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PubMed1996

[Disorders of anticoagulation and fibrinolysis in monoclonal gammopathies--another mechanism of paraprotein interference with hemostasis].

We have investigated the possible interaction of paraprotein (pp) with anticoagulation mechanisms and fibrinolysis. Eighty four patients with monoclonal gammapathy (MG) were included to the study, 59 of them with multiple myeloma (MM). In 48.8% cases some defect was found. Decreased levels of antithrombin III (AT III) was observed in 13.3%, protein C (PC) in 18.3% and protein S (PS) in 13.5% of patients. Distribution between the free and the bound PS fraction remained normal. The most frequent abnormality found was the reduction of plasminogen (PLG) activity, which was observed in 35.1% and elevated levels of plasminogen activator inhibitor, detected in 42.3% of cases, respectively. Decreased plasminogen activator activity was observed in only one patient. The relationship between isotype and concentration of paraprotein and frequency of factor levels abnormalities was not found. The incidence of arterial and/or venous thrombosis was higher in patients with laboratory defect in comparison with the unaffected, however, the difference was not statistically significant. In contrast, the incidence of hemorrhagic complications was significantly lower in these patients (p < 0.01), although in most of them simultaneous defect of plasmatic coagulation and/or platelet functions was detected. We suggest, the interaction with both hemostatic and anticoagulation systems could result to "elimination" of inauspicious effect of pp on hemostasis. The impairment of anticoagulation systems and fibrinolysis is another type of paraprotein interference with hemostasis. It is also considered to be another pathogenetic mechanism of secondary deficiency of AT III, PC, PS and PLG.

Adult↗
PubMed2004

Hemostasis in liver resection surgery.

Although patients with liver tumors are considered as challenging by hepatic surgeons, advances in liver resection procedures mean that virtually no liver tumor should be considered as unresectable. Newer techniques, such as in situ hypothermic perfusion, the "ante situm technique," and ex vivo liver resection have been recently introduced. The aim of these techniques is to provide a bloodless field and a prolonged and more precise dissection. The use of recombinant factor VIIa (rFVIIa), a hemostatic agent previously developed for bleed management in patients with hemophilia and inhibitors, has recently been investigated as a means of reducing red blood cell transfusion requirements during major liver surgery. This paper reviews details of this clinical trial, as well as current and future methods to manage hemostasis during liver resection surgery.

Blood Loss, Surgical↗
PubMed2002

[Endoscopic hemostasis in the treatment of bleeding peptic ulcer].

Upper gastrointestinal bleeding is still an important clinical problem, even though about 80% of bleedings due to peptic lesions stop spontaneously. Starting from 1970, a lot of endoscopic hemostatic procedures has been developed and employed with good results, but, at present, the key problem is represented by the selection and management of the patients at highest risk of rebleeding. This work reviews both techniques and devices most commonly used, but at present none of them can be considered actually better than the other ones. According to the SIED (Società Italiana di Endoscopia Digestiva) guidelines, the techniques of choice should be cheap, effective, safe and easy to perform, the pivotal role in determining the success rate of endoscopic hemostasis being played by the endoscopist's experience.

Animals↗
PubMed2004

Effect of preoperative administration of tepoxalin on hemostasis and hepatic and renal function in dogs.

Preemptive analgesia is an important part of surgical management, but some NSAIDs can adversely affect platelet function or renal or hepatic status. Tepoxalin is approved in the United States for control of pain and inflammation associated with arthritis and in Europe for relief of pain caused by musculoskeletal disorders. In this study, no significant effects on indices of hemostasis or renal or hepatic function were detected when a single preoperative oral dose of tepoxalin was administered to young healthy dogs undergoing anesthesia and surgery.

Analgesia↗
PubMed1995

Hemostasis for dental surgery.

Uncontrolled hemorrhage following dental surgery is one of the most serious emergency situations dentists may encounter. Uncontrolled hemorrhage following a surgical procedure requires prompt and appropriate action, or significant morbidity or mortality can result. Through a thorough understanding of hemostasis, the causes of uncontrolled bleeding and the means to control hemorrhage, risks can be minimized and morbidity averted. All dentists performing dental surgery should be well versed in the management of bleeding emergencies.

Blood Coagulation Disorders↗
PubMed1994

Hints for hemostasis.

As dermatologists perform more complex and extensive surgical procedures, persistent bleeding and hematoma formation may be encountered more frequently. Several hints for hemostasis are presented that will help dermatologists prevent uncontrolled hemorrhage and manage bleeding complications. Employing these techniques will ease patient and surgeon anxiety and help avoid unwanted surgical complications.

Aspirin↗
PubMed1994

[Hemostasis disorders and their correction in the early postoperative period in patients with pulmonary diseases].

Hemostatic changes were studied in 67 phthisiosurgical patients 2-3 days prior to surgery and in the early postoperative period. It has been found that blood coagulative disorders following lung surgeries with a small volume of blood loss require no special corrective measures. After massive blood loss there are pathological changes requiring correction of coagulation factor deficit. The policy of transfusion support which is based on substitution of blood loss with donor blood by 35-50% and blood-substituent solutions which exceed its volume by 1.7-2.8 times ensures the optimal maintenance of hemostasis with small and moderate intraoperative blood loss. Patients with massive blood loss develop hemostatic changes requiring replacement therapy to compensate losses of the coagulation factor.

Blood Coagulation Disorders↗
PubMedDate not supplied

Individual strategies of hemostasis for thoracic aortic surgery.

The problem of altered hemostasis remains a major challenge during thoracic aortic surgery. Bleeding is associated with a marked increase in morbidity and mortality. The hemostatic derangements are caused by multiple interrelated factors including interference with the vascular integrity, extensive surgical dissection, transient need for complete inhibition of the normal coagulation process, large blood products and fluid requirements, hemodilution, hypothermia, extensive ischemia and reperfusion, activation of systemic inflammatory responses, interference with fibrinolysis, and the use of extracorporeal circulation systems. Acquired coagulopathy must be specifically diagnosed and treated. Platelet deficiencies, both qualitative and quantitative, are the most predictable and consistent disturbance in the hemostatic function and the most common cause of intraoperative and postoperative bleeding. Precise surgical technique is essential to prevent blood loss. Topical agents should not be used for and cannot correct imperfections in surgical technique. Nonspecific measurements that are useful to decrease intraoperative blood loss include strict control of blood pressure and hemodynamic status, the induction of mild controlled hypotension, and the reversal of hypothermia. Rewarming may produce clear procoagulant effects by improving the efficacy of platelets and clotting factors. Platelet dysfunction can be reduced by several pharmacological interventions including acid aminocaproic, desmopressin and aprotinin; however, efficacy and safety are still being established. The most important factorS regarding safety in thoracic aortic surgery are a secure suture line and the experience of the surgical and anesthesiology teams.

Aortic Dissection↗
PubMed1981

Comparative effects of aspirin and acetaminophen on hemostasis.

The influences of aspirin and of acetaminophen on hemostasis were studied in normal healthy volunteers and in patients with either severe hemophilia A or hemophilia B. Acetaminophen did not alter the template bleeding time or the results of tests of platelet function in either group. Aspirin did prolong the template bleeding time and impaired platelet aggregation; these changes were most pronounced in patients with either form of hemophilia, and some (7/19) required plasma component therapy. Neither drug influenced the coagulation proteins or the fibrinolytic mechanism, as measured. The influences of a single dose (ranging from 975 to 1,950 mg) of acetaminophen and of a single dose (ranging from 325 to 2,925 mg) of aspirin were similar to those observed in persons receiving multiple doses. Acetaminophen is preferred in patients in whom a hemostatic influence is undesirable. However, either aspirin or acetaminophen can be used in normal healthy subjects.

Acetaminophen↗
PubMed1975

Prednisone-induced hemostasis in a platelet function abnormality.

A 6-year old girl had chronic thrombocytopenia and substantial platelet function abnormality associated with detectable IgM antiplatelet antibody. Treatment with prednisone was followed by an improvement in bleeding time, although in vitro platelet function deteriorated. This observation suggests an effect of prednisone on hemostasis that is independent of platelet function. Further trials of prednisone in patients with similar platelet function abnormalities who have a substantial bleeding tendency would appear indicated.

Adenosine Diphosphate↗
PubMed1993

Adventures in hemostasis. Desmopressin in cardiac surgery.

Desmopressin acetate (1-deamino-8-D-arginine vasopressin [DDAVP]) improves hemostasis in hemophilia A and von Willebrand's disease and in some platelet disorders. In complex cardiac operations, excluding simple coronary artery bypass graft procedures, we found that desmopressin reduced blood loss by 40% and the need for transfusion by 34%. Conflicting reports followed. Future trials should emphasize patients with excessive bleeding. A possible post-desmopressin prothrombotic state was studied after hip replacement surgery. The incidence of deep vein thrombosis associated with warfarin sodium therapy was the same as that associated with desmopressin plus warfarin therapy. No desmopressin-induced thrombotic tendency was detected. A trend toward reduced blood loss with desmopressin was not significant. During cardiac catheterization, the plasma von Willebrand factor level was correlated with hemodynamic variables, including pulmonary vascular resistance, pulmonary arterial pressure, and (inversely) with cardiac index. von Willebrand factor concentration was highest in mitral stenosis. The relationship of these factors to the response to desmopressin remains to be defined.

Aged↗
PubMed2003

Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis and of the Japanese Ministry of Health and Welfare for overt DIC.

We compared the criteria set by the International Society of Thrombosis and Hemostasis (ISTH) for the diagnosis of disseminated intravascular coagulation (DIC) with the criteria of the Japanese Ministry of Health and Welfare (JMHW) set for the diagnosis of overt DIC. We studied 1,284 Japanese patients with DIC. The rate of agreement in the diagnosis of DIC by the two diagnostic systems was 67.4%. In addition, only 2.0% of non-DIC patients by JMHW criteria were diagnosed with overt DIC by ISTH criteria, suggesting that ISTH for overt DIC includes typical cases of DIC. The concordance of diagnosis for DIC by ISTH and JMHW was significantly high in patients with trauma or acute promyelocytic leukemia. About 70% of DIC or overt DIC patients had more than 1 point in the scoring system for prothrombin time, but >50% of those patients had 0 point for plasma fibrinogen level. Abnormal fibrin and fibrinogen degradation product (FDP) levels and platelet counts were observed in >88% of DIC and overt DIC patients but were observed in >50% of non-DIC patients, indicating that these parameters are sensitive markers but not specific markers for the diagnosis of DIC. Considered together, our results suggest that the diagnostic criteria for DIC and overt DIC could be improved by changing the cut-off values of the global coagulation tests.

Blood Coagulation Tests↗
PubMed1990

Hemostasis in malignancy.

Hemostatic abnormalities are present in a majority of patients with metastatic cancer. These abnormalities can be categorized as 1) increased platelet aggregation and activation, 2) abnormal activation of coagulation cascade, 3) release of plasminogen activator, and 4) decreased hepatic synthesis of anticoagulant proteins like Protein C and antithrombin III. The abnormal activation of coagulation cascade is mediated through release of Tissue Factor, Factor X activators, and other miscellaneous procoagulants from the plasma membrane vesicles of tumor cells. Macrophages of a tumor-bearing host also produce increased amounts of Tissue Factor. Production of Factor X activators and macrophage Tissue Factor is decreased by warfarin. The ability of the tumor cells to produce platelet-aggregating activity and plasminogen activator parallels their metastatic potential in animal and experimental systems. These studies also show that antiplatelet agents and antibodies against plasminogen activator can suppress the metastatic process. One or more laboratory abnormalities of hemostasis can be shown in up to 95% of patients with metastatic cancer. These abnormalities, however, are unable to predict subsequent development of thromboembolic or hemorrhagic complications. Clinical complications occur in 9-15% of the patients in the form of thrombotic or hemorrhagic disorders. The therapy of tumor-related coagulopathy should be guided by its clinical expression. Subclinical DIC should not be treated. Coumadin is generally ineffective for therapy of thrombosis in cancer patients. There is no consensus regarding the use of heparin in acute promyelocytic leukemia (APL). The defibrination in APL may be from disseminated intravascular coagulation as well as systemic fibrinolysis, as shown by decreased alpha 2 antiplasmin levels. In such cases, epsilon aminocaproic acid plus heparin therapy may be of benefit.

Antithrombin III↗
PubMed1996

Evaluating systemic lupus erythematosus disease activity using molecular markers of hemostasis.

OBJECTIVE: To determine the usefulness of measuring sensitive markers of the coagulation-fibrinolysis system (i.e., thrombin-antithrombin III complex [TAT], D dimer fragments [DD], and plasmin-alpha2-plasmin inhibitor complex [PIC]) for evaluating disease activity in patients with systemic lupus erythematosus (SLE). METHODS: We studied 57 SLE patients. Plasma concentrations of DD were measured by latex agglutination using monoclonal antibodies; TAT and PIC were determined by sandwich enzyme-linked immunosorbent assay. Disease activity was determined by using the SLE Disease Activity Index (SLEDAI). RESULTS: Levels of TAT, DD, and PIC were higher in SLE patients than in healthy controls (P<0.05). Levels of TAT and DD showed good correlations with SLEDAI scores (for TAT r=0.66, P<0.001; for DD r=0.50, P<0.001). Elevated levels of TAT, DD, and PIC were decreased following treatment. CONCLUSION: These results strongly suggest that measurement of molecular markers of hemostasis is useful for evaluating disease activity in patients with SLE.

Adult↗
PubMed1993

Disordered hemostasis in extrahepatic portal hypertension.

To assess the contribution of naturally occurring portal-systemic shunts to the coagulopathy of patients with liver disease, we studied laboratory parameters of hemostasis in 20 adult patients with extrahepatic portal hypertension, secondary to portal vein thrombosis, that had resulted in variceal bleeding. All extrahepatic portal hypertension patients had normal liver function and histological appearance. None had any evidence of preexisting coagulation disorders, and none had bled or undergone sclerotherapy in the 6 mo before study. Age- and gender-matched groups of 20 healthy individuals and 20 stable patients with cirrhosis and portal hypertension who had a history of variceal bleeding served as controls. Both patient groups had thrombocytopenia consistent with hypersplenism and portal hypertension. Prothrombin international normalized ratio (extrahepatic portal hypertension, 1.3 +/- 0.12; cirrhosis, 1.7 +/- 0.2; control, 1.02 +/- 0.06; p < 0.05) and partial thromboplastin time ratios (extrahepatic portal hypertension, 1.12 +/- 0.1; cirrhosis, 1.26 +/- 0.2; controls, 1.01 +/- 0.03; p < 0.05) were significantly prolonged in both patient groups. Extrahepatic portal hypertension and cirrhotic patient groups had significantly increased levels of serum total fibrin(ogen)-related antigen (extrahepatic portal hypertension, 818 +/- 150 ng/ml; cirrhosis, 454 +/- 52 ng/ml; controls, 124 +/- 7.3 ng/ml; p < 0.05), fibrin monomer (extrahepatic portal hypertension, 168.8 +/- 16.9 ng/ml; cirrhosis, 115.6 +/- 11.1 ng/ml; controls, 19.7 +/- 0.4 ng/ml; p < 0.05) and D-dimer (extrahepatic portal hypertension, 118 +/- 9.6 ng/ml; cirrhosis, 129 +/- 10 ng/ml; controls, 53.2 +/- 1.6 ng/ml; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management.

Normal coagulation has classically been conceptualized as a Y-shaped pathway, with distinct "intrinsic" and "extrinsic" components initiated by factor XII or factor VIIa/tissue factor, respectively, and converging in a "common" pathway at the level of the FXa/FVa (prothrombinase) complex. Until recently, the lack of an established alternative concept of hemostasis has meant that most physicians view the "cascade" as a model of physiology. This view has been reinforced by the fact that screening coagulation tests (APTT, prothrombin time--INR) are often used as though they are generally predictive of clinical bleeding. The shortcomings of this older model of normal coagulation are nowhere more apparent than in its clinical application to the complex coagulation disorders of acute and chronic liver disease. In this condition, the clotting cascade is heavily influenced by numerous currents and counter-currents resulting in a mixture of pro- and anticoagulant forces that are themselves further subject to change with altered physiological stress such as super-imposed infection or renal failure. This report represents a summary of a recent multidisciplinary symposium held in Charlottesville, VA. We present an overview of the coagulation system in liver disease with emphasis on the limitations of the current clinical paradigm and the need for a critical re-evaluation of the current tenets governing clinical practice. With the realization that there is often limited or conflicting data, we have attempted to represent diverse opinion and experience from the perspectives of both hepatology and hematology beginning with a brief update on the physiology of normal coagulation.

Blood Coagulation Disorders↗
PubMed1984

Effect of hydroxyethyl starch and dextran on plasma volume and blood hemostasis and coagulation.

Six healthy male subjects were given in a crossover fashion medium molecular weight (HES 125) and low molecular weight (HES 40) hydroxyethyl starch, dextran, and balanced salt solution by intravenous infusion. The plasma volumes were determined using labeled albumin and plasma protein measurements. Three properties of factor VIII protein complex and indices of blood coagulation and hemostasis were measured before and after the infusions. Both the salt solution and HES 40 increased plasma volume, but their effect wore off within 3 hours. Dextran and HES 125 increased plasma volume significantly (P less than 0.001) more than the salt solution did, and the expansion was maintained for 24 hours. Plasma volume increases (dextran and HES 125) were associated with high nonglucose carbohydrate levels in plasma and low levels in urine. No or slight increases in plasma volumes (HES 40), on the other hand, were associated with low and high carbohydrate levels in plasma and urine, respectively. Serum alpha-amylase activity increased significantly after both HES preparations as compared to salt solution. Dextran and HES 125 decreased all the three values of factor VIII, these decreases being maximal 3 to 6 hours after administration and highest (about 25 per cent) for F VIII R:Ag and F VIII R:cof. It is concluded that HES 125 and dextran are equally effective plasma expanders.

Adult↗
PubMed1997

A hemophilia model in zebrafish: analysis of hemostasis.

We have developed artificial hemophilia in zebrafish by treating them with copper and measured their clotting function by a newly developed sensitive clotting time assay. The clotting function can be detected rapidly and reliably in 30 hr larvae and in adult fish by measuring the blood clotting time. We have used this assay to screen wild type zebrafish and identified fish with prolonged clotting time. This verifies the usefulness of this assay in future screening for recessive hemostasis defects generated by chemical and radiation mutagenesis methods.

Animals↗