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PubMed1979

The effect of normovolemic hemodilution on microvascular hemostasis in the rabbit.

Hemostatic plug formation has been studied in the rabbit mesenteric microcirculation during normovolemic hemodilution. A hemodilution method has been developed which maintains a constant platelet count. Using this method the primary hemostatic plug formation time (PHT) and the total hemostatic plug formation time (THT) has been assessed for different degrees of hemodilutions. Both PHT and THT are significantly prolonged for arterioles perfused with low hematocrits (10.6 and 14.2). At a hematocrit of 19.0 the hemostasis is most effective with the shortest hemostatic plug formation times.

Animals↗
PubMed1979

Glanzmann's thrombasthenia. Report of two oral surgical cases using a new microfibrillar collagen preparation and EACA for hemostasis.

Glanzmann's thromboasthenia is a rare congenital platelet disorder characterized by a prolonged bleeding time, a qualitative platelet defect, and severe hemorrhagic episodes. Patients with this disorder have been managed by administration of blood and blood components (most recently, platelet-rich plasma and platelet concentrates) to control hemorrhage resulting from trauma or surgical procedures. The two case reports presented here illustrate the use of a local hemostatic agent (microfibrillar bovine collagen, Avitene) and a systemic fibrinolytic inhibitor (epsilon aminocaproic acid, Amicar) to control postoperative hemorrhage secondary to elective extraction of teeth. The clinical results demonstrate excellent postoperative hemostasis and support recent in vitro observation of platelet adherence to the collagen preparation. This provides an alternate therapeutic modality in the management of patients with Glanzmann's disease and possibly other disorders of platelet function.

Abscess↗
PubMed1977

Control of heparinization by activated clotting time during bypass with improved postoperative hemostasis.

Heparin and protamine dosages monitored during open-heart operations by activated clotting time (ACT) have been reported to be superior to dosage schedules based on body weight or body surface area. To evaluate the automated ACT, 114 consecutive open-heart operations performed between October, 1974, and December, 1975, were studied. Fifty-eight operations prior to April, 1975, using a standard heparin-protamine protocol (Group I) were compared with 56 operations from April to December, 1975, monitored with an automated ACT (Group II). The two groups were similar with respect to surgical procedures, pump time, and perfusion techniques. The protamine/heparin ratio was 25% less in Group II compared with Group I, and the 12-hour postoperative blood loss was 48% less in Group II. The automated ACT is a reliable, rapid, and simple test that has resulted in improved hemostasis following cardiac operation.

Blood Coagulation Tests↗
PubMed1977

Hydraulic hemostasis in transurethral resection of the prostate using the Iglesias continuous suction resectoscope.

An intravesicoprostatic hydrostatic pressure less than 10 mm. Hg maintains normal anatomy and physiology of the muscular and vascular prostatic structures. An increase in hydrostatic intravesicoprostatic pressure to more than 10mm. Hg produces a distortion in the musculature of the prostate, especially at the true capsule, opening the cut vessels and making possible the absorption of the irrigant free of electrolytes (transurethral resection syndrome). A low hydrostatic intravesicoprostatic pressure permits the compression of cut vessels by the inflow hydraulic pressure of 90 cm. water, achieving hydraulic hemostasis during transurethral resection of the prostate. Less electrocoagulation is necessary, resulting in more rapid patient recovery.

Hemostasis, Surgical↗
PubMed1979

Hemostasis in massively transfused trauma patients.

Twenty-seven patients requiring massive transfusions were studied prospectively to determine whether administration of stored, modified whole blood induced a primary disorder of hemostasis evidenced by generalized microvascular oozing. Platelet counts fell in proportion to the number of units of blood transfused. In contrast, the levels of factors V and VIII correlated poorly with the units of blood transfused, 85% of the total variation in the levels being due to influences other than transfused blood. Levels of all other clotting factors were unrelated to the number of units of blood given. Eight patients developed abnormal bleeding. The cause appeared to be dilutional thrombocytopenia in five patients, and DIC in three. In six of the eight, bleeding was controlled with platelet concentrates alone. Two patients were given cryoprecipitate also. The most useful laboratory test for predicting abnormal bleeding was the platelet count. Fibrinogen levels should be followed as an aid in the diagnosis of DIC. The BT, PT, and PTT were not helpful in assessing the cause of bleeding, unless they were greater than 1.5 times the control value. We recommend that any patient receiving massive transfusions who develops diffuse microvascular bleeding be given platelet concentrates. Platelet counts as high as 100,000 may be required to control bleeding from surgical wounds. It is not necessary to supplement transfusions of stored, modified whole blood with fresh blood or fresh frozen plasma.

Adolescent↗
PubMed1977

[Variations in hemostasis in the infant under deep hypothermia].

Effects on hemostasis of deep hypothermia on infant has been studied on 29 infants operated upon for a cardiopathy under deep hypothermia. Results of this study show a diminution of the coagulation factors rate, an augmentation of the fibrinolytic activity and an unforeseable variability of the residual heparin leading in all cases to a complement of the heparin neutralization by Protamine.

Cardiac Surgical Procedures↗
PubMed1978

Clinical effects of aspirin and acetaminophen on hemostasis after exodontics.

The effects of aspirin and acetaminophen on postextraction hemostasis were evaluated in a double-blind study in a group of 43 patients; 20 received aspirin and 23 received acetaminophen. No significant difference was found in the observed postsurgical alveolus bleeding times or the patients' reported length of postoperative bleeding. However, Ivy bleeding times taken after the ingestion of 80 grains of medication showed an elevation in 75% of the aspirin users and in 60% of the acetaminophen group; the mean change in bleeding times was 2.75 times greater in the aspirin group.

Acetaminophen↗
PubMed1978

Morphology of the early hemostasis in human skin wounds: influence of acetylsalicylic acid.

The in vivo formation of hemostatic plugs was studied in humans in skin wounds made using the template bleeding procedure of Mielke (34). The wounds were excised by punch biopsy 10 seconds, 30 seconds, 2 minutes, and 3 minutes after they were made. The wounds were V-shaped and approximately 0.4 mm. deep. Within 30 seconds small hemostatic plugs were observed at the end of transected vessels. The plugs grew in size in the subsequent minutes and became impermeable. The platelets degranulated and formed pseudopods which became strongly interdigitated. The platelets at the periphery of the plugs showed discontinuities of the membranes. Cytoplasmic matrix and cell organelles had disappeared in many of these peripheral cells. Small fibrin fibers were already found at 30 seconds, mostly along the margins of the wounds and also at the periphery of the hemostatic plugs. Fibrin was absent from the center of the plugs and from the lumen of transected vessels. When part of a plug was extending into the vessel lumen, the platelets inside the vessel were less degranulated and less interdigitated than the rest of the plug. The effect of acetysalicylic acid (ASA) was studied in wounds before and 2.5 hours after ingestion of 2 gm. of ASA. Wounds were excised by punch biopsy 3 or 10 minutes after they had been made. Platelets in ASA were less degranulated, had fewer pseudopods, and showed less interdigitation than platelets in control plugs. Ballooning and fibrin deposition were similar in control and ASA plugs. Pronounced differences between control and ASA plugs were observed in a subject who exhibited a considerably prolonged bleeding time after ASA. The ASA plugs were very large; many plugs had fused and in addition numerous small platelet clumps, most likely fragments from the plugs, were found in the superficial scab of the wound. It is postulated that ASA plugs are less stable due to decreased interdigitation. This allows more disruption of the plugs and rebleeding. Consequently, more platelets are needed and longer time is required for hemostasis to occur.

Adult↗
PubMed1979

[Hemostasis system in lung cancer, benign tumors and chronic nonspecific pneumonias].

A comparative study, condicted on the coagulation status, indicated that tumor and chronic inflammatory processes in the lung as associated with high blood content of fibrinogen and fibrinogen B, the increased plasma tolerance to heparin and degree of thrombotest with a compensatory increase of the heparin content and antithrombin activity. Lung tumor patients contrary to patients with pneumonias showed a high thromboplastin activity and reduced fibrinolysis indices. The activation of euglobulin fibrinolysis is characteristic of the hemostasis system in patients with chronic pneumonias. The revealed alterations may be used both for timely prophylaxis of coagulopathy and as an adjuvant method in the differential diagnosis.

Adult↗
PubMed1976

[Transcervical adenomectomy with prior hemostasis (author's transl)].

After giving a brief description of the anatomy of the prostate, with special emphasis on the irrigation of same, the authors discuss 226 cases of adenoma of the prostate operated on transcervically with prior hemostasis, the transfusion consisting of a total of 111 of blood. In 68% of the cases, the urine became clear within 24 h after the operation. The probe was removed within the first 5 days in 70% of the cases. The complications found included: 9 cases of epididymitis (keeping in mind that deferent ducts are never linked), 4 cases of postoperative incontinence (in 3 cases the incontinence was temporary and disappeared within 3 months), and 3 deaths 2 weeks after the operation (1.3%) due to ictus, bronchopneumonia, and pneumonia, respectively. The hospital stay lasted 9 days, on the average. There were no cases of late hemorrhaging, fistula, or vesicle atony.

Aged↗
PubMed1978

[Hemostasis in hereditary hemorrhagic telangiectasia (author's transl)].

The investigation of a girl aged 8 with hereditary hemorrhagic telangiectasia showed an abnormality of primary hemostasis. The bleeding time was at the upper end of normal and platelet adhesiveness was decreased to a variable extent. Platelet life span was shortened, presumably due to the telangiectatic lesions typical of this disease. Platelet aggregation and ADP-content were normal as was the plasma coagulation system.

Blood Coagulation↗
PubMed1978

Comparative effects of aspirin and acetaminophen on hemostasis.

Aspirin, even in small doses, has a profound and relatively long-lasting effect on platelet function and hemostasis. This usually produces few clinical problems. However, if a patient has an underlying hemostatic defect, undergoes surgery or sustains an injury, or is a newborn, severe hemorrhage is a potential risk. Aspirin is contraindicated in these clinical contexts. In contrast, acetaminophen has no effect on the hemostatic mechanism unless massive overdose results in hepatic necrosis with depression of synthesis of coagulation factors. Acetaminophen can be used when indicated in clinical situations where the use of aspirin may be potentially dangerous.

Acetaminophen↗
PubMed1976

Factor V and VIII activation "in vivo" during bleeding. Evidence of thrombin formation at the early stage of hemostasis.

Factor V and VIII activity was measured by a one-stage assay on capillary blood issuing from a skin cut. This activity increases during bleeding. The phenomenon is suppressed by a previous injection of a low dose of heparin. These data give evidence of a very early local formation of thrombin during hemostasis. The study of this activation process in patients with congenital deficiency of blood clotting factor allows to investigate the mechanism of thrombin formation in vivo. This demonstrates the preeminence of the tissue factor pathway and the need of factor VIII for factor X activation in the extrinsic system.

Adult↗
PubMed1976

[The infrared contact coagulator for hemostasis in the renal parenchyma (author's transl)].

Investigations on hemostasis with the infrared contact coagulator (ICC) after renal pole resections in dogs with and without clamping of the renal vessels are reported. Clamping the renal vessels led to less bleeding, but the coagulation time was distinctly prolonged. In addition the use of ICC in renal pole amputations in humans is described in two cases of urogenital tuberculosis. In both cases we were able to stop the bleeding quickly and satisfactorily without clamping the renal vessels. The results of animal experiments and the significance of using the ICC in man are discussed.

Animals↗
PubMed1977

Kinetic characterization of hemostasis in thermal injury.

Hemostasis has been characterized by kinetic measurements in 12 patients with severe burns. Survival and turnover of 51Cr-platelets, 131I-fibrinogen, and 125I-plasminogen were simultaneously measured in 10 patients within 24 hours of injury; the disappearance times were shortened in concert to approximately 20% of normal values, and platelet and fibrinogen turnover were increased to more than three times normal. Serial studies in five of these patients 3 and 5 weeks later showed progressive improvement in kinetic measurements ,but normal values were not achieved. Two additional patients with similar rates of consumption demonstrated localization of radiolabeled platelets and fibrinogen in the burn wound. Heparin therapy did not modify consumption significantly. Enhanced fibrinolysis was reflected by marked reduction in 125I-plasminogen survival, depletion of the plasma plasminogen levels, and elevated levels of fibrin degradation products. Initial low levels of platelets and fibrinogen were followed by compensatory elevations; factor V and prothrombin complex factors were depressed during the first five days, but factor VIII levels were not reduced. Thermal injury is characterized by marked and prolonged consumption within the wound of platelets, fibrinogen, and plasminogen that is not reversible by heparin. This process depletes hemostatic components and causes bleeding when the burn is massive or complications are severe.

Adolescent↗
PubMed1977

[Effectiveness of using gelatin sponge for hemostasis during treatment of acute iliofemoral venous thrombosis].

Patients with acute thrombosis of profound large veins of the lower limbs and pelvis (83) were administered anticoagulants of indirect action, heparin and thrombolytic drugs (fibrinolysin or thrombolytin), as a result of it all patients showed marked hypocoagulemia, contributing to increased blood loss during the operation and the development of hemorrhagic complications postoperatively. With the purpose of hemostasis gelatin sponge was employed in 47 operative interventions. The number of hemorrhagic complications, while using the sponge, was reliably decreased as compared with the group of patients (57) in whom the sponge was not employed.

Acute Disease↗
PubMedDate not supplied

Hemostasis in schistosomiasis mansoni.

Hemostasis was studied in 18 patients with the hepato-intestinal form of Schistosomiasis mansoni and in 23 with the hepato-splenic form. Both groups are compared referring to alterations found. The relations between plasmatic coagulation factors and hepatocytic function tests are studied. In 6 patients the explorations were repeated after administration of hycanthone. In the patients with the hepato-splenic form, the presence of chronic consumptive coagulophathy was found. The coagulopathy disappeared either by treatment with heparine or by splenectomy. This observation points out the importance of splenomegaly in the development of chronic consumptive coagulopathy, and may be an important factor in indicating splenectomy in a patient with portal hypertension due to Schistosomiasis mansoni.

Adult↗
PubMedDate not supplied

[Changes in hemostasis in the postoperative period].

Hemostasis was investigated in the postoperative stage (at 24 hours and at 5 days) in 20 patients that had underwent major surgical interventions. The test applied for study of blood coagulation included : thrombocyte counting, the test of Howell, the activated recalcification time, the activated partial thromboplastin time, the prothrombin time (Quick), the thrombin time, estimation of fibrinogen concentration, the protamine sulphate test. The activity of the fibrinolytic system was investigated by the euglobulin clot lysis test and by the method of fibrin plates, while fibrinolysis inhibitors were assessed by determination of serum antiplasmines. Also the fibrinolytic degratation products were evaluated. The results indicate a biological condition that can be classified as "thrombophilia", characterized by hyperfibrinogenemia, the presence of fibrin monomers, a decrease of the fibrinolytic activators and an increase in the amount of antiplasmins, as well as a high percentage of fibrinolytic degradation products. Although the patients did not show manifest signs of thrombosis in the postoperative period, the results obtained indicate a tendency to intravascular formation and deposition of fibrin and suggest the necessity to apply prophylactic therapy with anticoagulants in the postoperative period.

Anticoagulants↗