By Christopher M. Loftus
This publication is an up to date reference on all facets of anticoagulation and hemostasis in neurosurgery. After a gap part on simple ideas and drug sessions in present use, specified attention is given to coagulation concerns suitable to all sufferers, not only neurosurgical ones. The insurance contains, for instance, deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. various vital matters particular to neurosurgical perform are then addressed, and a precis of present directions and most sensible practices is supplied. by means of bringing jointly the newest wisdom from around the self-discipline, this booklet will function a valid foundation for educated determination making in surgical perform. will probably be of day-by-day price for neurosurgeons and trainees all over the world and also will be of curiosity to emergency room physicians, surgeons typically, serious care physicians, neurologists, and health center medication specialists.
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Additional info for Anticoagulation and Hemostasis in Neurosurgery
It is preferable to use functional assays in the ﬁrst line assessment of hypercoagulability. Current anticoagulant therapy and ongoing or recent thrombotic events interfere with the interpretation of many of these tests. 25 Lupus Anticoagulant Testing Lupus anticoagulants (LA) are immunoglobulins with afﬁnity for phospholipid-bound proteins. Because they have a variety of target antigens LAs are nonspeciﬁc inhibitors. LA testing is part of every thrombophilia proﬁle. An unexpectedly prolonged screening PTT may also trigger an LA investigation.
LMWHs: Dalteparin (Fragmin), Tinzaparin (Innohep), Enoxaparin (Lovenox), Ardeparin (Normiﬂo), Danaparoid (Orgaran), Nadroparin (Fraxiparine), Certoparin (Embolex) (Fig. 4) Antithrombin (AT, previously known as antithrombin III), is a serine-protease inhibitor that regulates many of the enzymes activated during coagulation, particularly Xa and IIa (thrombin) [22, 23]. AT preferentially targets free enzymes over those that are part of prothrombinase complex. AT’s role is to limit the coagulation cascade to areas of vascular injury and thus protect the remainder of the circulation from undesired thrombotic events .
The plasma levels of these two platelet speciﬁc proteins are elevated in thrombotic stroke and coronary thrombosis. Both proteins can be measured, but special blood collection techniques are necessary and assays are performed by a reference lab. Thromboxane B2, a stable metabolite of the platelet eicosanoid pathway, can be measured by immunoassay. 3). Proper blood collection and handling as discussed above is essential. Clotted, hemolyzed, icteric, or lipemic specimens are rejected because they give unreliable results.
Anticoagulation and Hemostasis in Neurosurgery by Christopher M. Loftus