Author
Marc Schindewolf
Other affiliations: Goethe University Frankfurt
Bio: Marc Schindewolf is an academic researcher from University of Bern. The author has contributed to research in topics: Fondaparinux & Medicine. The author has an hindex of 19, co-authored 70 publications receiving 983 citations. Previous affiliations of Marc Schindewolf include Goethe University Frankfurt.
Papers published on a yearly basis
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TL;DR: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response).
Abstract: Background: Little is known about the incidence and causes of heparin-induced skin lesions. The 2 most commonly reported causes of heparin-induced skin lesions are immune-mediated heparin-induced thrombocytopenia and delayed-type hypersensitivity reactions. Methods: We prospectively examined consecutive patients who received subcutaneous heparin (most often enoxaparin or nadroparin) for the presence of heparin-induced skin lesions. If such lesions were identified, we performed a skin biopsy, platelet count measurements, and antiplatelet-factor 4 antibody and allergy testing. Results: We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%–10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayed-type hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7–15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9–26.3) and female sex (OR 3.0, 95% CI 1.1–8.8). Interpretation: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response). (ClinicalTrials.gov trial register no. NCT00510432.)
84 citations
TL;DR: The clinical range of heparin-induced skin lesions is reviewed, evidence and controversies in epidemiology, diagnosis, and differential diagnosis are emphasised, and the management of patients with these skin lesions are discussed.
78 citations
TL;DR: The mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE are discussed and their role as a suitable therapeutic target for V TE prevention is acknowledged.
Abstract: Multiple factors contribute to the risk of venous thromboembolism (VTE). Platelets have attracted much interest in arterial cardiovascular disease, whereas their role in VTE has received much less attention. Recent evidence suggests that platelets may play a more important role in VTE than previously anticipated. This review discusses the mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE. In addition, animal studies and randomized clinical trials that highlight the potential effect of antiplatelet therapy in venous thrombosis are evaluated to assess the role of platelets in VTE. The clinical significance of platelets for VTE risk assessment in specific patient cohorts and their role as a suitable therapeutic target for VTE prevention is acknowledged. The role of platelets in VTE is a promising field for future research.
59 citations
TL;DR: There is a wide fondaparinux off-label use (up to 50.3%) for suspected HIT, even in those patients with a high clinical pretest probability, despite the current diagnostic laboratory strategy based on the recommended 2-step strategy.
55 citations
TL;DR: Thrombophilia is a common finding in patients with UE-DVT, especially in those with thrombosis that is unrelated to venous catheters, and is the only thromBophilia that is differentially expressed after controlling for established VTE risk factors.
Abstract: The prevalence of coagulation disorders in patients with upper extremity deep-vein thrombosis (UE-DVT) is unknown due to only a few observational studies of limited size reporting varying results. Therefore, we aimed to evaluate the prevalence of thrombophilia in patients with UE-DVT compared to patients with lower extremity deep vein thrombosis (LE-DVT). One hundred fifty consecutive patients (15 to 91 years of age) with UE-DVT were recruited from the MAISTHRO (MAin-ISar- THROmbosis) registry. Three hundred LE-DVT patients matched for gender and age served as controls.Thrombophilia screening included tests for the factor V Leiden mutation, the prothrombin G20210A mutation, antiphospholipid antibodies and factor VIII (FVIII), protein C, protein S and antithrombin activities. At least one thrombophilia was present in 34.2% of UEDVT and 39.2% in UE-DVT that was unrelated to venous catheters relative to 55.3% in LE-DVT patients (p
55 citations
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01 Jan 2014
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.
Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.
9,618 citations
NewYork–Presbyterian Hospital1, University of Insubria2, University of Texas Health Science Center at Houston3, Chinese PLA General Hospital4, University of Vermont Medical Center5, Beth Israel Deaconess Medical Center6, Harvard University7, Loyola University Medical Center8, University of Chicago9, University of Milan10, Auckland City Hospital11, St Thomas' Hospital12, Hofstra University13, University of Michigan14, Population Health Research Institute15, Hamilton Health Sciences16, Ottawa Hospital Research Institute17, Brigham and Women's Hospital18, Vanderbilt University19, Universidad Católica San Antonio de Murcia20, University of Mainz21, McMaster University22, University of Liverpool23, Aalborg University24
TL;DR: The current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexistingThrombotic disease who develop CO VID-19 are reviewed.
2,222 citations
Abstract:
1,392 citations
Journal Article•
1,221 citations
TL;DR: The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak and Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
1,174 citations