[Low molecular weight heparin--a new antithrombotic agent?].
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Chemical Phenomena↗
Biomedical subjects
D Bergqvist
Publications and source records attributed to D Bergqvist.
The effect of heparin fragments of different molecular weights on experimental thrombosis and haemostasis.
The effect of heparin fragments of different molecular weights has been compared with that of conventional sodium heparin on experimental thrombosis in vivo and ex vivo and experimental haemostasis in vivo. In the first part of the study fragments of different molecular weights were given (4,900, 6,500, 9,500 and 22,200 dalton). All preparations including the control gave a significant prolongation of the haemostatic plug formation time in the rabbit mesenteric microcirculation, and all except the fragment with the lowest molecular weight reduced the frequency of jugular vein thrombosis (induced by a combination of endothelial denudation and stasis). There was a correlation between the XaI activity of the different heparin fragments and frequency of thrombosis. Using an ex vivo method (modification of Chandler's model) a dose dependent lag phase until start of thrombus formation was found. In the second part of the study a dose response investigation was made comparing different doses of a fragment (6,500 dalton) with conventional heparin in the same XaI doses (10, 30 and 60 units/kg). Sodium heparin in the highest dose prolonged the haemostatic plug formation time whereas none of the fragment doses did. The lowest dose both of the fragment and conventional heparin did not reduce the frequency of thrombosis, whereas the two higher doses did. Thus it may be possible to obtain preventive effect on thrombus formation with a heparin fragment.
Animals↗
The influence of a new low molecular weight sulphated polysaccharide from mussel broth (Org 30016) on haemostasis.
The effect on haemostasis of a new low molecular weight sulphated polysaccharide (4300 dalton) from mussel broth (Org 30016) was investigated. In an APT time test system it had an anticoagulant effect corresponding to 30-40% of that of heparin. It had no antithrombin effect. It exerted its effect only in test systems containing phospholipids. It did not prolong haemostatic plug formation time in the rabbit mesenteric microcirculation as did heparin. Formation of ex vivo Chandler thrombi was significantly inhibited. The practical interest of the substance comes from the combination of an antithrombotic effect and little influence on primary haemostasis.
Animals↗
Prevention of postoperative thromboembolism in Sweden--the development of practice during five years.
All clinics in Sweden (223) dealing with general, urologic, orthopaedic, and gynaecologic surgery were sent a questionnaire concerning their policy about prophylaxis against postoperative thromboembolism in 1982. The praxis was also compared with that obtained in a similar survey in 1977. 96% replied. 91% used some sort of specific prophylaxis which is significantly more than in 1977. Also a significantly larger number of patients were operated on with prophylaxis than in 1977 (25 vs 19%). The dominating methods were dextran 70 and low-dose heparin. Compared with 1977 peroral anticoagulation, low-dose heparin and mechanical methods had decreased significantly, low-dose heparin in combination with dihydroergotamine increased significantly and dextran showed an unchanged use.
Age Factors↗
[Suprarenal aortic sclerosis with multiple splenic infarctions].
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Aorta, Abdominal↗
[Microembolism--an important but often missed diagnosis].
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Aged↗
The effect of inhibition of thromboxane synthesis in experimental thrombosis and hemostasis.
The effect of a selective inhibitor of thromboxane synthesis (dazoxiben) was evaluated in different acute models for thrombosis and hemostasis. Dazoxiben significantly reduced the thrombogenicity of the modified human umbilical vein (Dardik Biograft) inserted in the carotid artery position in sheep. The effect was evident concerning patency, thrombus weight and platelet accumulation at the distal anastomosis. This paralleled a decreased production of thromboxane in both anastomoses and the midgraft region. Dazoxiben did not reduce either the frequency of jugular vein thrombosis (induced by a combination of endothelial damage and flow restriction) or arteriolar microembolism after laser injury in rabbits. Neither did it influence initial hemostasis as evaluated by measuring the hemostatic plug formation in the rabbit mesenteric microcirculation. It is concluded that thromboxane synthesis inhibition may be of value when attempting to improve the performance of small diameter vascular prostheses, the data obtained indicating a low risk for hemorrhagic complications.
6-Ketoprostaglandin F1 alpha↗
A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients.
A retrospective study was undertaken of all surgical patients in Malmö, Sweden, during the period 1951-1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty-one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmö as common a cause of death in operated as in nonoperated patients.
Adult↗
The effect of infrarenal aortic clamping and declamping on central haemodynamics and tissue blood flow in pigs--a comparison of fluid replacement between a colloid and a cristalloid.
A study has been undertaken to compare the effect of fluid administration of a cristalloid (Ringer glucose) with that of a colloid (dextran 40) on central haemodynamics and organ blood flow distribution during clamping and after declamping of infrarenal aorta in pigs. The declamping hypotension was significantly greater in the cristalloid group where a decrease in cardiac output was also seen. Tissue blood flow to the kidneys decreased in the cristalloid group during clamping but was maintained in the dextran group. At declamping there was a reactive kidney hyperaemia in the dextran group, while the medullar flow was still significantly decreased in the cristalloid group. The reactive hyperaemia seen in pancreas and small intestines was also greater in the dextran group.
Animals↗
Abdominal injuries in children: an analysis of 348 cases.
Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951-1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8.6 per cent mortality in the first 10 years of the period.
Abdominal Injuries↗
Juvenile diabetes mellitus--a risk factor for postoperative venous thromboembolism?
In a retrospective analysis of 125 patients and a prospective evaluation of 83 patients with terminal uremia undergoing kidney transplantation, juvenile diabetes mellitus was found to be a significant risk factor for the development of postoperative thromboembolism. We found a high frequency of objectively verified thromboembolism despite the relatively young age of the patients. Besides diabetes, no other clinical risk factor differed between patients with and without thrombosis.
Adult↗
Venous function five to eight years after clinically suspected deep venous thrombosis.
One hundred and fifty-four patients, who had been subjected to phlebography 5-8 years previously because of clinical suspicion of deep venous thrombosis (DVT), were investigated to evaluate the frequency of deep venous insufficiency (DVI). The evaluation included clinical examination, registration of subjective complaints and objective measurements with plethysmography, venous pressure and Doppler ultrasound. DVT had been present in 75 legs. There were no statistically significant differences between legs with and without earlier DVT apart from more venous outflow obstruction in the former. DVI was as common after calf vein thrombosis as after more proximal DVT. DVI was more frequent in elderly patients and in patients with a history of previous DVI or DVT. The sufficiency of the popliteal vein seemed to be of great importance in the development of DVI. More than one third of legs without DVT had developed DVI at follow-up.
Adult↗
Episodes of increased fibronectin level observed in a patient suffering from recurrent thrombosis related to congenital hypodysfibrinogenaemia (fibrinogen Malmoe).
A study has been conducted in a Swedish patient with severe thrombotic disease and repeated miscarriages related to a hypodysfibrinogenaemia with defective thrombin binding to the abnormal fibrin. The hypodysfibrinogenaemia was found in several members of the family. The patient also had an increased concentration of fibronectin in her plasma at two different occasions. This would appear to be unrelated to the abnormal fibrinogen since a normal concentration of fibronectin has been found in her relatives presenting the same fibrinogen anomaly, and in the patient at two other times. In conclusion, the thrombotic disorder in this patient presenting a congenital hypodysfibrinogenaemia may be explained by the defective thrombin binding to fibrin.
Adult↗
The influence of plasma volume expanders on initial haemostasis in the rabbit mesentery.
An experimental study was undertaken to evaluate the effect of dose (1 and 2 g/kg b.w.) and molecular weight (40 000, 70 000, 110 000 and 500 000 daltons) of dextran on primary haemostatic plug formation in the rabbit mesenteric microcirculation. All experiments were made 3 h after the infusion of the different substances. Albumin and hydro-oxyethyl starch treatment was used for control plasma volume expansion and did not influence arteriolar and venular haemostasis as compared with saline. Dextran gave a prolonged haemostatic plug formation time with increasing dose and with increasing molecular weights. Clinically relevant doses of dextran 40 and 70 (1 g/kg b.w.) did not influence haemostatic plug formation time.
Animals↗
Deep vein thrombosis after renal transplantation: a prospective analysis of frequency and risk factors.
In a prospective study the frequency of deep vein thrombosis during the first 3 weeks after kidney transplantation has been evaluated using the combination of thermography and strain-gauge plethysmography for objective diagnosis. 83 consecutive patients were included, 33 with juvenile diabetes mellitus. The overall frequency of thrombosis was 24.1%, diabetes mellitus being a significant risk factor. No other risk factors were found. The transplant did not influence the venous outflow from the corresponding leg. Plasminogen activator activity in the iliac vein wall at transplantation did not differ between patients with and without thrombosis.
Adult↗
Venous function after fracture of the lower extremity. A 9-year follow-up of 150 cases.
One hundred and fifty patients were examined 8-10 years after a fracture of the lower limb to evaluate whether the frequency of deep venous insufficiency (DVI) was influenced by the type of fracture. The evaluation included clinical examination, subjective complaints, venous pressure, plethysmography and doppler sonography. Symptoms and signs of DVI were more common in the fractured than in the uninjured limbs, while objectively diagnosed DVI did not differ between the groups. Only minor differences were present in the development of DVI between limbs with various types of fracture (hip fractures were not included in the study). High age and incompetence of the popliteal valves were more important in the development of DVI than the earlier fracture. The frequency of objectively measured DVI in the fractured limbs was 35 per cent and in the uninjured limbs 30 per cent.
Adolescent↗
Does thromboprophylaxis increase the risk for infectious complications after total hip replacement?
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Aged↗
Effect of platelet inhibition on experimental venous thrombosis in the rabbit.
An experimental model, based on a combination of endothelial damage and flow reduction, was used to induce thrombosis of the jugular vein in rabbits. The influence of ibuprofen, a cyclooxygenase inhibitor, was compared with that of dextran 70, which influences platelets, thrombus structure and flow. Albumin was used as a control of the volume-expanding effect of dextran. Ibuprofen was administered intravenously during the induction of thrombosis, and dextran and albumin were given 3 hours before the surgical procedure. Control rabbits received only Ringer's lactate. Dextran, but neither ibuprofen nor albumin, significantly reduced the incidence of thrombosis, though thrombus weight was not influenced. The data indicated that the effect of dextran in this model probably is primarily exerted via alteration of thrombus structure, and not by altered platelet function or hemodilution. The role of platelets in the initial development of thrombosis in this model thus may be questioned.
Albumins↗