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Biomedical subjects

L Poller

Publications and source records attributed to L Poller.

At least 181 records · Page 10Linked to original sources
PubMed1969

Coumarin therapy and platelet aggregation.

Platelet aggregation has been related to blood coagulation studies in patients on nicoumalone, a coumarin anticoagulant. Aggregation studies were performed by means of Chandler's tube and the adenosine diphosphate (A.D.P.)-induced optical density method. Platelet aggregation in Chandler's tube has been shown to be quite different from A.D.P. aggregation and to be dependent on the "intrinsic" (blood) clotting system. When the intrinsic system was depressed by coumarin anticoagulant, aggregation was delayed in Chandler's tube, but patients with a predominantly "extrinsic" (tissue) system defect gave normal results even when their prothrombin time was excessively prolonged. In contrast there was an increased response to A.D.P. in the anticoagulated patients.The study emphasizes the different mechanisms of platelet aggregation, which we have referred to as coagulation-induced and A.D.P.-induced aggregation. It also shows the limitations of routine control of oral anticoagulants by prothrombin time alone, as the coagulation-induced platelet aggregation appears to be quantitatively related to the overall level of clotting factors in the intrinsic system and independent of the extrinsic system.

Adenine Nucleotides↗
PubMed1968

Effects of low-dose oral contraceptives on blood coagulation.

A study has been performed on the effect of Norinyl-1 and Ortho-Novin, two low-dose oral contraceptives, on blood-clotting factors. Ortho-Novin contains twice the amount of hormone as Norinyl-1. It was therefore possible to observe whether any changes detected were related to the dose of oestrogen-progestin combination. The women were tested in parallel with matched normal female controls and a group in the third trimester of pregnancy. Significant rises in factor VII and X levels were found with both low-dose preparations from the third month onwards. There was no difference between patients on Norinyl-1 and Ortho-Novin, and hence the clotting changes do not appear to be dose-dependent. The long-term effects on clotting factors of these low-dose oral contraceptive preparations remain to be investigated.

Blood Coagulation↗
PubMedDate not supplied

Use of the activated partial thromboplastin time for monitoring heparin therapy: problems and possible solutions.

There is considerable variation in available methods for the activated partial thromboplastin time (APTT), giving widely differing results with patients on heparin treatment. The study is primarily concerned with the assessment of five of the widest used APTT reagents. The heparin response of these reagents has been related to their lipid composition and physical properties. Of the various correlations between lipid composition of the reagents and clotting performance only electrophoretic mobility was associated with the APTT response to heparin. There was a highly significant negative correlation between the APTT prolongation with heparin and electrophoretic mobility. When plasma is heparinized in vitro a differing order of ranking for APTT reagents is obtained than when heparinized patients are tested. The APTT response in patients with recent thrombosis must therefore be the best guide to the clinical dose of heparin. The therapeutic range of conventional heparin therapy is generally regarded as 1.5-2.5 times the control. External quality assessment programmes in the UK and USA have shown considerable differences between heparin dosage according to the APTT test systems. The definition of the therapeutic range must be derived from randomized clinical studies. The need for progress in standardization of the APTT monitoring of heparin is demonstrated.

Blood Coagulation Tests↗
PubMedDate not supplied

Quality control of the prothrombin time and international normalized ratios. National and international schemes.

The international normalized ratios (INR) system allows valid comparisons in results and quality of performance to be made between users of different thromboplastin reagents. In the international quality control surveys currently over 80% of the 53 countries participating report INR. Stated local international sensitivity index (ISI) values show fair agreement with values calculated from quality control returns obtained with local and reference reagents. The coefficient of variations (CV) of the INR in these surveys are between 11-22% depending upon INR values. In comparison, CV of the UK national scheme are currently 7-13%. However, analysis of UK results has shown high CV with high ISI reagents. This is due to the ISI effect as CV of INR is CV of prothrombin ratio (PR) multiplied by the ISI. Ideal thromboplastins should show good precision of PR and a low ISI to prevent this apparent deterioration when PR results are transformed into the INR scale. Instrumentation has a further effect on the INR result. Unfortunately, the effect is not uniform even within instrument type and model or even between normal and therapeutic results. Local instrument adjustment or local calibration is therefore necessary. Thus, quality control surveys continue to highlight problems in prothrombin time standardization.

Automation↗