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PubMed1983

[Hemostatic abnormalities of the patients with cancer. Clinical significance and fibrinolytic properties of the cancer tissues].

Hemostatic function of 129 patients with cancer of the digestive system was studied on the clinical point of view. Activator (A) and inhibitor (I) of fibrinolysis of 94 cancer tissues were determined by Malone's method. The following results were obtained: Latent DIC state was observed in the patients with advanced stage. Great majority of the patients with PT less than or equal to 85%, antithrombin III (AT III) less than or equal to 25 mg/dl, FDP greater than or equal to 5 micrograms/ml, alpha 1 antitrypsin (alpha 1 AT) greater than or equal to 340 mg/dl, plasminogen (plg) less than or equal to 10 mg/dl and alpha 2 plasmin inhibitor (alpha 2 PI) less than or equal to 80%, were eligible only for non-curative operation on the preoperative evaluations. Persistent decreases in PT, AT III, plg and alpha 2 PI mean poor prognosis, which were seen within about 6 months prior to death. In gastric cancer patients, these abnormalities showed correlations with serum choline-esterase, albumin and ferritin, and post-operative changes of these parameters suggested the recurrence. There were I activities in the cancer tissues which were scarcely detected in the normal tissues. Some differences in A/I ratios were observed on types of organs involved, histological types and differentiative degrees. There were no correlations between the hemostatic state and A/I ratios. These results indicate the clinical usefulness of the hemostatic functions of the cancer patients and the fibrinolytic properties of the cancer tissues, and also suggested that tumor bearing state, liver function and non-specific stimulating mechanisms participate in the appearance of the abnormalities.

Adenocarcinoma↗
PubMed1980

[Hemostatic properties of gastric juice under basal conditions and after stimulation with pentagastrin or secretin-pancreozymin (author's transl)].

Unsoluble gastric mucus and gastric juice from 11 normal volunteers were separated by centrifugation and investigated for hemostatic properties. Unsoluble gastric mucus added to citrated blood shortened reaction time and increased duration of maximum amplitude of thrombelastographic recordings, indicating an acceleration of hemostatic processes. On the other hand gastric juice inhibited coagulation and enhanced fibrinolytic activities, as shown by thrombelastographic recordings, prothrombin time, partial thromboplastin time, and euglobulin lysis time. Unsoluble gastric mucus accelerated hemostasis even more after stimulation by secretin-pancreozymin, as evidenced by thrombelastographic recordings. Gastric juice of patients with duodenal ulcers showed a significant change of these parameters to the opposite after pentagastrin. We conclude, that stimulation respectively inhibition of HCl and proteases, following pentagastrin respectively secretin-pancreazymin may influence hemostatic properties of gastric juice and gastric mucus as well.

Blood Coagulation Tests↗
PubMed1995

Hemostatic effects of heat probe thermocoagulation for patients with peptic ulcer bleeding: an experience of 329 patients.

BACKGROUND: The mortality rate of peptic ulcer bleeding has kept around 6-10% over the past thirty years. Rebleeding is the most important adverse prognostic factor. Heat probe thermocoagulation is suspected to have good hemostatic effect, there is doubt whether the experience of performing the HPT treatment for peptic ulcer bleeding will influence the hemostatic rate. So we report our experience of a large series for heat probe thermocoagulation. METHODS: Patients with an active bleeding source (spurting or oozing) or a nonbleeding visible vessel (NBVV) in a peptic ulcer disease were enrolled in this study. We used an Olympus GIF IT-10 or GIF 2T-10 panendoscope, an Olympus heat probe unit and a 3.2 mm probe (Olympus Co., Taipei, R.O.C.) to treat peptic ulcer bleeding. We classified the faculty into junior physician, having experience in less than 20 procedures, and senior physician, having experience in more than 20 procedures. RESULTS: Between September 1986 and October 1993, we treated 329 patients with active bleeding or nonbleeding visible vessels at the ulcer craters. The stigmata of recent hemorrhage in these patients included spurting hemorrhage in 102 cases (31%), oozing hemorrhage in 105 cases (31.9%), nonbleeding visible vessels in 122 cases (37.1%). The bleeders were most frequently found in the stomach (181,55%), then the duodenum (133,40.4%). The energy applied to each case was 886 +/- 844 joules (mean +/- SD). The initial hemostatic rate was 95.1% (313/329). Rebleeding occurred in 74 cases (23.6%), and 52 cases received a second heat probe thermocoagulation with to result in ultimate hemostasis in 43 cases (82.7%). Junior physician obtained similar initial hemostasis rate and rebleeding rate (92.6%, 26.4%) as compared with 96.2% and 22.7% of senior physician. Totally 33 patients received emergency operation, and 5 patients died. The volume of total blood transfusion was 2830 +/- 2184 ml (mean +/- SD). The hospital stay was 7.4 +/- 4.6 days (mean +/- SD). CONCLUSIONS: Heat probe thermocoagulation is very effective in the arrest of peptic ulcer bleeding with minimal complications and it is easy to learn in a short period of time.

Adult↗
PubMed1995

ARIC hemostasis study--IV. Intraindividual variability and reliability of hemostatic factors. The Atherosclerosis Risk in Communities (ARIC).

We have recently reported the short-term intraindividual variability of several coagulation factors and inhibitors included in the ARIC study (Chambless et al. Ann Epidemiol 1992; 2:723). In this paper, we reported the intraindividual variability results of additional hemostatic factors. Blood samples were collected for hemostatic assays three times at 1-2-week intervals from 39 subjects recruited from 4 ARIC field centers. The contributions of within-person, processing and assay (designated "method") and between-person variances to the total variance were estimated and from them the reliability coefficient, R, was computed as the proportion of total variance in the between-person component. The R value was high for beta-thromboglobulin and tissue-plasminogen activator: 0.83 and 0.81, respectively; and intermediate for D-dimer and plasminogen activator inhibitor-1: 0.73 and 0.72, respectively. Protein S (total and free) and platelet factor 4 had low repeatability (R < 0.50) derived mostly from "method" variability while low R value (0.03) for fibrinopeptide A was attributed to high "method" and "within-person" variability. Gender, age and the level of hemostatic factors did not influence the intraindividual variability.

Arteriosclerosis↗
PubMedDate not supplied

Early hemostatic alterations following bone marrow transplantation: a prospective study.

BACKGROUND: The occurrence of coagulation system alterations after bone marrow transplantation (BMT) and their possible role in the pathogenesis of thrombotic complications such as veno-occlusive disease of the liver (VOD) are still a matter of debate. The aim of this study was to evaluate prospectively the alterations in hemostatic balance developing during the early period after BMT (up to day +21) and their relationships (if any) with VOD. PATIENTS AND RESULTS: Twenty-nine patients (15 autologous and 14 allogeneic BMT) entered the study. No patient suffered from thrombotic and/or major hemorrhagic events. Since there were no differences between the two groups of patients with regard to modifications of coagulation parameters, they were considered together for the purposes of the study. We observed a progressive increase from baseline levels of fibrinogen, factor VIII activity (fVIII:C) and von Willebrand factor antigen (vWf), while factor VII antigen (fVIIAg), protein C and plasminogen significantly decreased. The alterations in these test values were maximal on day +14, with a trend towards normal levels one week later. There was no modification of PT, PTT, prothrombin fragment 1 + 2 (F 1 + 2), fXIIC, tPA, PAI-1, D dimer or protein S levels; serum levels of tumor necrosis factor-alpha were also unchanged. CONCLUSIONS: These results suggest that some alterations of the hemostatic system, probably a consequence of endothelial damage, can be detected early after BMT, but their clinical significance remains uncertain due to the lack of a correlation between hemostatic test alterations and the occurrence of thrombotic complications.

Adolescent↗
PubMedDate not supplied

Negligible hemostatic toxicity of intermediate-dose Erwinase in adult patients with acute lymphoblastic leukemia: preliminary data.

The hemostatic toxicity of low dose L-asparaginase from Erwinia carotovora (Erwinase) has been reported to be negligible in adult patients with acute lymphoblastic leukemia (ALL); conversely, no consistent data have been obtained when Erwinase is administered at intermediate doses. We report preliminary clinical and laboratory hemostatic data from 10 adult patients with ALL treated during induction phase with intermediate doses of Erwinase (20,000 IU/m2s.c. every other day, for a total of six administrations). No thrombotic or hemorrhagic events were registered and the mean values of PT, aPTT, fibrinogen, antithrombin and D-dimer did not change during treatment. Only one patient showed a decrease of antithrombin (48% on day 8) requiring temporary suspension of Erwinase therapy. These data suggest that intermediate doses of Erwinase also have negligible hemostatic toxicity in adult patients with ALL.

Adolescent↗
PubMed1993

[Serial changes in hemostatic and fibrinolytic states induced by coronary thrombolytic therapy].

The effects of coronary thrombolytic therapy with urokinase on the intrinsic hemostatic and fibrinolytic states were investigated by determining several markers for hemostatic and fibrinolytic activities in 6 patients with acute myocardial infarction who underwent coronary thrombolysis with urokinase. The markers for hemostasis and fibrinolysis were: markers for plasmin generation [alpha 2-plasmin inhibitor (alpha 2-PI), plasminogen, plasmin alpha 2-PI complex (PIC)]; markers for fibrinolysis [fibrin/fibrinogen degradation products-E fragment (FDP-E), FDP D-D dimer (D dimer), fibrinogen]; markers for hemostatic activity (prothrombin time (PT), antithrombin III (AT-III), protein C); markers for thrombin generation [thrombin antithrombin III complex (TAT)]; markers for intrinsic fibrinolytic activity [tissue plasminogen activator plasminogen activator inhibitor complex (TPA PAI complex)]. These markers were measured before, at 1 to 2 hours intervals during first 6 hours, daily during the next 3 days, and subsequently on the 7th and the 14th day after urokinase therapy. Fibrinolysis (determined by increased D dimer) occurred only when alpha 2-PI became unmeasurable with 96 x 10(4) or more units of urokinase administration, then persisted for more than 2 hours. TAT increased from 13.1 +/- 15.4 to 70.8 +/- 65.8 ng/ml soon after fibrinolysis occurred, indicating that thrombin generation occurred at the same time as fibrinolysis. The TPA PAI complex level before urokinase administration (26.4 +/- 6.4 ng/ml) was greater than the normal upper limit, indicating increased intrinsic fibrinolytic activity, then decreased after urokinase administration. These findings suggested that urokinase administration might affect the intrinsic fibrinolytic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Influence of maximal ergometric exercise on endothelin concentrations in relation to molecular markers of the hemostatic system.

The effects of moderate 30 min cycle ergometer exercise (aerobic metabolism; 0.85-3.71 mmol.1(-1) lactate) followed by short-term exercise at maximal capacity (anaerobic metabolism; 5.09 to 17.75 mmol.1(-1) lactate) on endothelin (ET) and hemostatic variables (tissue plasminogen activator [t-PA] antigen, prothrombin fragments [F1,2], thrombin-antithrombin III complex [TAT], prothrombin time and partial thromboplastin time) were investigated in 15 male healthy subjects of varying fitness levels. Endothelin was measured twice before and immediately after maximal cycle exercise. The results show an increase in endothelin concentration [10.0 pg.ml-1 (baseline) + 6.1 pg.ml-1 (increase post exercise)]. ET did not increase under control conditions. Moderate 30 min exercise caused an increase in t-PA antigen concentration (3.66 + 3.15 ng.ml-1) and short-term maximal exercise produced a markedly higher elevation in this variable (+10.6 ng.ml-1). F1,2 increased (810 + 40 pmol.l-1) under moderate and by 150 pmol.l-1 under anaerobic exercise. TAT increased only at maximal exercise levels (1.01 + 0.32 ng.l-1). No changes were found in any of these variables under control conditions. No correlation of endothelin and the hemostatic variables was found. It is concluded that endothelin and hemostatic markers increase independently during moderate and maximal exercise.

Adult↗
PubMed1996

Hematologic, hemostatic, and biochemical effects in dogs receiving an oral chondroprotective agent for thirty days.

OBJECTIVE: To evaluate the effect of a chondroprotective agent on hematologic, hemostatic, and biochemical variables in clinically normal dogs when administered over 30 days. ANIMALS: 13 clinically normal Beagles of either sex. PROCEDURE: Hematologic and hemostatic variables were assessed prior to treatment and on days 3, 14, and 30 of treatment. Biochemical variables were assessed before treatment and on day 30 of treatment. RESULTS: Significant (P < 0.05) decreases were noted in hematocrit, hemoglobin, WBC, and segmented neutrophil variables on days 3 and 14 of treatment. A significant decrease in red distribution width was noted on days 3 and 30, in RBC count on day 3, and in lymphocyte numbers on day 30. There were also significant reductions of aggregation in response to adenosine diphosphate and collagen on days 14 and 30. Significant decreases were noted in total ATP release in response to collagen on days 14 and 30, as well as significant decrease in platelet count on days 14 and 30. No changes were noted in prothrombin time, activated partial thromboplastin time, mucosal bleeding time, or biochemical variables during the study. CONCLUSIONS: Administration of this chondroprotective agent causes minor but not clinically important changes in hematologic and hemostatic variables in young, clinically normal dogs. CLINICAL RELEVANCE: Oral chondroprotective agents are widely prescribed in veterinary medicine for the treatment of degenerative joint disease; however, to date, little is known about safety of their use.

Administration, Oral↗
PubMedDate not supplied

Diagnosis of pre-disseminated intravascular coagulation stage with hemostatic molecular markers. The Mie DIC Study Group.

We examined various hemostatic abnormalities in 395 patients with disseminated intravascular coagulation (DIC), in 177 patients in a Pre-DIC stage, and in 99 patients who did not exhibit DIC. Pre-DIC was defined as the condition at least one week before the onset of DIC. The differences in activated partial thromboplastin time (APTT), FDP, prothrombin time (PT) ratio, fibrinogen, and platelet count between DIC and Non-DIC patients were significant, but there were no significant differences in these parameters between Pre-DIC and Non-DIC patients. Plasma levels of fibrin-D-dimer, thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), soluble fibrin monomer (sFM), prothrombin activated peptide F1 + 2 (F1 + 2), thrombomodulin (TM), tissue type plasminogen activator (t-PA), and PA inhibitor (PAI-I) in DIC patients were significantly higher than levels in Non-DIC patients. However, only TAT, sFM and PAI-I values in the Pre-DIC patients were significantly higher than the values in the Non-DIC patients. Almost all the hemostatic molecular markers examined had high sensitivity for DIC, but only TAT and PPIC had high sensitivity for Pre-DIC. Specificity for DIC was also high with TAT, sFM, and F1 + 2. Early diagnosis and early treatment are important in DIC; we believe that it is possible to predict Pre-DIC by assessing values for the combination of hemostatic molecular markers.

Antithrombin III↗
PubMedDate not supplied

[The effect of prostatilen on the hemostatic indices in chronic prostatitis (a clinical and experimental study)].

Prostatilen effects on hemostasis were studied in 120 intact and 240 chronic prostatitis rats, 34 patients with chronic prostatitis. Intact rats responded to prostatilen by inhibition of platelet-vascular and coagulation hemostatic mechanisms and activation of fibrinolysis. Experimental chronic prostatitis in rats induced hemostatic shifts to hypercoagulation. These parameters returned to normal after 5- and 10-day course of prostatilen administration. A single prostatilen dose was unable to produce the above action. As to patients with chronic prostatitis, there were also prostatilen-induced platelet-vascular hemostatic normalization and fibrinolysis activation. Hemocoagulation was affected in a less degree. Prostatilen effects were unrelated to the disease stage. Normalization of hemostasis seems to be one of the factors of prostatilen therapeutic efficacy in chronic prostatitis. This peptide is found effective as a pathogenetic treatment of chronic prostatitis.

Animals↗
PubMedDate not supplied

[Change in biochemical and hemostatic indicators in guinea pigs upon administering Ebola virus preparations].

The biochemical and hemostatic parameters were compared in guinea pigs after inoculation of Ebola virus strains lethal and nonlethal for them and of inactivated antigen of this virus. The time course of the main hemostatic and biochemical parameters in animals challenged with the lethal strain of Ebola virus differed much from that in other groups. This permits us to hypothesize that modification of the virus in the course of adaptation to the host results in the appearance of properties boosting the enzymatic processes and, hence, in depletion and failure of antioxidant and hemostatic defence, which aggravates the pathological process.

Alanine Transaminase↗
PubMed1997

[Hemostatic sutures in post-cesarean uterine inertia].

The present report describes a new technique of uterine hemostatic bonds. These sutures are used in cases of uterine inertia with the objective of produce a useful contraction in this organ after the childbirth, these bonds are useful either in cesarean operation as in delivery. The indication for these sutures in when after the usual methods for contracting the uterus as massage, uterus compression, oxytocin, ergonovics, or calcium, we can not achieve contraction and the hemorrhage persist. We report 69 cases in which the hemostatic bonds were applied. Just in one case was not possible to control the hemorrhage and a hysterectomy was required. In 68 cases hysterectomy was avoid by using the hemostatic sutures.

Adult↗
PubMedDate not supplied

Hemostatic abnormalities associated with cancer and its therapy.

Hemostatic abnormalities associated with malignancy have been described since the middle of the 19th century. Abnormalities associated with hypercoagulability and hemorrhage are reported in various percentages of patients depending upon the underlying neoplasm and the type of therapy. Changes in the quantitative and qualitative aspects of protein coagulation factors, anticoagulant proteins, circulating anticoagulants, platelets, and vascular responses have been noted. Clinical or subclinical disseminated intravascular coagulopathy (DIC) and associated paradoxical bleeding are common. Hemorrhage may be associated with a decrease of particular coagulation factors or alterations of vascular integrity and platelet numbers or function in various combinations. Evaluation of hemostatic abnormalities associated with cancer (HAAC) includes a careful history and physical examination, assessment of the prothrombin and activated partial thromboplastin times, platelet count, a test for fibrin or fibrinogen degradation products, and assay of fibrinogen levels. Specific findings may suggest the need for tests for naturally occurring protein anticoagulants (e.g., protein S, protein C, and antithrombin III), coagulation inhibitors, abnormalities of the fibrinolytic system, or other esoteric tests. Testing for F1 + 2 and fibrinopeptide A may be useful in determining early activation of prothrombin and thrombin, respectively, and a clue to incipient onset of DIC. Besides the disease, therapies for cancer can alter hemostatic activity. Chemotherapy has been reported to be associated with venous and arterial thromboses, cerebrovascular events, and coagulopathies. Radiation therapy decreases platelet production, particularly if the active bone marrow has been included in the field. Laboratory evaluation of HAAC requires consideration of the type of malignant disorder, the history and physical condition of the patient and any therapy.

Antineoplastic Agents↗
PubMedDate not supplied

[Morphological alternations and hemostatic disturbances as manifestation of mesenchymal dysplasia in nephroptosis patients].

The examination of 36 nephroptosis patients (33 females and 3 males, mean age 23 years) included assessment of hemostasis before and after nephropexia (15 patients), histological investigation of renal parenchyma biopsies (15 patients) and those of the skin from the lateral abdominal surface and musculus lumborum fascia (5 patients). Changes characteristic for an early stage of microcystosis were found in all the renal tissue biopsies. In the skin and muscular connective tissue there were dystrophic changes. Collagen fibers were undergoing elastoid degeneration. As to hemostatic disorders, there were diverse platelet dysfunctions and/or thrombocytopenias, 9 patients had low plasma level of Willebrand's factor, 28 showed impaired terminal clotting. Combination of the above defects was registered in 12 of 36 examinees. After nephropexia, platelet count and fibrinogen level noticeably increased, hemostatic disorders aggravated. Thus, nephroptosis is manifestation of connective tissue pathology associated with marked hemostatic changes.

Adult↗
PubMed2003

Non-invasive hemostatic closure devices: "patches and pads".

Initial device technologies developed to obtain hemostasis of percutaneous arteriotomy sites have used sutures or hemostatic plugs. Recently, a new class of noninvasive products have been introduced that promote rapid hemostasis in the form of a patch or pad. The purpose of this article is to review recent innovations using simple, but effective, hemostatic aids.

Animals↗
PubMed1998

Hemostatic efficacy of a fibrin sealant dressing in an animal model of kidney injury.

OBJECTIVE: The purpose of this study is to determine the hemostatic efficacy of a fibrin sealant dressing compared with a standard collagen control dressing in an animal model of kidney injury. METHODS: Twenty adult male Sprague-Dawley rats were administered general anesthesia and underwent partial nephrectomy with heparin anticoagulation (300 U/kg intravenous). Treatment of the cut surface of the kidney was randomized to three groups: group I, no hemostatic agent; group II, collagen dressing; and group III, fibrin sealant dressing. RESULTS: Blood loss was significantly less in group III (3.39+/-0.63 mL) than in group I (8.64+/-2.26 mL) and group II (8.63+/-1.72 mL; p < 0.001). The percentage decrease in the mean arterial pressure was significantly less in group III (34.09+/-15.58%) than in group I (59.66+/-16.19%) and group II (60.35+/-15.66%; p=0.015). CONCLUSION: Fibrin sealant dressings provide effective hemostasis and are superior to collagen dressings in an animal model of kidney injury. Additional development of fibrin sealant dressings for potential clinical use is warranted.

Animals↗
PubMed2003

Effect of a chitosan-based hemostatic dressing on blood loss and survival in a model of severe venous hemorrhage and hepatic injury in swine.

BACKGROUND: Hemorrhage is a leading cause of death from trauma. An advanced hemostatic dressing could augment available hemostatic methods. We studied the effects of a new chitosan dressing on blood loss, survival, and fluid use after severe hepatic injury in swine. METHODS: Swine received chitosan dressings or gauze sponges. Standardized, severe liver injuries were induced. After 30 seconds, dressings were applied and resuscitation initiated. Blood loss, hemostasis, resuscitation volume, and 60-minute survival were quantified. RESULTS: Posttreatment blood loss was reduced ( p< 0.01) in the chitosan group (264 mL; 95% confidence interval [CI], 82-852 mL) compared with the gauze group (2,879 mL; 95% CI, 788-10,513 mL). Fluid use was reduced ( p= 0.03) in the chitosan group (1,793 mL; 95% CI, 749-4,291) compared with the gauze group (6,614 mL; 95% CI, 2,519-17,363 mL). Survival was seven of eight and two of even in the chitosan and gauze groups ( p= 0.04), respectively. Hemostasis was improved in the chitosan group ( p= 0.03). CONCLUSION: A chitosan dressing reduced hemorrhage and improved survival after severe liver injury in swine. Further studies are warranted.

Animals↗