Free Heparin-Induced Thrombocytopenia (Hit): An Update Literature Review Sample
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The article on Heparin-Induced Thrombocytopenia (HIT) is easy to read and it is a review type article. It focuses on Heparin-Induced Thrombocytopenia (HIT) and discusses the incidence, pathophysiology, clinical features and diagnosis and treatment of Heparin-Induced Thrombocytopenia (Franchini M, 2005). The article contains sufficient medical related information and is understandable. It emphasizes the importance of recognizing Heparin-Induced Thrombocytopenia which is drug induced (unlike other types of Thrombocytopenia) and associated with significant morbidity and mortality if unrecognized (Franchini M, 2005).
The quality of information in the article published in the Thrombosis journal is high. It contains many technical medical terms and describes clinical features of Heparin-Induced Thrombocytopenia (HIT). This article contains information on clinical features, diagnosis and treatment options for Heparin-Induced Thrombocytopenia (HIT) with sufficient quantity of information (Franchini M, 2005). These are the features of review articles which are broad based and cover many related sub-topics from various authors. The quantity of information is sufficient for a 5 page review on Heparin-Induced Thrombocytopenia (HIT) with a schematic describing the pathophysiology of heparin-induced thrombocytopenia (Franchini M, 2005). It has a conclusion paragraph about the serious potential complications of heparin therapy and how to recognize and stop heparin therapy immediately (Franchini M, 2005).
The incidence of heparin-induced thrombocytopenia was discussed in the article. Approximately 8 percent of heparinized patients develop the antibody associated with with HIT and it is estimated that 1-5 percent of patients on heparin will develop HIT (Franchini M, 2005). The immune mechanism underlying HIT is explained and a complex of heparin and platelet factor 4 (PF4) plays a role (Franchini M, 2005).
Immediate cessation of heparin is mandatory when HIT is suspected but this does not stop thrombin generation or subsequent thrombotic events (Franchini M, 2005). Thus, it is very important to control the thrombin storm of HIT by appropriate treatment. Treatment options for HIT include danaparoid, thrombin-specific inhibitors-lepirudin and argatroban and a synthetic pentasaccharide known as fondaparinux (Franchini M, 2005). The article by Franchini M, 2005 is mostly a clinical science type of review and does not contain much basic science information on the topic Heparin-Induced Thrombocytopenia (HIT) (Franchini M, 2005). It contains sufficient clinical information and is readable. This article includes practical information such as developing awareness of and controlling the thrombin storm before it becomes too dangerous. This is very important and valuable information for a clinician treating the patient. Yes, I would definitely recommend it to my colleagues interested in Heparin-Induced Thrombocytopenia since the review article on the topic is informative and it also discusses treatment options for patients. I think it would be very helpful in clinical practice to recognize HIT in patients undergoing heparin therapy.
The information in the article can be easily found and the sources are relevant. The references sources for the review article are from relevant and prestigious peer- reviewed scientific and medical journals such as Circulation, Hematology, Blood Reviews, New England Journal of Medicine and Thrombosis Journal.
Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients
This article from the New England Journal of Medicine published in 2008 on hypertension in high-risk patients describes clinical trials with angiotensin-converting-enzyme (ACE) inhibitors in combination with other medications. It is not an easy article to read at all since it describes clinical trial studies performed on hypertensive patients with 2 different combinations of medication with ACE inhibitors (Jamerson K, 2008).
The quality of information in this article published in the prestigious New England Journal of Medicine is very high. The clinical trial methodology is well designed and conducted with a large number of patients in order to be statistically powerful. The quantity of information is immensely high and intense as would be expected from a New England Journal of Medicine journal. The article is 10 pages long and contains an additional appendix with references. The double-blind clinical trial (with 11,000 plus patients) hypothesized than a combination of an angiotensin-converting-enzyme (ACE) inhibitor and a calcium channel blocker would be more effective in decreasing the rates of cardiovascular events as compared to ACE inhibitor with a diuretic (Jamerson K, 2008).
The clinical trial on hypertension described in the article by Jamerson K and others, 2008 was named ACCOMPLISH (Avoiding Cardiovascular events through Combination Therapy in Patients Living with Systolic Hypertension). This clinical study conducted on 11,000 plus patients with hypertension concluded that ACE inhibitor calcium channel (benazepril–amlodipine) combination was superior to the ACE inhibitor diuretic (benazepril- hydrochlorothiazide) combination in reducing cardiovascular events (Jamerson K, 2008). These cardiovascular events included non-fatal myocardial infarction, nonfatal stroke, hospitalization for angina, coronary revascularization and death from cardiovascular causes (Jamerson K, 2008).
The patients in this study were from 5 countries- the United States, Norway, Sweden, Denmark and Finland and the clinical trial was conducted at 500 plus trial centers (Jamerson K, 2008). The statistical power in the clinical study is tremendous due to the extremely large sample size of 1199 patients with primary cardiovascular events. The high rate of blood pressure control in both groups of patients receiving different combinations of medications with ACE inhibitors in the ACCOMPLISH trial was remarkable (Jamerson K, 2008). The guidelines show a preference for thiazide diuretics when combination therapy is required for patients with hypertension but the results of this clinical study show the superiority of amlodipine in combination with ACE inhibitors in preventing cardiovascular events in patients at risk (Jamerson K, 2008). However, one potential drawback of the ACCOMPLISH clinical trial is that it had several patients with coronary disease and diabetes which is not fully representative of the broad population of patients with hypertension (Jamerson K, 2008).
The article is mainly a clinical science article since it describes clinical trials on ACE-inhibitor combination medication therapy for patients with hypertension who are at risk for cardiovascular events (Jamerson K, 2008). These clinical studies were conducted in various countries and clinical trial centers and described in details in the New England Journal of Medicine article (Jamerson K, 2008). The information in the article is well organized, easy to find and contains sufficient clinical information.
Yes, I would definitely recommend this article to my colleagues interested in ACE inhibitor combination treatment for hypertension. I think it would be very helpful in clinical practice in deciding which combination of medications along with ACE inhibitors to prescribe to patients with hypertension at risk for cardiovascular events. Although blood pressure control was similarly achieved (within 1mm Hg) in both groups of patients with the different ACE inhibitor combination treatments, the ACE inhibitor with calcium channel combination is superior in reducing cardiovascular events (Jamerson K, 2008). I would keep in mind that many patients had coronary disease and diabetes which is not representative of the broad range of patients with hypertension. Overall, I liked the article on hypertension since the clinical trials are well designed, informative and help address clinical issues relating to treatment for hypertension. The article is well presented and comprehensive.
The reference sources for this article are from American Journal of Hypertension, Journal of Clinical Hypertension, Lancet and JAMA which are all very relevant to this clinical study on patients with hypertension at risk for cardiovascular events (Jamerson K, 2008).
Franchini M, “Heparin-induced thrombocytopenia: an update”, Thrombosis Journal, Volume 3, Number 14, 2005
Jamerson K, et al., “Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients”, New England Journal of Medicine, Volume 359, Number 23, 2008
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