T

    更新日期:2009-04-01 00:00:00

  • Bezlotoxumab: A Novel Agent for the Prevention of Recurrent Clostridium difficile Infection.

    abstract::During the past decade, the incidence and severity of Clostridium difficile infection (CDI) have significantly increased, leading to a rise in CDI-associated hospitalizations, health care costs, and mortality. Although treatment options exist for CDI, recurrence is frequent following treatment. Furthermore, patients w...


    pub_type: 杂志文章,评审


    authors: Kufel WD,Devanathan AS,Marx AH,Weber DJ,Daniels LM

    更新日期:2017-10-01 00:00:00

  • Pharmacology and therapeutic use of low-dose dopamine.

    abstract::The renal pharmacologic effects of intravenous dopamine in doses of 0.5-3.0 micrograms/kg/min include increases in renal blood flow, glomerular filtration rate, solute excretion, and urine flow. Clinical studies revealed that low-dose dopamine can reverse oliguria, but these studies were poorly controlled, were confou...


    pub_type: 杂志文章,评审


    authors: Dasta JF,Kirby MG

    更新日期:1986-11-01 00:00:00

  • Mycobacterium szulgai in a patient with advanced acquired immunodeficiency syndrome: an unusual pathogen with unusual multidrug resistance.

    abstract::A 37-year-old Hispanic man with advanced acquired immunodeficiency syndrome developed extensive pulmonary disease with persistent cough, fever, night sweats, worsening dyspnea, and weight loss. Sputum samples showed scant growth of acid-fast bacilli. He failed to respond to the standard tuberculosis regimen of isoniaz...


    pub_type: 杂志文章


    authors: Kang-Birken SL,Prichard JG

    更新日期:2006-11-01 00:00:00

  • Evidence of the economic benefit of clinical pharmacy services: 1996-2000.

    abstract::We sought to summarize and assess original evaluations of the economic impact of clinical pharmacy services published from 1996-2000, and to provide recommendations and methodologic considerations for future research. A systematic literature search was conducted to identify articles that were then blinded and randomly...


    pub_type: 杂志文章,评审


    authors: Schumock GT,Butler MG,Meek PD,Vermeulen LC,Arondekar BV,Bauman JL,2002 Task Force on Economic Evaluation of Clinical Pharmacy Services of the American College of Clinical Pharmacy.

    更新日期:2003-01-01 00:00:00

  • Adjunctive aerosolized antibiotics for treatment of ventilator-associated pneumonia.

    abstract:STUDY OBJECTIVE:To determine clinical and microbiologic success in patients receiving adjunctive aerosolized antibiotics for the treatment of ventilator-associated pneumonia (VAP). DESIGN:Retrospective medical record review. SETTING:Level I trauma intensive care unit of a large academic medical center. PATIENTS:Fort...


    pub_type: 杂志文章


    authors: Czosnowski QA,Wood GC,Magnotti LJ,Croce MA,Swanson JM,Boucher BA,Fabian TC

    更新日期:2009-09-01 00:00:00