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PubMed1990

Platelet function in nephrotic syndrome patients at the Kenyatta National Hospital.

Platelet function was assessed in 40 patients with nephrotic syndrome but without renal failure in order to establish whether or not there is any haemostatic disorder lending to hypercoagulable state. The findings were compared with those from 40 normal controls. There was no clinical evidence of thromboembolic phenomena in the patients. Values for the mean platelet counts and clot retraction were similar (P less than 0.05), whereas significant decrease of platelet adhesiveness (P less than 0.001) as well as prolonged platelet aggregation time (P less than 0.001) were noted. This is different from some reports in literature which have frequently reported enhanced platelet function. There may be a difference in the way platelets metabolise arachidonic acid to potent aggregating agents, in the African patients as compared to patients studied elsewhere. The hypercoagulable state in our nephrotic syndrome may be explained by alterations in other haemostatic parameters rather than in platelet function.

Adolescent↗
PubMed2005

Normal D-dimer levels in patients with latent tuberculosis infection.

Studies have demonstrated a link between acute pulmonary tuberculosis and a hypercoagulable state, but there are no data on the coagulation state of patients with latent tuberculosis infection (LTI). The present prospective observational study was designed to help fill this gap. The sample included 84 patients (high school students and adults) with suspected LTI referred for the purified protein derivative (PPD) test. Results were read according to the criteria of the American Thoracic Society. Blood samples were collected at admission and assayed for D-dimer, the marker of the coagulation state, with the quantitative Miniquant test. D-dimer values were correlated with the PPD status and clinical parameters. Fifty-seven patients tested positive for LTI and 27 tested negative. There was no significant difference in D-dimer level between these groups (341 +/- 106 and 360 +/- 60 microg/ml, respectively). No significant correlation was found between D-dimer level and PPD status, patient age or occupation (health care worker or not), or clinical indication for the tuberculin test. The normal D-dimer levels in this series suggest that low-level inflammations such as LTI do not lead to a hypercoagulable state.

Adolescent↗
PubMed2002

Anticoagulation therapy in cerebral sinovenous thrombosis and ulcerative colitis in children.

We describe four pediatric patients with ulcerative colitis and cerebral sinovenous thrombosis and review the pediatric and adult literature on the treatment of sinovenous thrombosis. All of our patients had headache as the initial complaint with onset during an ulcerative colitis flare. Evaluation for hypercoagulable states revealed heterozygosity for prothrombin gene mutation and increased homocysteine level in one patient and mild elevation of anticardiolipin antibodies in two patients. Treatment in the acute period included thrombolysis, heparin, and low-molecular-weight heparin. Chronic therapy included warfarin, low-molecular-weight heparin, and aspirin. Peripheral vein thrombosis occurred in two patients while not on antiplatelet or anticoagulation therapy. Neurologic outcome was positive in this series without complications of therapy, suggesting that aggressive therapy should be considered. Although anticoagulation therapy of sinovenous thrombosis is controversial, particularly in the context of intestinal hemorrhage, it can be beneficial given the possibility of an ongoing hypercoagulable state.

Adolescent↗
PubMedDate not supplied

Occult colon cancer in a patient with an unexplained episode of pulmonary embolism.

The association between venous thromboembolism and cancer has been widely documented and the main factor responsible for cancer-induced venous thromboembolism is considered mostly linked to a hypercoagulation state induced by the cancer itself. There is no consensus on investigative strategies for occult cancer in a patient with a thrombophilic condition. We report a patient who manifested an isolated episode of pulmonary embolism without specific evident sources of venous thromboembolism. The routine clinical and laboratory work-up to detect an occult cancer did not reveal any malignancy. A history of duodenal ulcer in association with a recent slight alteration in bowel habits led us to perform an esophagogastroduodenoscopy which was negative for malignancy, and a barium enema followed by colonoscopy, which revealed the presence of a tumor limited to the large intestine. An unexplained clinically evident hypercoagulation state, even in the presence of mild clinical symptoms, needs more thorough diagnostic strategies when simple methods of screening for occult cancer are negative.

Adenocarcinoma↗
PubMed1996

Pediatric priapism associated with Mycoplasma pneumoniae.

OBJECTIVES: Priapism in the pediatric population is rare and most commonly occurs secondary to sickle cell disease or hematologic malignancy. We present a case of a 12-year-old boy with priapism who required aggressive surgical therapy for adequate detumescence. This patient had a recent viral upper respiratory infection and titers for Mycoplasma pneumoniae were indicative of infection. We propose that a hypercoagulable state was induced by the M. pneumoniae infection, which resulted in the priapism. METHODS: A 12-year-old boy with a recent upper respiratory illness presented to his pediatrician with priapism. After failing conservative management, the patient ultimately required a surgical shunt for detumescence. Serum was sent to detect antibodies against M. pneumoniae. RESULTS: The child failed to respond to corporeal irrigations and bilateral Winter shunts. He underwent an El-Ghorab procedure the following morning, which resulted in a flaccid penis. Serum M. pneumoniae antibodies were detected and indicated moderate infection. CONCLUSIONS: We propose that this 12-year-old boy had priapism secondary to infection with M. pneumoniae. M. pneumoniae infection can produce a hypercoagulable state, especially in selected areas of the circulation. This is the first reported case of priapism associated with M. pneumoniae.

Child↗
PubMed1993

Thrombotic complications of BMT: association with protein C deficiency.

A decrease in levels of circulating anticoagulant protein C has been shown to occur following autologous BMT, and this deficiency may contribute to a hypercoagulable state placing patients at risk for thromboembolic events. We report four patients who suffered a variety of thrombotic complications following BMT (non-bacterial thrombotic endocarditis, superior vena cava thrombosis, thrombotic stroke, purpura fulminans, small bowel infarction secondary to diffuse microvascular thrombosis), which were preceded by or temporally related to decreased levels of protein C. Treatment with fresh frozen plasma (FFP) led to slight, temporary increases in protein C levels but infusions of FFP did not prevent either death or extension of the thrombus in these four cases, suggesting the need for higher protein C doses and/or concomitant anticoagulation. Though no direct causal relationship between these thrombotic complications and the protein C deficiency can be proved, a generalized hypercoagulable state caused by protein C deficiency may have contributed to the development, severity or progression of these complications.

Adolescent↗
PubMed1993

Prothrombin fragment F 1 + 2 plasma concentrations in patients with gynecologic malignancies.

Malignant diseases have been shown to cause hypercoagulable states. Elevated prothrombin fragment F 1 + 2 plasma levels occur, when prothrombin is converted into thrombin by factor Xa. In order to evaluate the role of prothrombin fragment F 1 + 2 as an indicator for hemostatic disorders in patients with gynecologic malignancies, plasma levels of 76 patients with various malignancies of the female genital tract and those of 25 healthy subjects were investigated. Fifty-two of 76 (68.4%) patients with malignant diseases showed elevated F 1 + 2 plasma concentrations, whereas no elevated plasma levels were observed in the control group. Mean values of F 1 + 2 in the study group and the controls were 1.94 +/- 1.63 and 0.89 +/- 0.07 nmol/liter, respectively (P < 0.01). These results provide further evidence that gynecologic malignancies can induce hypercoagulable states.

Adult↗
PubMedDate not supplied

[Coagulation status in patients with deep venous thrombosis of the lower extremities].

PURPOSE: Venous thromboembolism is a relevant social and health care problem for its high incidence, pulmonary embolism-related mortality and long-term sequelae which may be disabling (post-thrombotic syndrome and ulceration). PROCEDURES: The aim of our work was to establish the presence of coagulation disorders (hypercoagulable states) in the patients with deep vein thrombosis (DVT) of the leg. Prospectively we have analyzed a group of 30 patients with echosonographicaly verified DVT of the leg who were admitted to the department of vascular surgery from August 1st 2000 to July 31st 2001. The following parameters were monitored: prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (Fib), alpha 2 anti-plasmin (A-2 AP), D-dimer (DD), antithrombin III (AT III) and factor VII. FINDINGS: Activation of the coagulation process was registered. The values of monitored coagulation parameters are shown in table 1. Plasma levels of monitored parameters in the patients with DVT of the leg were significantly higher than in the control subjects. CONCLUSION: In patients with a DVT a hypercoagulable state is common finding. Some parameters of coagulation activity such as D-dimer might be of great interest in the diagnostic strategy of DVT.

Adult↗
PubMed2005

A chronic dysfunctional stress response can cause stroke by stimulating platelet activation, migraine, and hypertension.

A hypothesis is presented on the mechanism of acute intracranial occlusion. The hypothesis is that a chronic dysfunctional response to stress can include migraine, hypertension and systemic platelet activation (a hypercoagulable state). Stress is defined as the perception of excessive threats or demands. Migraine, hypertension, and platelet activation constitute a physiological triad that exists as a distinct entity and can undergo sudden provoked or unprovoked worsening, causing acute stroke. The hypertension and headache may not be apparent in every stroke, much as headache is absent in acephalgic migraine. In support of this idea, a literature review is undertaken which leads to the conclusion that the labile rise in blood pressure and headache often seen with acute stroke are unlikely to be caused by the stroke. Systemic platelet activation has been documented in both migraine and stroke and is the missing piece of the puzzle. Migraine (or non-specific headache) and hypertension are markers of co-existing platelet activation, the hypercoagulable state which causes stroke. Migraine, and, putatively, hypertension and platelet activation, are driven by overactive pacemaker cells in the dorsal raphe nucleus of the midbrain, the nucleus which mediates one arm of the physiologic response to stress. A therapeutic prediction is made that drugs such as ethosuximide, which block the low voltage-activated T-type calcium channel, which is one of the ion channels implicated in the generation of pacemaker currents in the dorsal raphe nucleus, would be useful in stroke prevention.

Chronic Disease↗
PubMed2002

Tissue factor expression on monocyte subpopulations during normal pregnancy.

Pregnancy is often referred to as a hypercoagulable state due to changes in the haemostatic system. Tissue factor (TF) is the initiator of blood clotting in vivo. The effect of pregnancy on monocyte TF expression was determined in a longitudinal case control study (89 pregnant, 39 non-pregnant). Using whole blood flow cytometry and CD14 as a monocyte marker, TF expression was measured on all CD14 positive, CD14Bright and CD14Dim cells. TF expression was significantly lower in pregnant women than in non-pregnant control subjects, on all CD14 positive cells at 20 and 35 weeks, on CD14Bright cells at 12 and 35 weeks and on CD14Dim cells at 20 weeks. Additionally, we report that a higher percentage of CD14Dim than CD14Bright cells express TF. These results suggest that, in order to maintain homeostasis in haemostasis in an otherwise hypercoagulable state, monocyte TF expression is reduced during normal pregnancy.

Adult↗
PubMed2006

Anticoagulants in pregnancy.

UNLABELLED: Pregnancy is a hypercoagulable state that increases the risk of thromboembolic events. These risks may be further increased in the presence of an acquired or inherited thrombophilia. Thrombophilias have been associated with both maternal and fetal complications. The use of anticoagulants during pregnancy may reduce the risk of maternal thromboses as well as the risk of adverse pregnancy outcomes. The choice of an anticoagulant requires consideration of maternal risks, potential for teratogenicity, the underlying condition necessitating the treatment, and cost. This review examines the options for anticoagulation, the clinical situations that may warrant such treatment, and factors to be considered at delivery and during the postpartum period. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the roles of acquired and inherited thrombophilia in furthering the hypercoagulable state of pregnancy, identify the potential consequences of using anticoagulants during pregnancy, and summarize the treatment options when anticoagulation is required during pregnancy.

Adult↗
PubMed1994

Myocardial ischemia after orthotopic liver transplantation.

A hypercoagulable state exists after orthotopic liver transplantation. This hematologic abnormality may predispose patients to coronary thrombosis and unstable angina. The incidence of postoperative myocardial ischemia in such patients is unknown. Suitable electrocardiograms and clinical events of consecutive patients undergoing orthotopic liver transplantation (n = 45) and major intraabdominal surgery (n = 28) during a 3-month period at a major university teaching hospital and transplant center were examined retrospectively. Clinical myocardial ischemia or ischemic electrocardiographic changes, or both, occurred in 6 transplant patients compared with no patient in the nontransplant or comparison group. In 4 of the 6 patients with dramatic electrocardiographic changes and ischemic events, coronary arteriography failed to demonstrate significant obstructive disease. It is concluded that severe myocardial ischemia may occur in patients after orthotopic liver transplantation in the absence of significant coronary disease. A hypercoagulable state may predispose to coronary thrombosis in this setting, providing insight (and a future model for study) into the development of unstable angina.

Abdomen↗
PubMed1995

Evidence against hypercoagulability in coronary artery disease.

The strong epidemiological association between elevated plasma clotting factors and coronary artery disease is generally interpreted as evidence that patients with coronary atherosclerosis are in a procoagulant (hypercoagulable) state. A dynamic global test was used to assess the overall coagulation status of 761 patients with coronary artery disease scheduled for coronary artery bypass grafting and compared to healthy matched controls (n = 100). Platelet reactivity to shear-stress was simultaneously measured from identical, non-anticoagulated blood samples. Contrary to expectation, the overall coagulation in cardiac patients did not differ significantly from that of controls. Furthermore, the coagulation status of patients bore no relationship to the severity of coronary atherosclerosis. The latter is in contrast with platelet reactivities, which were significantly increased in patients with > or = 2 vessel disease as compared with single vessel disease. The present results do not necessarily conflict with the finding of elevated plasma clotting factors in cardiac patients. However, they do not support the claim that these markers are a reflection of a hypercoagulable state. Indeed, this study confirms that such patients are in a prothrombotic state, which is related to enhanced platelet reactivities, and not to a prothrombotic imbalance of the coagulation mechanism.

Blood Coagulation↗
PubMed1999

[Pulmonary thromboembolism angiographically confirmed: clinical and prognostic aspects].

OBJECTIVE: The aim of this study was to evaluate the clinical profile and prognosis of patients with an angiographically proven thromboembolism. METHODS: Data from 22 consecutive patients (13 males, 9 females; mean age 57.3 +/- 16.8 years) with pulmonary embolism confirmed by pulmonary angiography were reviewed. All our patients were previously submitted to non-invasive diagnostic procedures (blood examinations, EKG, chest x-ray, echocardiography). A V/Q scan was also performed in 5 patients. Fourteen patients were traditionally treated with heparin alone and the rest received thrombolytic therapy and heparin. Two patients had a thromboembolectomy. At discharge, all our patients were submitted to an oral anticoagulant therapy. The mean duration of the follow-up period was 26 +/- 12 months. RESULTS: The majority of the patients were in the 6th decade of life and it was possible to identify a hypercoagulable state in 82%. The most common symptom at the time of presentation was sudden chest pain (64%). The most specific sign in non-invasive procedures were right side cardiac dilatation seen echocardiographically (73%) and the mismatch in the V/Q scan (80%). The most common haemodynamic parameter (91%) observed in the right heart catheterization of these patients was the finding of a gradient between diastolic pulmonary artery and pulmonary capillary wedge pressures. Uneventful angiography was performed in all patients who showed massive pulmonary embolism (86%). Three patients (13.6%) died during the acute phase. At the end of the follow-up period, 10 patients were asymptomatic and 5 had heart failure. Four died, which corresponds to an overall mortality of 31.8% in 2.2 years of follow-up. None of the clinical or haemodynamic parameters analyzed (age, gender, arterial blood gases at presentation, hypercoagulable states, thrombolysis, pulmonary hypertension and extension of the embolism) were related to mortality. CONCLUSION: Angiographically confirmed pulmonary thromboembolism is still a poor outcome situation, even when a lot of diagnostic and therapeutic procedures are available.

Adult↗
PubMed2001

Coagulation system activity before coronary artery bypass surgery for unstable angina.

OBJECTIVE: To measure coagulation activity immediately prior to coronary artery bypass surgery. Previous reports have shown that a hypercoagulable state and reduced fibrinolytic activity increase the risk of postoperative graft failure. DESIGN: Fifty patients with unstable angina and ongoing low-molecular-weight heparin antithrombotic treatment for a median of 4 days and 25 stable patients undergoing elective surgery were included. RESULTS: Antithrombin levels were significantly lower whereas fibrinogen and plasminogen activator inhibitor-1 levels were higher in the unstable patients than in the stable patients. Median preoperative levels of thrombin-antithrombin complex (TAT), prothrombin fragment1+2 (F1+2), fibrin D-dimers and beta-thromboglobulin did not differ significantly in unstable and stable patients. There were signs of activated coagulation with elevated levels of TAT and F1+2 before the operation in half of the unstable patients, who had had chest pain at rest within 48 h preceding the operation and also in one-third of patients undergoing elective surgery. CONCLUSION: A hypercoagulable state may be present in unstable as well as in stable angina pectoris patients accepted for coronary artery bypass surgery.

Adult↗
PubMed2001

Hemostatic alterations in patients with benign and malignant colorectal disease during major abdominal surgery.

We determined sensitive markers of coagulation and fibrinolysis in plasma of 20 patients with malignant colorectal disease as compared to 17 patients with benign colorectal disease. Thrombin/antithrombin III complex (TAT), soluble fibrin (SF), total fibrinogen and fibrin degradation products (TDP), plasminogen activator inhibitor type-1 (PAI-1), urokinase-type plasminogen activator (uPA) and uPA receptor (uPAR) were measured preoperatively, starting anesthesia, during surgery and postoperatively. The purpose was to verify the supposed hypercoagulable state of cancer patients. In addition, we investigated whether the hemostatic alterations induced by general anesthesia and major abdominal surgery differed between the two groups. Patients with colorectal cancer showed initially an altered balance of hemostasis with a preponderance of procoagulant activity and fibrinolytic inhibition, as noted by marginally elevated TAT and PAI-1 plasma levels. The stimulus of anesthesia induction alone was sufficient to trigger not only activation of coagulation in these patients but also further activation of fibrinolysis and increased fibrinolytic inhibition. The marked activation of coagulation and fibrinolysis and enhanced fibrinolytic inhibition during surgery was more pronounced in patients with malignancy as compared to the control group. Postoperatively, a shift of the normal balance of hemostasis with a slight preponderance of fibrinolytic inhibition was observed, as evidenced by a marginally elevated PAI-1 plasma levels. The results of this study strengthen the hypothesis of a hypercoagulable state in patients with colorectal malignancy that may favor the development of thrombosis in this patient group.

Adult↗
PubMed1995

Massive ascitic fluid loss and coagulation disturbances after liver transplantation.

BACKGROUND & AIMS: A unique syndrome in which massive ascitic fluid loss developing 1-4 weeks after orthotopic liver transplantation (OLT) was associated with a hypercoagulable state and thrombotic complications is described. After OLT, severe coagulation abnormalities (international normalized ratio, 4.6) developed in a patient with ascitic losses of up to 12 L/day. The patient developed hypovolemia and severe systemic antithrombin III deficiency and venoocclusive disease in the graft. The aim of this study was to determine the prevalence of this syndrome after OLT. METHODS: Coagulation studies were performed in 25 additional patients with large ascitic fluid losses after OLT and in 7 cirrhotic patients not undergoing transplantation. RESULTS: All transplant recipients developed systemic deficiencies of multiple coagulation factors including antithrombin III. Markers of prothrombin activation were significantly elevated in both ascites and serum in all patients, and thrombotic complications subsequently developed in 5 patients. In the 7 cirrhotic patients, markers of prothrombin activation remained normal or minimally elevated and thrombotic complications were not found. CONCLUSIONS: Massive ascitic losses after OLT may lead to a hypercoagulable state from unreplaced losses of plasma coagulation factors into ascites and accumulation of thrombin in the systemic circulation. Hypovolemia and major coagulation abnormalities should be corrected with fresh frozen plasma, which may prevent the development of thrombotic complications.

Adult↗
PubMed1988

Fibrinopeptide A (FPA) levels in atrial fibrillation and the effects of heparin administration.

It has been reported that a patient with atrial fibrillation (AF) is in the hypercoagulable state and that this state results in a high incidence of systemic thromboembolisms. In this paper, we have investigated plasma fibrinopeptide A (FPA) levels and the effects of subcutaneous administration of heparin on these levels in patients with AF. Forty-five patients with hypertension (HT) or mitral stenosis (MS) were classified into four groups according to whether they had AF complications; i.e. HT with normal sinus rhythm (NSR), HT with AF, MS with NSR and MS with AF. Patients with AF demonstrated significantly higher plasma FPA levels and lower plasma antithrombin III (AT III) activities than those with NSR. When low dose heparin was administered to patients with AF, plasma FPA levels were decreased to the near normal range, accompanied by an increase in heparin-AT III complex activity and heparin concentration 0.5-1.0 h after injection. These levels were maintained for 5 h. From these results it was concluded that patients with AF were in the hypercoagulable state and that the measurement of plasma FPA levels provided a possibility to detect the underlying activation of blood coagulation.

Atrial Fibrillation↗