Thrombolytic Activity of Defibrotide Against Old Venous Thrombi

Niada, R; Porta, Rut; Pescador, Rodoeto; Mantovani, M; Prino, G

doi:10.1055/s-2007-1002747

Cited by 10 publications

(3 citation statements)

References 16 publications

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“…Although I find antithrombin to be highly effective in fulminant DIC, antithrombin concentrate has not yet been subjected to objective prospective clinical trials to clearly establish efficacy. Newer agents of potential therapeutic benefit for fulminant DIC are recombinant hirudin (288,290), defibrotide, and gabexate (291)(292)(293). Extensive clinical experience with these newer agents in DIC is limited.…”

Section: Fulminant Dicmentioning

confidence: 99%

Disseminated Intravascular Coagulation: A Review of Etiology, Pathophysiology, Diagnosis, and Management: Guidelines for Care

Bick

2002

Clin Appl Thromb Hemost

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The pathophysiologic mechanisms, clinical, and laboratory manifestations of DIC are complex in part due to interrelationships within the hemostasis system. Only by clearly understanding these extraordinarily complex pathophysiologic interrelationships can the clinician and laboratory scientist appreciate the divergent and wide spectrum of often confusing clinical and laboratory findings in patients with DIC. Many therapeutic decisions to be made are controversial and lack validation. Nevertheless, newer antithrombotic agents, and agents that can block, blunt, or modify cytokine activity and the activity of vasoactive substances appear to be of value. The complexity and variable degree of clinical expression suggests that therapy should be individualized depending on the nature of DIC, age, etiology of DIC, site and severity of hemorrhage or thrombosis and hemodynamics and other appropriate clinical parameters. At present, treatment of the triggering event, low-dose heparin or antithrombin concentrate and wise choice of components when indicated appear to be the most effective modes of therapy.

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Section: Fulminant Dicmentioning

confidence: 99%

Disseminated Intravascular Coagulation: A Review of Etiology, Pathophysiology, Diagnosis, and Management: Guidelines for Care

Bick

2002

Clin Appl Thromb Hemost

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“…Newer agents of potential therapeutic benefit for fulminant DIC are recombinant hirudin, 167,169 defibrotide, and gabexate. [170][171][172] Extensive clinical experience with these newer agents in DIC is limited. About 75% of patients will respond to the two earlier outlined sequential therapeutic steps.…”

Section: Fulminant Dicmentioning

confidence: 99%

Disseminated Intravascular Coagulation: Objective Clinical and Laboratory Diagnosis, Treatment, and Assessment of Therapeutic Response

Bick¹

1996

Semin Thromb Hemost

115

183

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Current concepts of the etiology, pathophysiology, clinical and laboratory diagnosis and management of fulminant and low-grade disseminated intravascular coagulation (DIC) have been presented. Considerable attention has been devoted to interrelationships within the hemostasis system. Only by clearly understanding the pathophysiological interrelationships can the clinician and laboratory scientist appreciate the divergent and wide spectrum of often confusing clinical and laboratory findings in patients with DIC. Objective clinical and laboratory criteria for diagnosis of DIC have been delineated, thus avoiding needless confusion and empirical decisions regarding the diagnosis. Many therapeutic decisions to be made are controversial and will remain so until more is published about specific therapeutic modalities and survival patterns. Also, therapy must be highly individualized depending on the nature of DIC, age, etiology of DIC, site and severity of hemorrhage or thrombosis, and hemodynamic and other clinical parameters. Also presented are clear criteria for severity of DIC and objective criteria for defining a response to therapy. Also, since it is often difficult for the individual physician to decide when to stop expensive therapy, objective criteria by which therapy may be stopped when continuation is likely fruitless are presented as a guideline.

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“…The desired level should always be ~125%, and the aforementioned calculation should be performed and the derived antithrombin dose delivered every 8 h. Although this author finds antithrombin to be highly effective in fulminant DIC, antithrombin concentrate has not yet been subjected to objective prospective clinical trials to clearly establish efficacy. Newer agents of potential therapeutic benefit in fulminant DIC are recombinant hirudin (167,169), defibrotide, and gabexate (170)(171)(172). Extensive clinical experience with these newer agents is limited.…”

Section: Fulminant Dicmentioning

confidence: 99%

State-of-the-Art Review : Disseminated Intravascular Coagulation: Objective Criteria for Clinical and Laboratory Diagnosis and Assessment of Therapeutic Response

Bick

1995

Clin Appl Thromb Hemost

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Disseminated intravascular coagulation (DIC) is a confusing disorder from both the diagnostic and therapeutic standpoints. Confusion and controversy stem from the facts that many unrelated diseases can trigger DIC, that there is a lack of uniformity in clinical manifestations and a lack of consensus in the appropriate laboratory diagnosis, and that no agreement exists about specific therapeutic methods. Recommendations for and evaluation of treatment regimens becomes even more difficult because (a) often morbidity and survival are more dependent on the specific cause of DIC and (b) none of the generally used specific therapies, including heparin, antithrombin concentrate, and protein C concentrate, have been subjected to objective prospective randomized trials.One intent of this review is to provide specific and objective guidelines and criteria for the clinical diagnosis, laboratory diagnosis, and assessment of severity of DIC and, most important, to provide an objective system to assess efficacy of any given specific therapy, free from influences of the underlying disease (1). This approach allows for objective decisions regarding diagnosis, treatment, and response to therapy in individual patients. These guidelines also provide objective criteria for prospective randomized trials to assess the safety and efficacy of a specific therapeutic agent for DIC, apart from the morbidity and mortality associated with the underlying disease(s) that induced the DIC process. In developing objective criteria, the rationale for each is briefly presented, including a general review of the etiology, pathophysiology, clinical and laboratory diagnosis, and successful treatment of DIC.

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Thrombolytic Activity of Defibrotide Against Old Venous Thrombi

Cited by 10 publications

References 16 publications

Disseminated Intravascular Coagulation: A Review of Etiology, Pathophysiology, Diagnosis, and Management: Guidelines for Care

Disseminated Intravascular Coagulation: A Review of Etiology, Pathophysiology, Diagnosis, and Management: Guidelines for Care

Disseminated Intravascular Coagulation: Objective Clinical and Laboratory Diagnosis, Treatment, and Assessment of Therapeutic Response

State-of-the-Art Review : Disseminated Intravascular Coagulation: Objective Criteria for Clinical and Laboratory Diagnosis and Assessment of Therapeutic Response

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