Emostasi e trombosi

Le malattie emorragiche e trombotiche, siano esse congenite o acquisite, rappresentano un aspetto clinico rilevante nella pratica medica, anche del medico non specialista. La trombosi venosa profonda e la sua più temibile complicanza, l’embolia polmonare, colpiscono ogni anno l’1% della popolazione, con un andamento crescente al crescere dell’età. La trombosi arteriosa, che può portare all’ictus cerebrale o all’infarto del miocardio, rappresenta una quota rilevante delle cause di ricovero in ospedale, con significativo rischio di mortalità o sequele a lungo termine, ed è ancor oggi al primo posto come causa di morte nei Paesi Occidentali. Persino in corso di tumori, l’evento trombotico può condizionare significativamente l’aspettativa di vita, influenzando i tempi e le modalità di trattamento della malattia neoplastica.Ugualmente in Italia non meno di 10.000 persone sono affette da malattie emorragiche geneticamente determinate, destinate a durare tutta la vita, con il loro impatto di costi sul Sistema Sanitario Nazionale e di alterata qualità della vita. Anche le complicanze emorragiche acquisite, siano esse indotte da farmaci, indotte da autoanticorpi o insorgenti in particolari situazioni cliniche (es. emorragie post-partum) costituiscono una sfida diagnostico-terapeutica che spesso si connota con i caratteri dell’urgenza e drammaticità.L’elemento unificante di tutte queste patologie è rappresentato dalle alterazioni dell’equilibrio emostatico del paziente. L’emostasi, che comprende diversi meccanismi come la coagulazione del sangue prodotta da una serie di enzimi, l’attività delle piastrine e dell’endotelio e la fibrinolisi, è un meccanismo fisiologico complesso, sofisticato, che presiede primariamente ad una efficace e pronta risposta dell’organismo all’evento che causa l’emorragia. Alterazioni dell’emostasi in difetto (rischio emorragico) o in eccesso (rischio trombotico) possono essere determinate da eventi genetici o acquisiti, anche temporanei (es. chirurgia), la cui diagnosi e trattamento richiedono spesso una conoscenza dei meccanismi che sottendono a tali eventi.Paradossalmente, nonostante la trasversalità di queste patologie, che possono interessare il genetista, il pediatra, l’ematologo, l’internista, il neurologo, il cardiologo…, non esiste in Italia una scuola di specialità dedicata allo studio delle malattie della coagulazione del sangue, essendo esse per lo più parzialmente ricomprese nella Scuola di specializzazione in Ematologia. La Società Italiana per lo Studio dell’Emostasi e della Trombosi (SISET) ha da anni sottolineato la necessità di formare e stabilire la figura di Esperti in Emostasi e Trombosi che possano fungere da riferimento nelle singole realtà ospedaliere. Di pari passo, la SISET ha individuato la necessità di elaborare degli strumenti di formazione per il medico anche non specialista o studente che possano essere d’aiuto già nel corso degli studi universitari.In quest’ottica, il Consiglio Direttivo della SISET ha deciso, oltre alla usuale organizzazione del Congresso Societario Biennale e dei Corsi annuali, di produrre uno strumento specifico, cioè un trattato di malattie emorragiche e trombotiche. Il testo, composto da numerosi e ben noti specialisti del settore, vuole essere un primo passo nel far comprendere la complessità ma anche gli aspetti affascinanti associati allo studio e alla pratica clinica nel settore delle malattie emorragiche e trombotiche. Si è deciso di lasciare ampia libertà nella stesura dei capitoli ai singoli autori, anche a costo di alcune ripetizioni che però sono pre-requisiti essenziali allo svolgimento e alla completa comprensione dei singoli capitoli.Non è stata fatica di poco conto, ma speriamo che alla fine il risultato sia gratificante per tutti noi nella misura in cui il testo potrà essere d’aiuto non solo allo studente, ma anche al medico non specialista che voglia approfondire le conoscenze in alcuni settori di questa branca della medicina.Non possiamo che essere grati a tutti gli Autori che si sono accollati un impegno gravoso per le loro giornate già così intensamente attive e dense di impegni. All’Editore Piccin il nostro ringraziamento per la disponibilità, l’attenzione e il supporto fattivo che ha voluto prestare a questa iniziativa.

Designed as a practical, succinct guide, for quick reference by clinicians with everyday questions, this title guides the reader through the range of approaches available for diagnosis, management, or prevention of hemorrhagic and thrombotic diseases or disorders. * Provides essential practical management for all those working in the field of hemostasis and thrombosis * Includes new chapters on direct oral anticoagulants, acquired inhibitors of coagulation, and expanded discussion of thrombotic microangiopathies * Covers in a clear and succinct format, the diagnosis, treatment and prevention of thrombotic and haemostatic disorders * Follows templated chapter formats for rapid referral, including key points and summary boxes, and further reading * Highlights controversial issues and provides advice for everyday questions encountered in the clinic

2014 BMA Medical Book Awards Highly Commended in Internal Medicine category! A unique clinical focus makes Consultative Hemostasis and Thrombosis, 3rd Edition your go-to guide for quick, practical answers on managing the full range of bleeding and clotting disorders. Emphasizing real-world problems and solutions, Dr. Craig S. Kitchens, Dr. Barbara A. Konkle, and Dr. Craig M. Kessler provide all the clinical guidance you need to make optimal decisions on behalf of your patients and promote the best possible outcomes.

Since the very beginning of critical care medicine, much attention has been paid to the risk of bleeding, but only recently the risk of thrombosis has been recognized in critical patients; in fact, current laboratory investigations aimed to monitor blood coagulation are more focused on the assessment of the hemorrhagic than of the thrombotic risk. Since mid-90s, many studies have detected powerful pro-thrombotic actions of endogenous mediators in sepsis and other inflammatory conditions, including trauma and postoperative status. Unfortunately, the related complication are both hard to detect and extremely harmful. The volume provides a full coverage of the hemocoagulative problems in anesthesia and intensive care, taking into consideration the physiology and monitoring of hemostasis, its relation with sepsis, and the specific aspects of the various critical conditions - from trauma to burns, to heart and transplant surgery or acute renal failure.

Managing patients with thrombotic vascular disease is complex and challenging: Ischemic vascular disease remains a complicated interplay of atherosclerosis and thrombosis--even with the evolution in our understanding of the pathobiology of thrombosis. There has been tremendous growth in therapeutic options which are quickly finding their place in daily practice, including a remarkable expansion in the number of intravenous and oral antithrombotic agents and new antiplatelet agents Now more than ever, all cardiologists, hematologists, and specialists in vascular medicine, as well as other professionals, such as hospital pharmacists, who deal with prognosis and intervention in preventing thrombosis, need a resource that distills current knowledge of this important subject. Written and edited by today's leading international, Therapeutic Advances in Thrombosis, 2e provides physicians with the very latest in medical and surgical advances in antithrombotic therapies. With this comprehensively updated edition you get: Coverage of virtually all aspects of venous and arterial thrombotic disease and the corresponding therapies Strategies to manage specific clinical conditions and how to tailor treatment to individual patient needs Updated chapters covering thrombolysis in ST-elevated myocardial infarctions; thrombosis in patients with diabetes, pregnancy, and renal dysfunction Special emphasis on the pharmacology of novel anticoagulants and their practical use in venous thromboembolism and atrial fibrillation. Plus, all chapters fully explore clinical trial designs and outcomes for particular treatment therapies, as well as contain the relevant ACC/AHA/ESC guidelines, so you can confidently apply what you learn.

This text provides a comprehensive guide to anticoagulation in the hospital setting. Designed specifically for use by hospital-based clinicians and associated hospital-based staff (nurses, nurse practitioners, physician assistants), the book addresses the most commonly used anticoagulant agents and primary indications for their use. In addition, this evidence-based book carefully reviews the epidemiology and treatment of complications associated with anticoagulants, addresses the use of anticoagulants in special populations, discusses new advances in anticoagulation, and finally, discusses how to develop programs related to improving the administration and safety of anticoagulants.

This textbook provides a unique, pocket-sized, self-directed study guide to fluid, electrolyte and acid base homeostasis for undergraduate biomedical science, pharmacology, medical and allied health students. It details the chemical (mostly ionic) composition of body fluids, explains how abnormalities arise, what laboratory tests can be used to identify and analyze the cause of these disorders and shows how normality can be achieved to maintain health.

Reproductive hemostasis: A global approach to a global challenge A hemostatic change in women through their reproductive lifetime is emerging as an issue of global importance. No wonder, as obstetric hemorrhage remains a major cause of maternal mortality in both developed and developing countries. Thrombophilias and pulmonary embolisms are a threat to maternal and fetal well-being. Hemostasis and Thrombosis in Obstetrics & Gynecology provides a framework for assessing and managing hemostatic disorders in women. Written by an international team, it provides globally applicable guidelines for obstetric hematology. The practical approach to clinical management includes: Hematologic changes in pregnancy Red cell disorders Platelet disorders Inherited and acquired thrombophilia Inherited bleeding disorders Postpartum hemorrhage Blood and bleeding disorders in women can be managed by obstetrician-gynecologists or hematologists, separately or together. Hemostasis and Thrombosis in Obstetrics & Gynecology provides specialists from both disciplines with the information necessary to manage their patients effectively.

The Textbook of Hemophilia has become a definitive resource for all those managing hemophilia patients. It covers all the common and rare bleeding disorders, both in terms of clinical management as well as the genetic, laboratory, financial and psychological aspects. This second edition covers all the latest developments in the field of hemophilia, with new chapters on: the genetic and molecular basis of inherited blood disorders how to manage adolescent and older patients emergency medicine and inherited blood disorders national hemophilia databases Drawing on the vast experience of the authors, the aim of this textbook remains the same - to improve the care of patients suffering from hemophilia. The book is full of detailed guidance and advice on everyday clinical questions making it invaluable to all trainee and practicing hematologists.

This practical guide provides all the information necessary to understand the clotting mechanisms, as well as how to prevent, diagnose, and treat bleeding and clotting disorders. Practical Hemostasis and Thrombosis has been updated to reflect all the important advances made since the first edition. It includes an in-depth description of platelet abnormalities and disseminated intravascular coagulation, as well as covering the laboratory and molecular biological tests needed for the diagnosis of bleeding and clotting disorders. Clinicians will find useful advice for everyday questions in each specialty area as the book describes hemorrhagic and thrombotic problems in cardiology, neurology, hepatology, nephrology, oncology, obstetrics, pediatrics, intensive care and transfusion medicine. An invaluable resource for all hematologists, trainee hematologists preparing for examinations and clinicians this book should be kept close at hand for frequent consultation

"Il carattere distintivo di quest'opera nei confronti delle precedenti è l'innesto di una serie di capitoli più specialistici, che ho affidato a noti competenti nelle rispettive tematiche, ottenendo la pronta e disinteressata collaborazione di tutti coloro a cui ho rivolto l'invito".