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PubMed2004

Effectiveness of microporous polysaccharide hemospheres for achieving hemostasis in mohs micrographic surgery.

BACKGROUND: Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. OBJECTIVE: The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. METHODS: Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). RESULTS: Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). CONCLUSION: The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal.

Aged↗
PubMed1987

Vasopressin analogues. Their role in disorders of hemostasis.

At this time, when the acquired immunodeficiency syndrome, hepatitis, and other blood-borne diseases threaten patients, with bleeding disorders, who need treatment with blood products, it is rewarding to realize that a number of them can be safely and effectively treated through the stimulation of their own VIII:C and vWF production with desmopressin. Desmopressin is clinically useful for treatment of patients with moderate and mild hemophilia. The limits of the clinical indications are the nature of the bleeding episode, the resting factor level, the level that must be achieved, and the length of time the level must be maintained to manage any given bleeding episode. Desmopressin can be used more extensively to raise VIII:C in von Willebrand's disease, than in classic hemophilia, because fewer of the patients have the severe form of the disease that is unresponsive to desmopressin. VIII:C increases to about four times the resting values that can be expected in both hemophilia and von Willebrand's disease, but it must be kept in mind that the range of individual responses is large. Even though it is not easy to correct the prolonged bleeding time, particularly in patients with dysfunctional vWF, this drawback is of clinical importance for only a minority of cases. Use of desmopressin in acquired diseases of primary hemostasis has been proposed more recently, and our experience is more limited than for congenital bleeding disorders. Uremia is probably the most firmly established indication, because the bleeding time is often dramatically shortened by desmopressin, and hemorrhages can be stopped or prevented. The indications for the compound in liver cirrhosis and congenital and acquired platelet dysfunctions are promising but much less well-established. The mechanism of action of desmopressin is not well-known, and more work must be done to fill this important gap. This problem is not only of theoretical importance, because understanding of the mechanism of action of the compound should open up new perspectives into understanding the physiological mechanisms that regulate hemostasis. Many unclarified aspects of the mechanism of desmopressin action might be elucidated by using specific antagonists and also by using appropriate animal models. (Dogs and primates respond partially to desmopressin, but rats and rabbits do not respond at all).(ABSTRACT TRUNCATED AT 400 WORDS)

Deamino Arginine Vasopressin↗
PubMed2006

Stability of stored canine plasma for hemostasis testing.

BACKGROUND: A review of the literature revealed limited information about the stability of samples for coagulation testing in dogs. OBJECTIVE: The aim of this study was to evaluate the stability of individual coagulation factors, clotting times, and other parameters of hemostasis in stored canine plasma. METHODS: Citrated plasma samples were obtained from 21 dogs. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen concentration, and factor I, II, V, VII, VIII, IX, X, XI, and XII activities were measured on an automated coagulation analyzer with commercially available reagents. Antithrombin (AT) activity and D-dimer concentration were measured on an automated chemistry analyzer using validated kits. Samples were analyzed within 1 hour after collection (initial analysis) and once daily for 2 or 4 consecutive days following storage at room temperature (RT) or 4 degrees C, respectively. RESULTS: Storage time at either temperature did not have any effect on PT, factor II, V, VII, X, or XII activities, D-dimer concentration, or AT activity. In contrast, aPTT was significantly prolonged after 72 and 96 hours at 4 degrees C; fibrinogen concentration was decreased after 48 hours at RT; the activities of factors VIII and IX were decreased after 48, 72, and 96 hours at 4 degrees C; and factor XI activity was decreased after 72 hours at 4 degrees C. CONCLUSIONS: Results suggest that storage of canine plasma for 2 days at RT does not have a significant effect on hemostasis test results with the exception of a slight decrease in fibrinogen concentration. In contrast, aPTT and factors VIII, IX, and XI were unstable in refrigerated plasma after 48 or 72 hours of storage.

Animals↗
PubMed1990

Hemostatic protein-polymer sheath: new method to enhance hemostasis at percutaneous biopsy.

Serious hemorrhagic complications have been reported with percutaneous biopsy, albeit infrequently. A hemostatic protein-polymer sheath (PPS) designed to limit the risk of bleeding was evaluated by performing liver biopsies on pigs given anticoagulants. After administration of anesthesia and laparotomy, biopsies were performed under direct vision with a cutting biopsy needle (a) alone, (b) fitted with the PPS, or (c) fitted with a thrombin-coated PPS. Dry sponges were applied and subsequently weighted to quantitate blood loss. At all levels of anticoagulation, use of the PPS enhanced hemostasis; the thrombin coating supplemented effectiveness. The PPS appears to be a simple and effective method of achieving hemostasis at high-risk percutaneous biopsy.

Animals↗
PubMed2004

The Band Electrode: ongoing experience with a novel TURP loop to improve hemostasis in 265 patients.

INTRODUCTION: Intraoperative bleeding, one of the major complications of conventional transurethral resection of the prostate (TURP), has led to a search for various alternative methods of tissue ablation in patients with benign prostatic hyperplasia. In 1996, we introduced the newly designed Band Electrode, which combines a high degree of resection efficiency with a better hemostasis. MATERIAL AND METHODS: 265 consecutive patients with prostatism underwent TURP with the Band Electrode. This modified loop electrode does not consist of a thin wire but is rather a flat metal band with a width of 1.2 mm. International prostate symptom score (IPSS), Life Quality Index (L), peak urine flow and postvoid residual urine were evaluated pre- and postoperatively. Additionally, electrical parameters have been recorded with a specially designed high-frequency generator. RESULTS: Median IPSS decreased from 23 preoperatively to 8 and 9 at 12 (n = 194) and 24 months (n = 172), respectively (p < 0.001). Life Quality Index (L) dropped from 4 to 2 and 2, respectively (p < 0.001). Peak urine flow increased from 8.2 ml/s to 18.2 (at postoperative day 3), 17.8 and 17.4 ml/s, respectively (p < 0.001). Median postvoid residual urine decreased from 77 to 15, 22 and 21 ml, respectively (p < 0.001). Resected tissue mass averaged 25 (8-102) g, resection time was 36.5 (18-82) min. Indwelling catheters were removed 32 (24-72) h postoperatively. None of the patients required blood transfusions or showed signs of a TUR syndrome. Despite a 1.3 times higher power need, the total energy application in vivo was comparable to conventional TURP. CONCLUSIONS: This simple exchange of active electrodes leads to a superior hemostasis and thus safety in TURP. Resection speed, tissue ablation and total energy need remain identical.

Aged↗
PubMed2005

Prostate fossa packing: a simple, quick and effective method of achieving hemostasis in suprapubic prostatectomy.

INTRODUCTION: Suprapubic prostatectomy remains a very common surgical treatment for bladder outlet obstruction from an enlarged prostate in the developing world. It is a technically simple procedure which can be learned by nonurologists who perform the bulk of these procedures in the developing world. Intraoperative and postoperative bleeding, however, can be a problem. We describe our experience with prostatic fossa packing at the time of the procedure, as a very simple, quick and effective technique for maximal hemostasis. MATERIAL AND METHODS: We have used this technique for several years at our institution and the results have been excellent. However, the major advantages of this technique became highlighted when the primary author visited Eritrea on a medical mission trip and used it in 42 consecutive cases. We looked at the hemorrhagic complications, both intraoperatively and postoperatively, infections and other complications related to the technique. RESULTS: The 42 patients were typical of the patients that are seen in the developing world for suprapubic prostatectomy. The age range was 49-102 years. 75% had indwelling urethral catheters secondary to urinary retention. The duration of the catheters was from 2 weeks to 10 months. All the patients who had the indwelling catheters had bacteriuria. 56% had associated bladder calculi and 25% had associated inguinal hernias. The average surgical time was 45 min. The average intraoperative blood loss was estimated at 160 ml. There were no blood transfusions. There were no infections and there were no complications related to the packing. CONCLUSION: Packing of the prostatic fossa at the time of enucleation of the adenoma is a very simple, quick and effective way to achieve hemostasis in suprapubic prostatectomy. It is also very easy to learn. With this technique we have achieved zero rate of transfusion and no infections. The surgical time is also reduced. We have had no morbidities associated with this technique and highly recommend it.

Aged↗
PubMed2006

Thrombin generation by activated factor VII on platelet activated by different agonists. Extending the cell-based model of hemostasis.

BACKGROUND: Platelet activation is crucial in normal hemostasis. Using a clotting system free of external tissue factor, we investigated whether activated Factor VII in combination with platelet agonists increased thrombin generation (TG) in vitro. METHODS AND RESULTS: TG was quantified by time parameters: lag time (LT) and time to peak (TTP), and by amount of TG: peak of TG (PTG) and area under thrombin formation curve after 35 minutes (AUC-->35min) in plasma from 29 healthy volunteers using the calibrated automated thrombography (CAT) technique. TG parameters were measured at basal conditions and after platelet stimulation by sodium arachidonate (AA), ADP, and collagen (Col). In addition, the effects of recombinant activated FVII (rFVIIa) alone or combined with the other platelet agonists on TG parameters were investigated. We found that LT and TTP were significantly decreased (p < 0.05) and PTG and AUC-->35min were significantly increased (p < 0.05) in platelet rich plasma activated with AA, ADP, Col, and rFVIIa compared to non-activated platelet rich plasma from normal subjects (p = 0.01). Furthermore platelet rich plasma activated by the combined effects of rFVIIa plus AA, ADP or Col had significantly reduced LT and TTP and increased AUC-->35min (but not PTG) when compared to platelet rich plasma activated with agonists in the absence of rFVIIa. CONCLUSION: Platelets activated by AA, ADP, Col or rFVIIa triggered TG. This effect was increased by combining rFVIIa with other agonists. Our intrinsic coagulation system produced a burst in TG independent of external tissue factor activity an apparent hemostatic effect with little thrombotic capacity. Thus we suggest a modification in the cell-based model of hemostasis.

Journal Article↗
PubMed2001

Platelet adhesion receptors and their participation in hemostasis and thrombosis.

Circulating blood platelets survey the integrity of the vascular wall and respond after tissue trauma to control hemorrhage. During the initial response to vascular injury platelets adhere to injured surfaces and aggregate to form a platelet plug or thrombi. However, the complete arrest of hemorrhage depends not only upon platelets but other factors, as well, collectively referred to as hemostasis. For normal hemostasis to occur platelets along with the blood coagulation cascade act cooperatively to arrest blood flow. Nevertheless, platelets within the blood clot are of paramount importance as evidenced by the critical bleeding occurring with a reduced platelet count, a condition referred to as thrombocytopenia. Moreover, the same processes occurring under normal circumstances to prevent hemorrhage may also interfere with blood flow in atherosclerotic arteries and cause life-threatening situations, such as myocardial infarction, the leading cause of death in developed countries. Thus, normal platelet function involves maintaining a balance between preventing excessive blood loss and allowing essential blood flow to critical tissues and organs. (c) 2001 Prous Science. All rights reserved.

Journal Article↗
PubMed1999

[The bleeding ulcer of the duodenum: the procedure in unreliable hemostasis].

The treatment of patients with bleeding duodenal ulcers is still one of the most complicated and discussable problems in surgery. The aim of this study was an attempt to predict the relapse of bleeding from ulcer of the duodenum on the basis of the experience in the treatment of 539 patients with this disease, 101 of whom underwent surgery. Diagnostic criteria for prognosis of repeated bleeding have been developed and the role of each of them in reliability of hemostasis in ecores was determined. It was established that indication for urgent operations for unreliable hemostasis is determined by the sum of 11 scores and more, as probability of bleeding recurrence in this situation in 90.2%.

Adult↗
PubMed1975

[Study of several parameters of hemostasis in Masugi's rabbit nephritis].

During experimental Masugi nephritis in the rabbit, were demonstrated various disturbances in hemostasis: a) during the initial stage: immediate, severe and transient fall in the platelet count without any change in Factor V;b)during the secondary stage, from the 7th to the 8th day onwards, increase in platelets and fibrinogen, in relation with the intensity of the nephrotic syndrome; c) in parallel, appearance of urinary fibrinogen split products in relation to the intensity of the glomerular lesions, evidence for the presence of intraglomerular fibrin. These facts confirm the role played by platelets in coagulation phenomena secondary to the immune reaction. They indicate, furthermore, the existence of hemostasis disorders during the nephrotic syndrome.

Animals↗
PubMedDate not supplied

[Hemostasis disorders in cancer patients with massive intraoperative blood loss].

The hemostasis system was examined before, during, and after surgery in 130 patients with blood loss from 50 to more than 200% total circulatory volume. Blood loss caused deep changes in the hemostasis system, presenting as acute and subacute syndrome of different hypocoagulation degree in parallel with fibrinolysis activation of different intensity, or as hemodilution coagulopathy, or combination of both. Laboratory signs of acute DIC syndrome anticipate its clinical manifestation, which allows rapid correction of the detected disorders and prevention of severe hemorrhages. A complex of methods for rapid diagnosis of coagulopathic hemorrhages is developed. Various approaches to the treatment of DIC syndrome during and after surgery were used in patients with massive blood loss.

Antifibrinolytic Agents↗
PubMedDate not supplied

[Effect of ethyl alcohol on selected parameters of the hemostasis system in vitro].

Alcohol produces several disorders in all components of hemostasis system. However, its mechanism of action is not clear. Therefore, an effect of ethyl alcohol on the selected parameters of both platelet and plasma hemostasis has been examined in vitro. Blood aggregation induced by ADP and PAF and platelet-leucocytic aggregates have been determined in vitro in the group of 45 healthy volunteers. Out of plasma parameters the selected factors of blood coagulation and fibrinolysis have been examined. Results suggest that the examined concentrations of ethyl alcohol mainly affect platelet function decreasing platelet aggregation. Alcohol does not affect significantly blood coagulation and fibrinolysis occurring in vitro.

Adult↗
PubMed2005

[Hemostasis and lipid peroxidation in the therapy of brain concussion at exacerbation].

130 patients with brain concussion (BC) and 30 virtually healthy subjects, aged 16 to 50, were examined for the purpose of studying the influence exerted by different drugs affecting blood coagulation, fibrinolysis, lipid peroxidation (LPO) and antioxidant protection at exacerbation. Changes of hemostasis in BC were shown to be of the adaptation nature and to depend essentially on a conducted treatment. Normalized plasma components in the hemostasis system were registered in groups receiving cavinton. The drug, when used, reduced the LPO intensity and intensified the activity of dismutase superoxide on days 9-12 after trauma.

Adolescent↗
PubMed2005

[Research of the hemostasis effect of chitosan acetic acid solution].

The effect of chitosan with different molecular weight and deacetylation degree on blood hemostasis was tested. The experiments found evident alteration of red blood cell morphology and unusual coagglutination between erythrocytes in the anticoagulant blood which was treated by chitosan acetic acid solution. The red blood cells clot formation experiments showed that chitosan with low deacetylation degree (60%-70%) caused more red blood cells to assemble when compared versus chitosan with other deacetylation degrees. The effect of molecular weight between 10(5)-10(6) was not obvious. The thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and concentration of fibrinogen (FIB) of blood treated by chitosan acetic acid solution were measured. The results proved that the hemostasis property of chitosan acetic acid solution was independent of the platelets and the normal "Cascade-like" coagulation pathway.

Acetic Acid↗
PubMed2005

[The condition of vascular-thrombocyte hemostasis in the elderly with arterial hypertension].

The aim of the study was to analyze the main parameters of vascular-thrombocyte hemostasis in patients with systolo-diastolic and isolated systolic arterial hypertension (SDAH and ISAH) aged over 65 years. The subjects were 201 elderly patients with AH. The study revealed that uncomplicated AH in the elderly was characterized by activation of vascular hemostasis and increase of thrombocyte aggregation ability, manifested by the increase of Willebrand factor level, the presence of spontaneous and irreversible aggregation, coincidence of the first and the second waves of aggregation, and intensification of aggregation in response to "moderate" and "strong" inductors. Unlike ISAH, uncomplicated SDAH in the elderly is characterized by noticeable prevalence of night-peakers in the day profile of arterial pressure, and is accompanied by more pronounced thrombocyte hyperfunction; this difference should be taken into account while administering disaggregation therapy.

Aged↗
PubMed2006

[Temporary hemostasis in the injuries of great vessels of different location].

Temporary hemostasis is one of the main points in emergency surgery of patients with trauma of major vessels. Folley catheters were used for temporary hemostasis in bleedings from stab-cut wounds with a narrow wound canal. The method of temporary clamping of the abdominal aorta above the visceral branches during profuse abdominal bleedings of unknown etiology is described in detail.

Adult↗
PubMed2006

[A case of esophageal arterial bleeding in which transcatheter arterial embolization was useful for hemostasis].

We report a case of hemostatic treatment by transcatheter arterial embolization (TAE) of the left gastric artery and a branch of the left bronchial artery for oozing hemorrhage in the lower esophagus, because of incomplete endoscopic hemostasis. A 52-year-old woman with systemic lupus erythematosus was previously admitted three times to our hospital for endoscopic treatment of hemorrhage in the lower esophageal lesions. The procedure of TAE for esophageal hemorrhage seems to be a useful treatment for cases of incomplete endoscopic hemostasis.

Arteries↗
PubMed1990

[Multivariate analysis for the understanding of typical diabetic hemostasis criteria. 3. Determination of a typical retinopathy parameter-constellation].

Features of metabolism and haemostasis which are different in diabetics of both types in comparison with normal subjects were covered by the statistical method of multivariance analysis depending on the severity of diabetic retinopathy. In 29 diabetics without retinopathy, 46 patients with stage I or II, and 36 patients with stage III the following parameters could be found as optimal criteria for characterizing the extent of vascular changes: blood sugar concentration, concentration of sialic acid and HDL cholesterol in the serum, serum protein, sialic acid per protein volume, total cholesterol in the serum and capillary fragility and number of large spreading forms of platelets features of hemostasis. Thus, diabetic retinopathy is characterized by a wide spectrum of different features containing the parameters of hemostasis. Thrombocytic vascular interactions are characterized by platelet spreading and capillary fragility which are significant for the development of diabetic retinopathy.

Biomarkers↗