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PubMedDate not supplied

Association between prolonged bleeding time and gastrointestinal hemorrhage in 102 patients with liver cirrhosis: results of a retrospective study.

BACKGROUND: Gastrointestinal bleeding is a frequent complication of liver cirrhosis (LC) and represents an important warning sign of imminent death. Platelet dysfunction is an abnormality occurring prevalently in severe liver failure, and could well predispose to bleeding. METHODS: One hundred and two patients with liver cirrhosis diagnosed by needle liver biopsy were studied. According to the Child-Pugh classification, 23 were A class, 42 B class and 37 C class cases. Prothrombin activity, aPTT, fibrinogen, FDPs, XDP and platelet count were measured in each patient; bleeding time was measured in all but 17 of them. Forty (39%) had experienced gastrointestinal bleeding during the last 3 years (2 A class, 12 B class, 26 C class). RESULTS: Patients with a history of previous gastrointestinal bleeding showed lower values for prothrombin activity and fibrinogen, and higher percentage of elevated FDP and XDP levels; moreover, they presented lower platelet counts and more prolonged bleeding times than patients without gastrointestinal blood loss. CONCLUSIONS: While our findings confirm the relationship between hyperfibrinolysis and bleeding, the association between bleeding time prolongation and gastrointestinal blood loss suggests studying platelet function prospectively in LC in order to analyze its role, if any, in favoring hemorrhage activity.

Adult↗
PubMedDate not supplied

Liver biopsy bleeding time: an unpredictable event.

The aim of this study was to observe the correlation between liver biopsy bleeding time, prothrombin time ratio and platelet count. The subjects were 51 consecutive patients referred for laparoscopic liver biopsy. The intervention was laparoscopy under local anaesthetic and liver biopsy with observation of post biopsy bleeding time. No correlation was found between observed liver biopsy bleeding time and platelet count or prothrombin time ratio. Thus, mild to moderate coagulopathy does not appear to be associated with prolonged bleeding following liver biopsy. Equally, normality of these coagulation studies does not indicate an absence of risk for post liver biopsy bleeding.

Adult↗
PubMed1988

No acute effect of cigarette smoking on bleeding time of habitual smokers.

To study the influence of cigarette smoking on blood platelet function, bleeding time was measured in two groups of 14 habitual smokers before and after a 20-minute period during which the subjects either smoked two cigarettes (experimental group) or rested (control group). The second bleeding time appeared to be slightly shortened upon cigarette-smoking (-0.1 min) and was found to be prolonged in the control group (+0.4 min). These changes did not differ significantly from each other (P = 0.38). Consequently, bleeding time of habitual smokers is not affected by smoking two cigarettes.

Adolescent↗
PubMed2003

Managing PAD with multiple platelet inhibitors: the effect of combination therapy on bleeding time.

PURPOSE: Patients with lower-extremity peripheral arterial disease (PAD) face a high risk of cardiovascular morbidity and mortality. Platelet inhibition (PI) significantly reduces this risk. Combination PI is common and increasingly indicated in patients with PAD; however, the effect on platelet function has not been objectively evaluated. Aspirin (ASA), clopidogrel (Clop), and cilostazol (Cilo) are the three most commonly used PI drugs in patients with PAD. A prospective, sequential evaluation of platelet function using the template bleeding time (BT) was performed for PAD patients taking these medications singly and in combination. METHODS: Twenty-one patients with PAD, averaging 65.9 years of age, were studied. Patients were placed on sequential two-week regimens of the following therapies: washout (no PI), ASA (325 mg daily), ASA + Cilo (100 mg twice daily), washout, Cilo, Cilo + Clop (75 mg each day), washout, Clop, Clop + ASA, and Clop + ASA + Cilo. At the end of each phase, trained personnel measured the BT. RESULTS: Baseline bleeding time for the group was 4.29 +/- 1.69 minutes. ASA (BT = 6.64 +/- 3.52) and Clop (BT = 10.17 +/- 5.4) significantly prolonged bleeding time (P < 0.01); however, no significant effect was observed with Cilo alone (BT = 5.41 +/- 2.69). Combined treatment with ASA + Clop (BT = 17.39 +/- 4.59) had a more pronounced effect on BT compared with either agent alone (P < 0.01). The addition of Cilo to either ASA (BT = 8.3 +/- 4.27) or Clop (BT = 12.7 +/- 7.46) or the combination of ASA + Clop (BT = 17.92 +/- 4.69) did not prolong BT. CONCLUSION: All patients with PAD require platelet inhibition, and many require pharmacotherapy for intermittent claudication. The platelet inhibitors aspirin and clopidogrel are used for the reduction of ischemic events. They significantly prolong bleeding time individually and to a greater extent in combination. Cilo is used to improve walking distance in patients with intermittent claudication. When Cilo is added to ASA, Clop, or the combination of the two, there is no additional increase in bleeding time. Therefore, Cilo can be used in combination with other platelet inhibitors without an additional effect on platelet function as reflected by the bleeding time.

Aged↗
PubMed1980

Standardization of the bleeding time.

The Duke, Ivy and immersion methods for performing the bleeding time are reviewed and modifications of these methods are discussed. Certain of the automated devices are described. It is concluded that the bleeding time, when properly standardized, is an important test in the evaluation of a hemostatic disorder.

Bleeding Time↗
PubMed1979

In vivo platelet retention in human bleeding-time wounds. II. Effect of aspirin ingestion.

PRB was studied in normal human subjects before and after aspirin ingestion. Aspirin ingestion resulted in a prolongation of individual bleeding times greater than 2.4 min (greater than 2 S.D. beyond the group mean before aspirin) in 62.5% of 48 paired studies. The relationship of platelets retained vs. time was linear during the first 3 min of bleeding before and after aspirin. The mean PRB decreased from 22.1 +/- 9.2 to 9.6 +/- 8.6 (p less than 0.001) after aspirin ingestion. Subjects whose bleeding time was prolonged greater than 2.4 min had a significantly higher mean PRB before aspirin and a significantly greater mean decrease in PRB after aspirin than those whose bleeding time was prolonged less than or equal to 2.4 min. Aspirin ingestion reduced the number of EDTA-irreversible clumped platelets present in wound blood approximately 50% during the second and third minute of bleeding, but large numbers of EDTA-reversible platelet clumps were observed in wound blood before and after aspirin. Although platelet retention was significantly decreased during the first 3 min of bleeding after aspirin, the percent of venous blood platelets present in wound blood just prior to the arrest of hemorrhage was equal before and after aspirin. These observations indicate that aspirin prolongs the bleeding time by decreasing platelet clumping and slowing the rate of platelet thrombus formation in severed blood vessels. The presence of platelet clumps in wound blood after aspirin ingestion indicates that alternative mechanisms of platelet aggregation, independent of the arachidonate pathway of prostaglandin synthesis, proceed in vivo unaltered by aspirin.

Adult↗
PubMed1995

Platelet aggregation at high shear is impaired in patients with congenital defects of platelet secretion and is corrected by DDAVP: correlation with the bleeding time.

Techniques measuring platelet aggregation in vitro under the high shear rate conditions that can be found in the microcirculation could reflect the status of primary hemostasis better than the turbidimetric technique. We studied platelet aggregation at high shear in patients with prolonged bleeding time caused by congenital platelet secretion defects such as delta-storage pool deficiency and primary secretion defect. Two different techniques were used: shear-induced platelet aggregation in a cone-and-plate viscometer and the filter aggregation test. With both techniques, platelet aggregation at high shear rate was defective in 14 patients with delta-storage pool deficiency and in 8 with primary secretion defect. There was a statistically significant correlation between platelet aggregation at high shear rate and the bleeding time. In patients with delta-storage pool deficiency, platelet aggregation at high shear rate and the bleeding time were significantly correlated with the platelet serotonin content. The intravenous infusion of 1-deamino-8-D-arginine vasopressin (DDAVP) (0.3 micrograms/kg) increased the plasma concentration of von Willebrand factor (vWf), shortened the bleeding time, and potentiated platelet aggregation at high shear rate in all patients. Because platelet aggregation at high shear rate requires vWf, the effect of DDAVP is probably due to the induced increase in plasma vWf. Therefore, platelet aggregation at high shear rate is defective in patients with congenital defects of platelet secretion and is potentiated by DDAVP. Potentiation of platelet aggregation at high shear rate may be one mechanism by which DDAVP shortens the prolonged bleeding time of patients with congenital defects of platelet secretion.

Bleeding Time↗
PubMedDate not supplied

[Thrombocytic alpha-delta-storage-pool-disease: shortening of bleeding time after infusion of 1-desamino-8-D-arginine vasopressin].

BACKGROUND: The synthetic vasopressin derivate desmopressin (1-desamino-8-D-arginine vasopressin) has been reported to shorten the bleeding time in patients with hemophilia A, von Willebrand's disease and several functional platelet disorders. In addition to substitution of platelets, vasopressin is therefore used to prevent bleeding complications. CASE: We report the case of a 14-year-old female patient with prolonged bleeding time due to the rare thrombocytic alpha-delta-storage-pool-disease. When normal donor platelet substitution alone was ineffective, bleeding time was normalised after infusion of desmopressin and elective wisdom-tooth extraction was performed without significant postoperative bleeding. DISCUSSION: Infusion of desmopressin appears to be effective in shortening bleeding time in thrombocytic storage-pool-disease. Its use could prevent bleeding complications after trauma and surgical interventions and may possibly help to spare the need for platelet concentrates.

Adolescent↗
PubMedDate not supplied

Does dietary arsenic and mercury affect cutaneous bleeding time and blood lipids in humans?

Fish species may contain considerable amounts of trace elements, such as selenium (Se), arsenic (As), and mercury (Hg). The present study investigated the relationships between dietary intake of these elements and cutaneous bleeding time and blood lipids in 32 healthy volunteers. For 6 wk, one group (n = 11) consumed approx 250 g Se-rich fish daily, providing them with an average Se intake of 115 +/- 31 micrograms Se/d, Hg intake of 18 +/- 8 micrograms/d, and As intake of 806 +/- 405 micrograms/d, all values analyzed in 4-d duplicate food collections. To study the effect of Se alone, one group (n = 11) included Se-rich bread in their normal diet, giving them a Se intake (135 +/- 25 micrograms/d) that was comparable to the fish group. A control group (n = 10) ate their normal diet, providing 77 +/- 25 micrograms Se/d, 3.1 +/- 2.5 micrograms Hg/d, and 101 +/- 33 micrograms As/d. The dietary As load strongly correlated both with bleeding times and changes in bleeding times (r = 0.48, p < 0.01 and r = 0.54, p < 0.002, respectively). Dietary Hg showed a positive correlation with LDL-cholesterol (r = 0.55, p < 0.01), whereas dietary Hg in the fish group showed a strong negative relationship with HDL-cholesterol (r = -0.76, p < 0.01). Selenium seemed to have only a modest effect on bleeding time. Our results suggest that mercury and arsenic from fish may be factors contributing to or modifying some of the known effects of fish ingestion.

Adult↗
PubMed1989

Modified bleeding time in the infant.

The present authors developed a modified template bleeding time for use in the newborn infant. The sensitivity of the bleeding time to the presence of antibiotics, indomethacin, generalized illness, and thrombocytopenia was tested in 242 infants. Both indomethacin and thrombocytopenia similarly prolonged the BT, and the latter could be corrected by raising the platelet count.

Anti-Bacterial Agents↗
PubMed1992

Low dose infusion of adenosine diphosphate prolongs bleeding time in rats and rabbits.

The effect of intravenous infusion of adenosine diphosphate (ADP) on haemostatic and thrombotic mechanisms was studied in rats and rabbits. Infusion of ADP (0.2-1 microMol/kg/min) in rabbits prolonged the skin capillary bleeding time threefold after between 1/2 and 2 hours of infusion. Prolongation of the bleeding time was parallelled by reduced in vitro sensitivity of platelets to ADP in citrated platelet-rich plasma. No major changes in respiratory frequency and heart rate were observed. On the other hand, infusion of adenosine (1 microMol/kg/min) did not affect the bleeding times. Intravenous ADP (0.1 microMol/kg/min) significantly prolonged the bleeding time in anaesthetized rats. Platelet and red cell counts before and during the ADP infusion indicated slight, reversible platelet aggregation. After 75 min the ratio between red cells and platelets resumed a steady pre-experimental level. Platinum wires placed in the abdominal aorta of rats to monitor thrombus formation during ADP infusion indicated an antithrombotic effect of prolonged, low dose infusion of ADP. Since infusion of adenosine did not affect the haemostatic mechanisms, these observations may indicate that ADP infusion desensitized the platelet responsiveness to aggregating stimuli in vivo, and/or that prostacyclin production by endothelium was stimulated by infusion of ADP.

Adenosine↗
PubMed1993

Aprotinin reduces clopidogrel-induced prolongation of the bleeding time in the rat.

High doses of aprotinin have been shown to reduce blood loss and blood transfusion requirements in patients undergoing open heart surgery and recent studies in animals have shown that aprotinin was able to reduce bleeding associated with rt-PA administration. Our study was designed to demonstrate an effect of aprotinin (Iniprol) on the prolongation of the bleeding time associated with the treatment with a potent analogue of ticlopidine: clopidogrel. Bleeding time was determined in rats by transection of the tip of the tail. 2 hours after a single oral administration, clopidogrel (5 mg/kg, p.o.), induced a 4-fold increase in the bleeding time. Aprotinin administered as a bolus iv injection followed by continuous infusion strongly reduced bleeding time prolongation associated with clopidogrel treatment. This effect was dose-related and reached a maximum (congruent to 50% inhibition--P < 0.001) at and above the total dose of 40 U Ph Eur/kg (80,000 KIU/kg). After administration of a total dose of 60 U Ph Eur/kg (120,000 KIU/kg), aprotinin modified neither the antiaggregating effect of clopidogrel nor its antithrombotic activity, as determined in various experimental models. For this reason, aprotinin might constitute a useful antagonist of the haemorrhagic risk associated with interventional therapy under treatment with ticlopidine or clopidogrel.

Animals↗
PubMed1983

Plasma levels of acetylsalicylic acid and salicylic acid after oral ingestion of plain and buffered acetylsalicylic acid in relation to bleeding time and thrombocyte function.

Buffered acetylsalicylic acid (Alka Seltzer, B-ASA) and plain aspirin (P-ASA) tablets were compared as to their effects on bleeding time and platelet function in eight healthy male volunteers. Two doses (500 and 1000 mg) of each preparation were investigated in a cross-over design, each volunteer being his own control in each dose group (n=4). Both preparations disturbed platelet aggregation to the same extent. Bleeding time increased after both preparations, though significantly more after the buffered preparation than after plain acetylsalicylic acid, irrespective of the dosage. The 1000 mg dose prolonged bleeding time significantly more than the 500 mg dose, irrespective of the preparation. Kinetic analysis showed that B-ASA gave higher peak plasma levels of acetylsalicylic acid (ASA) and accordingly salicylic acid peak levels were also higher after the buffered preparation. It is concluded that B-ASA in equi-analgesic doses prolongs bleeding time more than the plain preparation. Since it is less agressive on the gastro-intestinal mucosa, its use may be advantageous in situations where acetylsalicylic acid induced loss of platelet aggregation is desired. However, the risk of prolonged bleeding--e.g. after tooth extractions--is probably higher after the buffered preparation.

Adult↗
PubMed1990

Desmopressin-induced improvement in bleeding times in chronic renal failure patients correlates with platelet serotonin uptake and ATP release.

Hemostatic defects resulting in life-threatening hemorrhagic episodes are a common occurrence in the chronic renal failure patient. Hemorrhagic tendencies correlate best with laboratory tests of bleeding times. The identification of a specific hemostatic defect and its role in bleeding dyscrasias has yet to be elucidated. Our studies demonstrate that factor VIII coagulant activity and factor VIII related antigen (vWF:Ag) are normal or greatly elevated in uremic renal failure patients with greatly prolonged bleeding times. The multimeric state of the von Willebrand factor is also normal in these patients. The bleeding times were normalized in all 15 patients, 90 minutes post-infusion with desmopressin (DDAVP). No significant changes in factor VIII/vWF associated properties, blood cell counts, or coagulation factors were observed post-DDAVP treatment. However, a significant increase in platelet serotonin uptake (p less than .025) and ATP release (p less than .025) was detected after DDAVP treatment. These results indicate that DDAVP acts on the platelet membrane. This is further substantiated by the ability of DDAVP to block vasopressin-induced platelet aggregation in a dose- and time-dependent fashion. Perturbations in the movement and storage of serotonin and the release of adenosine 5'-triphosphate (ATP) in the platelets of uremic individuals are proposed to play a critical role in regulating bleeding times.

Adenosine Diphosphate↗
PubMed1993

In vivo study of bleeding time and arterial hemorrhage in hypothermic versus normothermic animals.

This in vivo study confirmed impaired hemostasis during hypothermia in a swine model. Group I (normothermic, n = 8) and group II (hypothermic, n = 8) animals were anesthetized and instrumented for continuous peritoneal irrigation and monitoring of heart rate and blood pressure. The effects of hypothermia, hypotension, and inotrope on bleeding time and bleeding from two types of arterial injuries were evaluated. Our findings were that (1) bleeding time was significantly prolonged in hypothermic animals; (2) the differences in blood loss from partially torn artery (PTA) and completely cut artery (CCA) at both normothermic and hypothermic temperatures did not reach statistical significance; and (3) blood loss from PTA was greater than CCA when norepinephrine (Levophed) was infused to elevate blood pressure in hypotensive animals at normal core temperature.

Algorithms↗
PubMed1961

The rate of blood loss from skin punctures during the Ivy bleeding time test.

The rate of blood loss from skin punctures during the performance of the Ivy bleeding time test has been measured by a simple technique in normal individuals, in patients without defects of the haemostatic or coagulation system, and in patients with known haemorrhagic disorders.A wide range was found in normal individuals, but repeated tests on a single individual showed a smaller variation. Nearly half of the tests on patients with von Willebrand's disease, thrombocytopenia, ;capillary type' of bleeding, or haemorrhagic renal failure gave abnormally high rates of blood loss. Haemophilic, Christmas disease, and Dinedevan-treated patients gave low volumes and rates of blood loss.A group of patients has been encountered in whom the bleeding time was normal but the rate of blood loss was increased. The majority of these had haemorrhagic symptoms and other evidence of a defective haemostatic or coagulation system. It is suggested that a consideration of the rate of blood loss in those patients with a normal bleeding time gives additional help in interpreting the Ivy test. A high rate may indicate the need for further investigation of the haemostatic and coagulation system.

Bleeding Time↗
PubMed1983

The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration.

Bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration were measured in rabbits recovering from thrombocytopenia caused by a single injection of anti-platelet serum. Similar measurements were made on rabbits in a steady state of normal platelet production. The effects of a sustained state of thrombocytopenia on megakaryocyte DNA concentration were investigated by repeated daily injections of anti-platelet serum. It is shown that bleeding time depends on both platelet count and mean platelet volume. Furthermore changes in mean platelet volume appear to play a more important role in haemostasis than changes in platelet count. The mean megakaryocyte nuclear DNA concentration is significantly increased after 24 hours of thrombocytopenia and continues to increase as thrombocytopenia is sustained. Thromboxane B2 production/unit volume of platelet is increased in platelets produced after 24 hours of thrombocytopenia compared with platelets produced in normal steady state function. As a consequence platelets produced in response to thrombocytopenia not only have a larger mean platelet volume but are also more reactive. Mean platelet volume, as well as platelet count, should be considered as an index of haemostasis and its dysfunction, thrombosis.

Animals↗
PubMed1994

[Shortening of acetylsalicylic acid-prolonged bleeding time by means of desmopressin].

The pathomechanism of desmopressin (DDAVP)-dependent shortening of the bleeding time prolonged by acetylsalicylic acid (ASA) was investigated by the Ivy bleeding time (BT) and the in vitro bleeding test (IVBT). Additionally, platelet aggregation and von Willebrand factor (vWF) were determined. The possible effect on plasma or platelets was examined by blood compositions containing citrated whole blood after ingestion of ASA plus either plasma or platelets after application of DDAVP (control: plasma or platelets after ASA). Excellent correlations were found between BT and IVBT as well as vWF (r2 = 0.97-0.99). In contrast, platelet aggregation decreased after administration of DDAVP. Experiments with blood compositions showed an effect of plasma and platelets as well in the IVBT after DDAVP administration. The results demonstrate the superiority of the IVBT to describe the in vivo function of platelets in comparison with the platelet aggregation test.

Aspirin↗