Essential Guide to Blood Coagulation Book

List of contributors ix

Preface xi

Abbreviations xiii

Part 1 General hemostasis

1 Schematic presentation of the hemostatic system Nils Egberg 3

2 Proposals for sampling instructions Margareta Blombäck Nils Egberg 6

Points to note prior to sampling 6

Sampling time and patient preparation 7

Referrals for coagulation analyses 8

Sampling 8

3 Laboratory investigations Jovan P. Antovic Nils Egberg 11

Nomenclature 11

Reference intervals for laboratory investigations 13

Screening analyses 13

Special analyses 18

Markers of coagulation activation (hypercoagulation markers) 24

DNA analyses 25

Global hemostatic assays and bedside methods 27

Useful components in research studies 28

Other nonhemostatic variables of importance 32

Part 2 Bleeding disorders

4 Hereditary bleeding disorders Margareta Holmström Margareta Blombäck 37

General remarks about hemophilia A and B 37

General remarks about von Willebrand's disease 38

Factor concentrates used for treatment of hemophilia A and B and VWD in Sweden in 2009 39

Treatment strategy in severe forms of hemophilia and VWD 41

Surgery in patients with bleeding disorders 43

Tooth extraction in a hemophilia patient 44

Caution in patients with bleeding disorders 44

Treatment principles for different types of bleeding disorders (severe, moderate and milder forms of hemostatic defects) 46

Severe platelet function defect, e.g. Glanzmann's thrombasthenia 48

Mild hemostatic defects 48

Blood sampling in bleeding disorders 50

Bleeding risk charts 51

5 Critical bleedings Hans Johnsson 52

Introduction 52

Massive bleeding 52

Transfusion coagulopathy 53

Treatment 53

Complicating factors56

Ongoing treatment with platelet-inhibiting and antithrombotic drugs 57

6 Investigations of increased bleeding tendency Nils Egberg Margareta Holmström 58

Introduction 58

Diagnosis 58

Reasons for pathologic screening analyses and further actions 60

Causes of thrombocytopenia 60

Causes of prolonged activated partial thromboplastin time 61

Causes of elevated PT(INR) 62

Investigation of bleeding tendency-practical aspects 62

Part 3 Thromboembolic disorders

7 Venous thrombosis and pulmonary embolism Anders Carlsson 67

Introduction 67

Incidence of thrombosis in different clinical materials 67

Venous thrombosis 68

Pulmonary embolism 71

8 Drug treatment in deep vein thrombosis and pulmonary embolism Anders Carlsson 75

Treatment of acute deep vein thrombosis and pulmonary embolism 75

Drug treatment in deep vein thrombosis and pulmonary embolism 77

Action to take to avoid the risk of thrombosis 86

Primary prophylaxis against deep vein thrombosis and pulmonary embolism 88

9 New anticoagulants: focus on currently approved oral factor Xa and factor Ila inhibitors Rickard E. Malmström 91

Introduction 91

Rivaroxaban 91

Dabigatran 95

Ongoing clinical studies and other therapeutic indications 100

Possibility of and need for therapeutic monitoring of new anticoagulants 100

10 Arterial thromboembolism Kenneth Pehrsson Håkan Wallen Jesper Swedenborg Nils Wahlgren 103

Ischemic heart disease 103

Thrombolysis 104

Percutaneous coronary intervention 105

Cardiac arrhythmias (atrial fibrillation) 106

Stroke and transient ischemic attack (TIA) 109

11 Investigation of thromboembolic tendency Margareta Holmström 112

Introduction 112

Venous thromboembolism 113

Arterial thromboembolism 114

Disseminated intravascular coagulation 114

Part 4 Special hemostasis

12 Hemostasis in obstetrics and gynecology Katarina Bremme 119

Thrombosis during pregnancy 119

Heart disease: treatment of women with mechanical heart valve prostheses 126

Thromboprophylaxis in obstetrics and gynecology 126

Blood sampling in children of women with severe forms of thrombophilia 132

Obstetric epidural / spinal analgesia (anethesia) 133

Complications during pregnancy 134

Postpartum bleeding 140

Thromboprophylaxis in legal and spontaneous abortions 141

Thromboprophylaxis in gynecologic surgery 141

Oral contraceptives, hormone substitution 142

Investigation prior to artificial insemination 145

Investigation in repeated miscarriages 145

Investigation in menorrhagia 146

13 Hemostasis defects in children Pia Petrini 147

Bleeding disorders in children 147

Thromboembolic disorders in children 154

14 Emergency conditions associated with coagulation activation Jovan P. Antovic Margareta Holmström 161

Disseminated intravascular coagulation 161

Heparin-induced thrombocytopenia 167

Thrombotic microangiopathies (TTP and HUS) 169

Index 171