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PubMedDate not supplied

Spectrum of hemostatic derangements, in Budd-Chiari syndrome.

BACKGROUND: Hemostatic abnormalities have been reported in various hepatocellular diseases. We evaluated the hemostatic functions in patients with Budd-Chiari syndrome. METHODS: Biochemical liver function tests, and measurement of prothrombin time, activated partial thromboplastin time, and plasma levels of anti-thrombin III (antigen) and activity of protein C were done in 36 patients with Budd-Chiari syndrome. RESULTS: Liver biochemistry was abnormal in 34 patients. Plasma prothrombin time and activated partial thromboplastin time were prolonged in 17 (47%) and 23 (64%) patients, respectively. Antithrombin III antigen levels and protein C activity were reduced in 15 (50%) and 25 (83%) patients, respectively, among the 30 patients studied. Albumin levels showed significant correlation with coagulation test results, levels of anti-thrombin-III, and protein C activity. CONCLUSION: Hepatic synthesis of coagulation factors and anticoagulants is reduced in Budd-Chiari syndrome; this may play a role in recurrence of thrombosis.

Budd-Chiari Syndrome↗
PubMed1992

Contribution of perfusion techniques to the evaluation of the hemostatic effectiveness of platelet concentrates.

Perfusion systems allowing the morphometric analysis of platelet interactions with vessel subendothelium under flow conditions have been applied to evaluate the quality and function of stored platelets. Studies performed in vitro indicate that despite the existence of storage lesions, platelets in concentrates stored for up to 5 days retain their ability to interact with the subendothelium. Perfusion studies ex vivo with nonanticoagulated blood from anemic-thrombocytopenic patients have shown the critical hemorrheological role of red blood cells facilitating platelet interactions with subendothelium. Similar studies performed on severely thrombocytopenic patients who received transfusions of platelets stored at 4 degrees C indicate that incompletely viable platelets can contribute to primary hemostasis through procoagulant mechanisms. The latter results suggest that storage lesions which contribute to impairment of platelet function may result in enhancement of platelet procoagulant activities. Perfusion techniques have contributed to the evaluation of the hemostatic effectiveness of platelet concentrates. These techniques will provide a useful model to test the impact of new storage technologies on platelet hemostatic function.

Animals↗
PubMed1992

[Electron microscopy observation on pre- and post-treatment skin of dorsum pedis of chyluric patient treated with heat-clearing and hemostatic drugs--the lymphangial wall damage being the pathogenesis of chyluria].

Heat-clearing and hemostatic drugs were effective in treating chyluria. In order to explore the curative mechanism, a group of 10 in-patients with chyluria were chosen and treated with heat-clearing and hemostatic drugs for 45 days. Some pre- and post-treatment skin from dorsum pedis of the patients were taken off and observed under electron microscope. It showed that the walls of lymphatic capillaries were seriously damaged before treatment and rehabilitated wall after treatment. The pinocytotic vesicles were packed tightly in the endothelial cells of capillaries before treatment and their number was decreased remarkably after treatment; the mast cells were rare in number and abnormal as spindle shape before treatment and they increased in number and became round or oval in shape, the nucleus became large, the granules they contained became more in number and larger in size after treatment, lymph edema was noticed before treatment and it disappeared after treatment. The result showed that the extensive lesion of lymphangial walls is the pathogenesis of chyluria, while the rehabilitation of them is the curative mechanism. It seems that in the process of rehabilitation the mast cells act took the role of "soldier-engineer".

Adult↗
PubMed1992

[Changes in the level of certain hemostatic factors during treatment with lovastatin in patients with primary hyperlipoproteinemia and phenotype IIa and IIb].

12 weeks of hypolipidemic therapy with lovastatin in patients with primary hyperlipoproteinemia phenotype IIa (20 persons) and IIb (10 persons), apart from decrease of serum total cholesterol, LDL-cholesterol and apolipoprotein B concentration caused significant decrease of antithrombin III, plasminogen and Factor VII activity. The mean decrease in antithrombin III activity (from 103.5 to 91.7% in HLP IIa and from 97.3 to 85.4% in HLP IIb) was significant in both groups, decrease of Factor VII activity (from 111.9 to 100.1%) was significant in HLP IIa and decrease of plasminogen (from 101.9 to 90.6%) in HLP IIb. There were no changes in fibrinogen concentration, prothrombin, Factor VIII activity and aPTT during treatment. Significant correlations of changes in blood lipids and changes in hemostatic factors after treatment were observed. The results of this study indicate that changes in blood lipids during hypolipidemic therapy are associated with significant changes in hemostatic factors.

Antithrombin III↗
PubMed1992

[The changes in molecular markers for hemostatic activation after t-PA therapy in case of pulmonary embolism].

We observed the changes of molecular markers for hemostatic activation in a patient with acute pulmonary embolism treated with 2 x 10(7) unit tissue plasminogen activator (t-PA). Blood samples were obtained before, just after, at 30 min, 1, 2, 6, and 24 hours after the infusion. Molecular markers included thrombin-antithrombin III complex (TAT), plasminogen-alpha 2 plasmin inhibitor complex (PIC), and thrombomodulin (TM). Marked elevation of TAT was observed from immediately after the t-PA infusion to 6 hours after, although it had been observed for only 1 hour in our previous report on the cases of acute myocardial infarction. PIC level was significantly increased during t-PA infusion but returned to almost baseline value 6 hours after the end of t-PA infusion. This finding was almost the same as the one previously reported concerning acute myocardial infarction cases. TM level increased throughout the evaluation, and remained so, even on the 7th day after t-PA infusion. Our present data revealed a clear difference between the reactive TAT increases after t-PA therapy in acute myocardial infarction cases and in acute pulmonary embolism cases. Our present data also revealed a prolonged elevation of TM during the acute period of pulmonary embolism. It is therefore necessary to keep an eye on the changes of molecular markers for hemostatic activation after t-PA therapy in acute pulmonary embolism.

Aged↗
PubMed1992

Hemostatic aspects of envenomation by North American snakes.

1. North American poisonous snakes have a wide spectrum of complex venoms. 2. Venom, especially that of the rattlesnakes, may cause a variety of hemostatic abnormalities by directly, yet only partially, cleaving fibrinogen, activating the fibrinolytic system, or activating and clearing platelets through the action of proteolytic enzymes. 3. Because these venoms do not result in the generation of thrombin, the syndrome is distinct from true DIC. Bleeding or thrombosis is rare. 4. As thrombin generation remains intact, hemostasis is largely preserved despite dramatic changes in hemostatic tests. 5. Therapy with heparin, blood, or blood products is rarely indicated. 6. Therapy with antivenin in selected cases is logical and efficacious.

Animals↗
PubMed1992

[The hemostatic system and the status of aortocoronary venous autografts in patients with ischemic heart disease after surgery for direct myocardial revascularization based on autopsy research data].

The study was undertaken to examine the relationship between the major hemostatic factors in the early postoperative period and the status of an autovenous graft in 19 patients with coronary heart disease who died 3 to 40 days after aortocoronary bypass surgery. The hemostatic system was monitored on the patients' admission and during the whole observation. Hypercoagulation was recorded in all patients in the first postoperative hours. A trend towards hypercoagulation during the entire period of observation was more marked in 7 patients whose postmortem study revealed even one nonfunctioning graft than in 12 patients with maintained patency of all grafts. The major parameters associated with graft thrombosis were platelet aggregation, ethanol test, and levels of soluble fibrin monomer components. Platelet aggregation and the presence and degree of soluble fibrin monomer components were of independent correlative significance. The magnitude of degenerative and proliferative changes in the vein was associated with the interval after the surgery. Myocardial infarction in the early postoperative period was related to graft dysfunction.

Aorta↗
PubMed1992

[Clinical experience of urological surgery of the patients with hemostatic disorder or hemolytic disease].

This report deals with clinical experience of urologic surgery of patients with hemostatic disorder or hemolytic disease. In the past 5 years from May 1986, 14 operations were conducted in our clinic on 13 patients, consisting of 4 with von Willebrand disease (vWd), 1 with hemophilia B, 4 who had warfarin administration, 3 with essential thrombocythemia and 2 with spherocytosis. Almost all patients were treated hematologically before the urological operations. Except in 1 case, the post-operative course was favorable and under hematologic control. Massive bleeding in 1 case was obviously attributable to over-dosage of warfarin. It is difficult to determine the optimal dose of warfarin under an unstable hemostatic condition during the operation and recovery periods. However, it is possible to carry out urologic surgery for these patients under appropriate hematologic control, and ESWL was safely performed without medical treatment on 3 patients; 1 with vWd, 1 treated with warfarin and 1 with spherocytosis.

Adult↗
PubMed2004

[Endoscopic control of hemorrhage in the upper part of the digestive tract using hemostatic clips].

One of the endoscopy methods to stop upper gastrointestinal tract (GIT) bleeding in the limelight these days is hemostasis using metal clips. This method is indicated especially in patients with bleeding from an eroded artery and in patients where other hemostatic methods proved to be unsuccessful. Goal of our work was to assess successfulness of hemostasis, percentage of early rebleedings, and lethality of patients managed with this method. At the same time we present indications and locations of bleedings in these patients. We have retrospectively evaluated a group of 75 patients indicated for urgent endoscopy for GIT bleeding in a period from August 2000 till the end of February 2002. An average age of these patients was 69.7 years. We haven't managed to stop bleeding in 2 cases. In 12 patients (15.1%) rebleeding appeared within two days following intervention. From all the patients with early rebleeding: 4 patients had an ulcer and an eroded artery in stomach (4 died from bleeding, one of them undergone a surgery), 4 patients had an ulcer in duodenal bulb with artery at base (3 undergone surgery, 1 died), three patients had esophageal bleeding, and one patient had bleeding from the suture in stomach wall (undergone surgery and died). In majority of cases (82.8%) patients were managed with a combined technique (clip + adrenaline injection). With regard to a location of lesions treated with clip application, following locations were treated: esophagus 9.5%, stomach 40.5%, pylori channel 2.7%, duodenal bulb 39.2%, gastroenteroanastomosis 4.1%, D2 4.1%. Bleeding in 76% of patients was from an ulcer and artery (Forrest Ia, IIa). Results confirmed high effectiveness of hemostatic clips in primary hemostasis of GIT bleeding--in our sample more than 95%. An early rebleeding appeared in 15% of patients. Results presented correspond with data presented in world literature.

Aged↗
PubMed2004

Hemostatic function and carotid artery disease.

AIM: Since conventional risk factors predict less than one half of future cardiovascular events, other factors that contribute to atherogenesis need to be evaluated. The aim of this study was to investigate whether clotting factors are associated with carotid artery disease. Furthermore, we tried to determine whether clotting factors could be used to predict the risk of cerebrovascular events in patients with internal carotid artery stenosis. METHODS: Twenty-six patients with high-grade (>70%) internal carotid artery stenosis and 43 age-matched controls were evaluated for atherogenic risk factors and hemostatic function. Laboratory tests included plasma assays of fibrinogen, tissue plasminogen activator (TPA), D-dimer, plasminogen activator inhibitor 1 (PAI-1), plasminogen and factor VII:c. Nineteen (72%) patients had history of stroke or transient ischemic attack, while the remaining 7 (28%) were asymptomatic. Statistical analysis was performed using multiple linear regression analysis. RESULTS: Carotid artery stenosis was associated with high levels of TPA (p<0.001), D-dimer (p=0.019) and PAI-1 (p<0.001). No statistically significant correlation was found between the presence of carotid artery disease and the levels of fibrinogen (p=0.28), plasminogen (p=0.96) or factor VII:c (p=0.19). As regards the clinical manifestations, none of the studied clotting factors was correlated with the history of cerebrovascular events in the patients with carotid stenosis. CONCLUSION: The results of this study show that the hemostatic system may play a role in the development of carotid artery atherosclerotic disease, while it does not seem to affect the development of symptoms in patients with carotid stenosis.

Aged↗
PubMed2004

[Relationships between hemostatic variables and delay of surgical repair of femoral neck fracture in elderly patients].

BACKGROUND: This study was conducted to clarify the preoperative risk of thrombosis in elderly patients with femoral neck fracture by determining the relationships between hemostatic variables and time from injury until surgical repair. METHODS: Thirty-four patients over 70 years of age with femoral neck fracture were assigned to the following three groups according to the delay of surgical repair: usual operation group (within 3 days), delayed operation group (from 4 to 7 days) and much delayed operation group (more than 8 days). Hemostatic variables including molecular markers were determined before surgical repair. RESULTS: Thrombin antithrombin complex level in the usual operation group was significantly increased. The D-dimer level in the usual operation group was significantly higher than that in the delayed operation group, but the levels in the delayed and much delayed operation groups were still higher than the levels in normal subjects. CONCLUSIONS: These findings suggest that elderly patients with femoral neck fracture may have a relatively high risk for the occurrence of pulmonary thromboembolism receiving anesthesia for surgical repair because of hypercoagulopathy caused by stress response and possible deep vein thrombosis caused by lying on a bed for a long period.

Aged↗
PubMed1992

Influence of aging on the activity of the hemostatic system: prothrombin fragment 1+2, thrombin-antithrombin III complexes and D-dimers in 80 healthy subjects with age ranging from 20 to 94 years.

To determine the influence of aging on the activity of the hemostatic system, we measured the plasma concentration of prothrombin fragments 1+2 (F 1+2), thrombin-antithrombin III complexes (TAT) and fibrin degradation fragments D-dimers (D-D) in 80 healthy subjects with age ranging between 20 and 94 years. All subjects were free of acute or chronic diseases. The three markers (semi-log scale) were positively correlated with age (r greater than 0.7, p less than 0.01). Mean plasma levels of F 1+2, TAT and D-D were two- to five-fold higher in subjects with age greater than or equal to 60 as compared to those less than 60 years (n = 40 in both groups). In these two groups, normal values for F 1+2, TAT and D-D ranged from 0.3-1.2 vs 0.7-2.4 nmol/l, 1.4-2.6 vs 1.9-6.4 micrograms/l and 33-433 vs 312-1180 micrograms/l, respectively. Sex did not influence the results. We conclude that the activity of the hemostatic system is markedly age-dependent, and that elderly subjects display a biological picture of "prethrombotic" state. In addition, for a right clinical use of these three markers, age should be taken into account when normal range is to be established.

Adult↗
PubMedDate not supplied

[Effect of the heparin-lysine complex on the hemostatic and insular systems].

We studied the effect of chronic intraperitoneal administration of heparin-lysine complex on the state of the hemostatic and insular systems in young and senescent animals (rats). This complex exerted a positive effect on physiological function of the coagulant, anticoagulant, and fibrinolytic components of the hemostatic system in the norm and in developing experimental alloxan diabetes. In this case, both the complex and its components, lysine and heparin, had a pronounced antidiabetogenic effect.

Animals↗
PubMedDate not supplied

[The effect of cytomedines on the hemostatic and antioxidant potential of patients in the early stage of diabetic retinopathy].

Epithalamine produces a dose-dependent antioxidant effect in patients in the early stage of diabetic retinopathy (DR). Retinalamine normalizes the parameters of local hemostatic potential only under the conditions of completely restored antioxidant activity and lipid hydroperoxide level. Combined administration of epithalamine and retinalamine is recommended for correcting pathological changes of the hemostatic and antioxidant potential and for preventing the blood vessel damage in patients in the early stage of DR.

Adult↗
PubMed2005

[Hemostatic effects of Sorbalgon dressing after intranasal endoscopic surgery].

OBJECTIVE: To study the therapeutic effects of Sorbalgon dressing for hemostasis after intranasal endoscopic surgery. METHODS: Intranasal endoscopic surgery was performed in 50 patients with bilateral chronic nasosinusitis and nasal polyps, after which the hemostatic effect of Sorbalgon and Vaseline dressings and nasal cavity reaction were observed. RESULTS: Sorbalgon dressing resulted in milder nasal swelling and pain without obvious nasal hemorrhage and mucous membrane reaction, and the average time of nasal recovery was shorter in comparison with Vaseline dressing, which caused severe pain, obvious haemorrhage, and nasal mucous membrane swelling with prolonged nasal recovery. Three months after the operation, similar mucous membrane epithelialization was observed in the nasal cavity managed with the two dressings. CONCLUSION: Sorbalgon dressing has good hemostatic effect after intranasal endoscopic surgery.

Adult↗
PubMed2005

Tissue factor pathway inhibitor, natural coagulation inhibitors and hemostatic activation markers in patients with acute coronary syndromes.

OBJECTIVE: This study aims at characterizing the hemostatic changes, in a large cohort of Saudi Arab patients with acute coronary syndromes. METHODS: We consecutively enrolled 389 patients (unstable angina [UA]: n=181; myocardial infarction [MI]: n=208) in this study at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the period from April 2000 to November 2001. We collected blood samples before coronary angiography. Controls (n=101) were healthy males and females. All hemostatic assays were undertaken using enzyme linked immunosorbent assay based techniques and commercial kits. RESULTS: The mean plasma levels of both bound and free tissue factor pathway inhibitors (TFPI) were significantly higher and to comparable levels, in patients with MI and UA, than in healthy control levels. Markers of thrombin generation: the mean levels of prothrombin fraction 1+2, thrombin antithrombin complexes, and D-Dimer were very significantly elevated in the 2 patients groups than in controls. Proteins C and antithrombin III showed statistically significant reduction especially in patients with MI. Plasminogen activator inhibitor levels were significantly elevated in the 2 patient groups, but were higher in MI patients. The mean levels of fibrinogen and D-Dimer as well thrombin antithrombin complex were higher and the levels of free tissue factor pathway inhibitor were lower in patients with 3-vessel coronary artery disease than those with single and double vessel disease. CONCLUSION: The results of this study confirm the existence, and to a similar extent, of a hypercoagulable state in Saudi patients with MI than UA and in those with 3-vessel coronary artery disease than those with one or 2-vessel disease.

Angina, Unstable↗
PubMed2005

Hemostatic balance on the surface of leukemic cells: the role of tissue factor and urokinase plasminogen activator receptor.

BACKGROUND AND OBJECTIVES: The frequency of thrombotic complications is increased in patients with acute leukemia. Since coagulation processes take place on cell membranes, we hypothesized that expression of coagulation proteins on blast membrane could determine the hemostatic balance on the surface of leukemic cells and may correlate with thrombotic manifestations. DESIGN AND METHODS: Fifty-one consecutive patients with newly diagnosed acute leukemia were enrolled over an 11-month period. Twenty-five of the patients had acute myeloid leukemia (AML)-M(0-2), 11 had AML-M3, 6 had AML-M(4-5), and 9 acute lymphocytic leukemia (ALL). Peripheral blood and bone marrow were analyzed by flow-cytometry for tissue factor, protease-activated receptor 1, tissue factor pathway inhibitor, urokinase plasminogen activator receptor, and thrombomodulin. RESULTS: Regardless of the leukemia subtype, tissue factor was predominantly present on leukemic blast surfaces as compared to protease-activated receptor 1, tissue factor pathway inhibitor, urokinase plasminogen activator receptor and thrombomodulin and it was significantly elevated (mean 63+/-6%) in AML-M3 and AML-M(4-5) as compared to AML-M0(-2) and ALL (mean 37+/-4%, p<0.001). Likewise, urokinase plasminogen activator receptor expression was greater in AML-M(4-5) (49+/-11%) than in in AML- M(0-2), M3 and, ALL (mean 17+/-3%, p<0.001). Thrombotic manifestations were present in 13 out of 51 (26%) patients. The tissue factor to urokinase plasminogen activator receptor ratio was higher in patients with a thrombotic event than in patients without thrombotic events (16+/-4 vs. 6+/-2, p=0.042). INTERPRETATION AND CONCLUSIONS: This study demonstrates that tissue factor predominates on leukemic blast surface, particularly in M3 and M4-5 subtypes, while urokinase plasminogen activator receptor is increased on M4-5 blasts. The hemostatic balance on the blast surface may contribute to thrombotic manifestations in leukemic patients.

Adult↗
PubMed2006

[Complex clinical and laboratory characterization of hemostatic disorders in premature neonates with respiratory distress syndrome].

The pattern of time courses of changes in the basic parameters of homeostasis has been studied in premature neonates with respiratory disorders of varying severity in early neonatality. It is shown that in premature neonates with respiratory distress syndrome, all links of the hemostatic system occur and the activity of the major pool of anticoagulants (antithrombin III and protein C) decreases. The most informative indices are proposed for monitoring hemostatic parameters as determination of basic tests, the levels of protein C, D-dimer, and SFMC.

Hematologic Tests↗