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PubMed1999

Relationship between hemostatic factors and known cardiovascular disease correlates in two suburban populations in Taiwan.

The Cardiovascular Disease (CVD) Risk Factor Two-Township Study is a longitudinal cardiovascular epidemiologic study of two suburban towns in Taiwan. Analyzing baseline data from 1,080 men and 1,510 women aged 18 and above, this paper focuses on the relationship of several hemostatic factors to CVD correlates: blood lipids, apolipoproteins, glucose, and uric acid, and blood pressure. Information on these relationships can shed light on whether hemostatic factors contribute to the pathogenesis of CVD independently or through known mechanisms. Pearson correlation and multiple regression analysis were used to analyze the data. In the population studied, cholesterol, and apolipoprotein B had the strongest correlations with all hemostatic factors tested. Triglyceride was also strongly associated with factor VIIc. Factor VIIIc, factor VIIc, and fibrinogen, ordered by the strength of the correlation, were positively and significantly correlated with glucose, uric acid, and blood pressure levels. The associations of apolipoprotein B and cholesterol with fibrinogen (p = 0.14-0.20) were not as strong as those with factors VIIc (p = 0.28-0.37) and VIIIc (p = 0.15-0.30). Factors VIIc and VIIIc were independently associated with most clinical variables studied, including the levels of cholesterol components, triglyceride, glucose, uric acid, and diastolic blood pressure. These finding indicate that states of coagulating factors correlated, to varied degrees, with levels of blood lipid parameters, uric acid, and blood pressure in the population studied.

Apolipoproteins↗
PubMed1999

Hemostatic activation under anticoagulant treatment: a comparison of unfractionated heparin vs. nadroparin in the treatment of proximal deep vein thrombosis.

BACKGROUND: Multiple clinical trials have been performed to compare standard heparin with low molecular weight heparin in the therapy of deep vein thrombosis, but little is known about the time course of the markers of hemostatic system during the treatment with these two heparin regimens. METHODS: Twenty patients with proximal deep vein thrombosis confirmed by duplex ultrasound and phlebography were randomly assigned to either unfractionated heparin (UH) given as an intravenous bolus of 80 U/kg followed by a constant infusion of 18 U/kg/h, or nadroparin 185 AXa IU/kg once daily subcutaneously. Oral anticoagulants were started at day 4. Markers of hemostatic activation (F1+2, FPA, TAT, D-dimer) were measured daily for 4 days. Primary endpoints were the time course of these markers; secondary endpoints consisted in the evaluation of thromboembolic and hemorrhagic complications by clinical outcome and Marder score. RESULTS: Treatment with UH resulted in a rapid achievement of therapeutic heparin levels. UH reduced markers of fibrin formation and fibrinolysis more rapidly than nadroparin (p < 0.05). Within the nadroparin group activation of prothrombotic markers four hours after the subcutaneous injection (peak level) was significantly lower when compared with the time prior to injection (trough level). Secondary endpoints showed no significant difference between the two groups. CONCLUSION: Continuous intravenous perfusion of UH administered on a basis of a weight-adjusted nomogram controlled markers of the hemostatic system more rapidly than once-daily subcutaneously administered weight-adjusted nadroparin.

Adult↗
PubMedDate not supplied

Endoscopic hemostasis for bleeding peptic ulcer using a hemostatic clip or pure ethanol injection.

BACKGROUND/AIMS: Endoscopic hemostasis is frequently chosen as the treatment of first choice for bleeding peptic ulcers. We retrospectively compared the hemostatic effects of hemoclips and endoscopic ethanol injection in patients with bleeding gastric and duodenal ulcers. METHODOLOGY: The subjects were 149 patients with 156 bleeding peptic ulcer lesions who were treated by endoscopic hemostasis, comprising 127 gastric ulcers and 29 duodenal ulcers. Hemoclips were used for 68 lesions (hemoclip group) and ethanol injection was done for 88 lesions (ethanol group). RESULTS: The hemostasis rates were 98.5% for the hemoclip group and 92.0% for the ethanol group. There was no significant difference in hemostatic effect between these two methods. All patients with unsuccessful hemostasis had a visible vessel larger than 2.0 mm in diameter and/or concomitant disease. CONCLUSIONS: The results suggest that these two endoscopic hemostatic methods are both highly effective. The presence of a large visible vessel may be predictive of unsuccessful hemostasis.

Adult↗
PubMed2000

Increased fibrinogen levels and hemostatic abnormalities in patients with arteriolar nephrosclerosis: association with cardiovascular events.

Increased plasma fibrinogen levels and hemostatic abnormalities suggestive of a prothrombotic state are present in patients with end-stage renal failure and could contribute to increased cardiovascular morbidity in these patients. We investigated the relationship between abnormalities of the hemostatic system and the degree of renal failure and whether these abnormalities are associated with increased prevalence of cardiovascular events in patients with arteriolar nephrosclerosis. In 425 patients recruited at a hypertension clinic we assessed the renal function by creatinine clearance, urinary protein excretion, and microalbuminuria, the prevalence of atherosclerotic disease, and measured prothrombin time, activated partial thromboplastin time. fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer, and antithrombin. Early impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) caused by arteriolar nephrosclerosis was found in 172 patients. Patients with early renal failure were significantly older and had significantly greater values of blood pressure, plasma fibrinogen, F1+2, and D-dimer than patients with normal renal function. Elevated D-dimer and fibrinogen levels were independently associated with the presence of decreased creatinine clearance. Log fibrinogen, log F1+2, and log D-dimer were inversely correlated with creatinine clearance. The prevalence of coronary artery, cerebrovascular, and peripheral vascular disease was significantly greater in patients with mild renal failure than in those with normal renal function. Elevated levels of fibrinogen and D-dimer were associated with the presence of atherosclerotic disease independent of renal function and other risk factors. In conclusion, changes in hemostatic parameters occur early in the course of renal failure in patients with arteriolar nephrosclerosis, suggesting a prothrombotic state that may contribute to the risk for atherosclerotic disease at all levels of renal function.

Adult↗
PubMed2000

o-raffinose cross-linked hemoglobin improves the hemostatic defect associated with anemia and thrombocytopenia in rabbits.

Several different preparations of cross-linked hemoglobin (CLHb) are being evaluated for their efficacy and safety as red cell substitutes in a variety of preclinical and clinical settings. Because CLHb is known to sequester nitric oxide (NO) and inhibit NO-mediated processes, we hypothesized that CLHb would have a hemostatic effect by enhancing platelet reactivity, inducing vasoconstriction, or both. Infusion of o-raffinose CLHb shortened the prolonged microvascular bleeding time and decreased blood loss from ear incisions in rabbits rendered anemic and thrombocytopenic. Moreover, this hemostatic effect persisted for at least 24 hours after infusion. Phenylephrine induced a degree of vasoconstriction similar to that induced by CLHb but did not shorten the bleeding time or decrease blood loss, suggesting that vasoconstriction alone cannot account for the hemostatic effect of CLHb. There was no evidence of CLHb-induced activation of coagulation in vivo, since infusion of CLHb did not increase circulating levels of thrombin-antithrombin complex. In vitro, CLHb abolished the inhibitory effect of the NO donor 3-morpholinosydnonimine on platelet aggregation and enhanced the aggregation of stimulated but not resting platelets. This potentiating effect was not attenuated by the addition of superoxide dismutase or catalase. To evaluate the potential arterial thrombogenicity of CLHb, a model of carotid artery thrombosis was developed in rabbits without thrombocytopenia or anemia. Compared with albumin infusion, CLHb infusion shortened the time to complete carotid occlusion. These data suggest that CLHb may shift the thromboregulatory balance toward clot formation, resulting in decreased bleeding in anemic and thrombocytopenic rabbits and possibly increasing arterial thrombogenicity in normal rabbits.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Comparison of hemostatic disturbances between patients on CAPD and patients on hemodialysis.

OBJECTIVE: Disturbances in hemostasis are common findings in uremic patients. Both bleeding diathesis and thrombosis are observed. The purpose of this study was to assess whether renal replacement therapy in the form of hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) affects coagulation and fibrinolysis in patients with end-stage renal failure. DESIGN: Comparison of hemostatic measures in patients on CAPD, HD, and matched healthy controls. SETTING: Department of Nephrology and Internal Medicine, Bialystok University School of Medicine. PATIENTS AND METHODS: Twenty-four HD patients and 23 CAPD patients were evaluated with respect to platelet aggregation, hemostatic parameters, serum lipids, lipoprotein(a), and cytokines [tumor necrosis factor alpha (TNFalpha) and interleukin-1 (IL-1)]. INTERVENTIONS: Four exchanges of CAPD per day, using 2.0 L dialysate over a period of 25 +/- 31 months; or 4-5 hours of HD 3 times per week for a period of 31 +/- 22 months. RESULTS: Platelet aggregation in whole blood and platelet-rich plasma was significantly impaired in both groups of dialyzed patients compared to healthy volunteers. Markers of endothelial cell injury (thrombomodulin and von Willebrand factor) were significantly higher in HD and CAPD patients compared to the control group. A similar pattern of changes was observed for lipoprotein(a), fibrinogen, tissue factor pathway activity, and factor VII activity. Activity of factor X was significantly enhanced in CAPD compared to HD patients and controls. Euglobulin clot lysis time was significantly prolonged in HD and CAPD patients over controls, being more prolonged in CAPD patients. Markers of ongoing coagulation (thrombin-antithrombin complexes and prothrombin fragments 1+2) were higher in uremic patients, significantly higher in CAPD than in HD. A marker of ongoing fibrinolysis (plasmin-antiplasmin complexes) was higher in uremic patients but was lower in CAPD than in HD patients. Concentrations of TNFalpha and IL-1 were higher in HD than in CAPD patients. CONCLUSION: Patients on CAPD showed evidence of a higher degree of hypercoagulation than HD patients.Thus, hemostatic abnormalities in end-stage renal failure may be affected to some extent by the choice of renal replacement therapy.

Adult↗
PubMed2001

Comparison of the responses of global tests of coagulation with molecular markers of neutrophil, endothelial, and hemostatic system perturbation in the baboon model of E. colisepsis--toward a distinction between uncompensated overt DIC and compensated non-overt DIC.

This study correlates changes in neutrophilic activity and endothelial injury with markers of hemostatic activity following the infusion of increasing concentrations of E. coli organisms. It focuses on the hemostatic response as a marker of microvascular injury and uses the response to increasing concentrations of E. coli to refine our definition of disseminated intravascular coagulation (DIC) and distinguish between a compensated (non-overt DIC) and uncompensated (overt DIC) response. We observed that the global coagulation tests reflected activation of the hemostatic system in a dose dependent manner (overt DIC) in the early phases (T+2 to 6 h) of the response to increasing concentrations of E. coli, but that they failed to do so in the late phases (T+ 24 to 48 h). We observed that molecular markers, soluble thrombomodulin and elastase, unlike thrombin/antithrombin and plasmin/antiplasmin complexes, remained elevated out to T+24 to 48 h indicating endothelial injury that persists beyond the initial inflammatory insult in compensated as well as uncompensated DIC.

Animals↗
PubMed1975

Hemostatic abnormalities in chronic aggressive hepatitis and liver cirrhosis.

Hemostatic defects of chronic aggressive hepatitis (CAH), 25 cases, and of liver cirrhosis, 20 cases, were investigated. The following assays were performed: liver function tests, thromboelastogram, prothrombin time (PT), partial thromboplastin time (PTT), factors I, II, V, X, XIII, euglobulin lysis time, fibrinogen degradation products (FDP), platelet count, morphology and agglutinability. High incidence of hemostatic defects was present in both groups. Thromboelastogram, PTT, prothrombin and qualitative platelet abnormalities were most common. On the whole, severity of hemostatic alterations in cirrhosis was more pronounced than that found in CAH, FDPs were increased in more than 50% of the CAH cases and only in a few cirrhotic patients. Bleeding occurred more frequently in cirrhosis (55%) than in CAH (4%) and, within the cirrhotic patients' group, it was associated with a more severe thrombocytopenia.

Adult↗
PubMed2002

Use of FloSeal hemostatic sealant in transsphenoidal pituitary surgery: technical note.

OBJECTIVE: Bleeding during transsphenoidal pituitary surgery can lead to a variety of operative difficulties. When the endonasal transsphenoidal approach is used, even mild intraoperative hemorrhage can lessen visibility in the confined operative field of view. This technical note describes the use of a hemostatic agent we have found of benefit in obtaining prompt hemostasis during this operation. METHODS: Operative records were reviewed for an 18-month period for all patients who underwent transsphenoidal surgery since we began using FloSeal hemostatic sealant in January 2000. RESULTS: During the study period, 293 transsphenoidal operations were performed for pituitary lesions. Of these, 20 procedures involved vigorous or persistent bleeding. When the standard techniques for hemostasis failed or were inadequate, FloSeal, a sterile mixture of a gelatin matrix and thrombin component mixed at the time of use, was applied to the site of hemorrhage by use of a 14-gauge angiocatheter to reach the sella. We observed complete hemostasis immediately on application of FloSeal in all cases except one, which required a second application. Hemostasis was obtained immediately after the second application. No operations were aborted during this period as a consequence of undue bleeding. CONCLUSION: We detail the method in which we use FloSeal in transsphenoidal surgery and report our impression of its effectiveness. FloSeal has been demonstrated to be safe and biocompatible as compared with hemostatic agents currently in use.

Adolescent↗
PubMed2002

Effective management of bleeding during tumor resection with a collagen-based hemostatic agent.

In a prospective controlled trial hemostatic effectiveness of a novel collagen-based composite (CoStasis) was compared with a collagen sponge applied with manual pressure at diffusely bleeding sites after surgical tumor resection. The proportion of subjects achieving complete cessation of bleeding within 10 minutes (i.e., hemostatic success) and the time to "complete hemostasis" were determined at raw surgical sites after tumor resection among 23 experimental and 30 control subjects. There was a similar distribution in tumor types (e.g., benign vs malignant) evaluated between treatment groups. A significantly greater proportion of experimental subjects achieved complete hemostasis within 10 minutes of observation compared with controls [23 of 23 (100%) vs 21 of 30 (70%); P = 0.003]. The median time required to achieve complete hemostasis was more than three times longer for subjects treated with the collagen sponge compared with subjects treated with CoStasis (243 vs 78 seconds; P = 0.0001). Approximately 80 per cent of experimental subjects achieved complete hemostasis within 2 minutes compared with only 35 per cent of controls. There were no adverse events related to the experimental treatment in this study. These results support the use of this novel hemostatic agent to control diffuse surgical site bleeding after tumor resection at diverse anatomical locations.

Abdominal Neoplasms↗
PubMed2002

[Hemostatic abnormalities in DIC].

There are global coagulation tests and hemostatic molecular markers in the diagnosis of disseminated intravascular coagulation (DIC). In the global coagulation tests, the sensitivity of prothrombin time ratio and fibrinogen for the diagnosis of DIC is low, but their specificity is high. In platelet count and FDP, the sensitivity for the diagnosis of DIC is good, but the specificity is low. Fibrinogen may be unsuitable for the diagnosis of DIC, because it increases of the inflammatory reaction. It is possible to theoretically diagnose DIC by increased tissue factor production. It is currently considered that hemostatic molecular marker should be utilized to diagnose DIC. Thrombin-antithrombin complex and soluble fibrin are reflected to hypercoagulable state, thrombomodulin to vascular endothelial cell injuries, and plasminogen activator inhibitor-I to hypofibrinolytic state. In leukemia with DIC, hyperfibrinolysis and marked bleeding symptoms are often observed. In septicemia with DIC, hypofibrinolysis and severe organ failure often occur. Early diagnosis and treatment of DIC are important to improve the prognosis, and hemostatic molecular markers should be useful for that purpose.

Blood Coagulation Tests↗
PubMed2002

[Hematologic and hemostatic tests availability in view of remuneration for medical services].

Hematologic and hemostatic tests are important and indispensable for diagnosing any kind of hematologic disease. Recent advances in hematologic tests are seen in automation of the blood cell counts and morphological analyses that are required for diagnosing hematologic diseases, and in the accumulation and availability of genetic and chromosomal examinations related to their diagnosis. Although hemostatic tests used to be mainly aimed at checking bleeding tendency, they are now being directed toward diagnosing thrombotic tendency. Medical expenses have hardly been increased in past revisions of reimbursement schedules for medical services, which has driven hospital management into an even tighter corner. In the field of laboratory examination, test fees were heavily slashed and calculated on an all-inclusive basis, forcing budgetary restrictions on the management of test laboratories. I discuss the medical reimbursement for hematologic and hemostatic tests, focusing on the fiscal 2002 revision of the medical service fee schedule implemented in April.

Blood Coagulation Tests↗
PubMed1999

[Analyses on structural and physicochemical properties of collagen hemostatic sponge].

The ultraviolet spectrum and aminoacid content of collagen hemostatic sponge prepared from bovine tendon were analyzed, and the struture and composition of collagen spoge were confirmed. Physicochemical properties measurements showed that collagen hemostatic sponge had excellently stable quality. It was concluded that the technology for preparing collagen hemostatic sponge was reasonable and reliable.

Collagen↗
PubMed1992

Hemostatic factors and risk of cardiovascular disease in women. An overview.

This report presents an overview of epidemiologic and clinical studies on the relationship between plasma levels of hemostatic factors and risk of cardiovascular disease in women. In addition, research on an association between hemostatic factor levels and gender, as well as estrogen status, is briefly reviewed. Only the Framingham Heart Study has published prospective results showing elevated fibrinogen levels to be associated with excess risk of coronary heart disease among women. However, taken together, the evidence to date from epidemiologic and clinical studies suggests potentially important hemostatic effects of aging, gender, and sex hormone levels on risk of cardiovascular disease in women.

Cardiovascular Diseases↗
PubMed1992

Distributions of hemostatic variables in blacks and whites: population reference values from the Atherosclerosis Risk in Communities (ARIC) Study.

The Atherosclerosis Risk in Communities Study measured hemostatic variables in nearly 16,000 men and women, aged 45 to 64 years, from four US communities. This report, based on the first 12,681 participants, presents distributions of fibrinogen concentration, factor VII activity, factor VIII activity, von Willebrand factor antigen, protein C antigen, antithrombin III activity, and activated partial thromboplastin time. Many of the hemostatic variables differed between blacks and whites, and by sex and age. For example, compared to whites, blacks had higher mean values of fibrinogen, factor VIII, von Willebrand factor, and antithrombin III, and lower mean values of protein C. Some seasonal fluctuations in hemostatic variables were noted; most notably, mean values of factor VII were lowest and protein C were highest in subjects examined in the summer compared to those examined during the other seasons. These results provide population-based reference values on blacks and whites for those interested in the relation of hemostasis to disease.

Arteriosclerosis↗
PubMed2004

[Endoscopic hemostasis using high-frequency hemostatic forceps for hemorrhagic gastric ulcer].

Gastric ulcer is a major responsible lesion for upper gastrointestinal bleeding. Several methods for endoscopic hemostasis are widely used throughout Japan to treat the ulcerative lesion. High-frequency hemostatic forceps is one of the endoscopic coagulation devices developed solely for hemostasis. Unlike biopsy forceps, it has narrow opening angle, a small cup and a dull edge to make pinpoint holding of the target lesion possible. We applied high-frequency hemostatic forceps for eleven cases of hemorrhagic gastric ulcer with exposed vessels. All of the cases were treated by endoscopic hemostasis with the device. Initial hemostasis obtained in all of the cases(100%), and no rebleeding was observed. Additional treatment, however, was necessary in four cases(36%). No serious complication, like perforation, was observed. We concluded that endoscopic hemostasis using high-frequency hemostatic forceps for hemorrhagic gastric ulcer is safe and effective method.

Hemostasis, Endoscopic↗
PubMed2005

[The relationship between hemostatic changes in liver cirrhosis patients with different degrees of liver lesions in reference to Child-Pugh scores].

OBJECTIVE: To investigate the relationship between hemostatic changes in liver cirrhosis patients with different degrees of their liver lesions. METHODS: Forty-three patients (35 men, 8 women; age: 25 to 71 yr) with liver cirrhosis were divided into three subgroups (A, B, and C) on the basis of Child-Pugh classification. Among the patients, 13 were classified as Child-Pugh class A, 15 were class B, 15 were class C. 16 healthy individuals served as controls. A series of hemostatic tests and parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), factors II, V, VII, VIII, IX, X, vWF assay, antithrombin-III (AT-III), protein C (PC), D-dimer, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor activity (PAI) were performed on 43 patients and the 16 healthy controls. RESULTS: PT and APTT were progressively prolonged from A to B and then to C. In comparison to the controls there was a significant difference. Fibrinolytic activity and the activities of factors II, V, VII, IX, X were progressively decreased from A to B and then to C. In comparison to the controls there was a significant difference . AT-III and PC activity were progressively decreased from A to B and then to C. In comparison to the controls there was a significant difference. D-dimer and t-PA-antigen were progressively increased from A to B and then to C. In comparison to the controls there was significant difference. PAI activity did not display significant changes in the four groups. CONCLUSION: We found that there is a close relationship between the severity of cirrhosis and the hemostatic changes. Because the deterioration of the coagulation function and increasing fibrinolytic activity parallel the severity of liver cirrhosis, adequate treatment for cirrhotic bleeding should not only correct the coagulation defects, but also lower the increased fibrinolytic activity.

Adult↗
PubMed1990

Effects of desmopressin acetate (DDAVP) and dextran on hemostatic and thromboprophylactic mechanisms.

The effects on hemostatic and thromboprophylactic mechanisms of intravenous desmopressin (DDAVP, 0.3 micrograms/kg) and dextran 40 and 70 given both separately and in various combinations were evaluated in five male volunteers. Dextran did not inhibit the DDAVP-induced hemostatic changes. The dextran-induced decrease in platelet adhesiveness and the prolonged bleeding time were totally reversed by DDAVP. Hematocrit decrease was seen after both drugs, lasting longer when they were combined. We conclude that DDAVP and dextran may be used concomitantly, each with maintained beneficial properties. DDAVP will still act hemostatically by increasing platelet adhesiveness, factor VIII and von Willebrand factor and by shortening the dextran-induced prolongation of bleeding time. Dextran and DDAVP may even have additive antithrombotic effects due to the DDAVP-induced stimulation of the fibrinolytic activity, which is not inhibited by dextran, and to rheologic changes such as hematocrit decrease induced by both drugs.

Adult↗