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Intraoperative hemostasis during kidney transplantation and the use collagen mesh dressing covered by fibrin glue (TachoComb).

In this paper we present influence of use of haemostatic dressing TachoComb, onto bleeding from surface of transplanted kidney. Kidney transplantation (KTX) seems to be main method of treatment of terminal renal failure. Enlarging number of KTX results in growing frequency of intra and postoperative complications. Hemorrhagic complications can impact clinical status of recipient and graft function. Haemostatic dressing was applied at 29 cases. Control group in which only gas compresses were used consisted of 25 patients. It was proved, that use of dressing from collagen mesh covered by fibrin glue TachoComb, after kidney transplantation diminished parenchymal bleeding and time necessary to get complete hemostasis.

Aprotinin↗

[ Influenza virus proteins modulate hemostasis in vitro and in vivo ].

We studied the effect of influenza virus proteins--hemagglutinin, neuraminidase, nucleoprotein, and membrane protein--on hemostasis in vitro and in vivo. The obtained data demonstrated that the envelope proteins hemagglutinin and neuraminidase increased the plasma fibrinolytic and anticoagulant activities and the activity of human tissue plasminogen activator. Among the core proteins of influenza virus, membrane protein proved to have the highest activity; in contrast to hemagglutinin and neuraminidase, it inhibited fibrinolysis, increased the coagulation activity of the plasma, and decreased the activity of human tissue plasminogen activator. Combined action of hemagglutinin and neuraminidase increased the plasma fibrinolytic and anticoagulant activities exceeding their individual effects. Combined action of an envelope protein hemagglutinin and membrane protein also increased the plasma fibrinolytic and anticoagulant activities although to a lesser extent as compared to hemagglutinin alone. The obtained data indicate that the viral proteins are physiologically active and can induce hemostatic changes specific for influenza.

Animals↗

[State of hemostasis during naphthalane treatment of patients with obliterating atherosclerosis of the vessels of the lower limbs].

A total of 67 patients with obliterating atherosclerosis of the vessels of low extremities were followed up in the treatment at the Naphthalane health resort. The patients with the disease stages I, IIA and IIB were subjected to sitting and general naphthalane bath therapy. The studied patients were investigated for the values of the blood coagulation and functional abilities of thrombocytes before and after naphthalane treatment. Analysis of the results obtained demonstrated a favourable effect of naphthalane on hemostasis displaying hypocoagulative effect and improving the blood viscosity. The use of naphthalane as a multiprofile factor in the treatment of the aforementioned patients was found to be advisable and could be considered as a pathogenetic method of treatment for those suffering from this disease.

Arteriosclerosis Obliterans↗

[Effect of long-term physical training on hemostasis in patients with coronary heart disease and non-insulin dependent diabetes].

AIM: To study effects of 6-month physical training on some parameters of hemostasis in patients with coronary heart disease and non-insulin dependent diabetes (NIDDM). RESULTS: Long-term physical training resulted in lowering of fibrinogen level and increase of fibrinolytic activity assessed as euglobulin fraction clot lysis time, while factor VII activity remained unchanged. These changes were accompanied with elevation of total and high density lipoprotein cholesterol levels without any shifts in low density lipoprotein cholesterol and triglycerides. Most pronounced positive effect physical training exerted on results of a test with standard single fat load, which was used as a model of postprandial lipemia. Serum cortisol level significantly decreased after 6-month training, especially after fat load and subsequent physical exertion. CONCLUSION: In patients with combination of coronary heart disease and NIDDM long-term physical training was associated with decreased thrombogenicity of blood.

Coronary Artery Disease↗

[Hemostasis-altering drugs and regional anesthetic techniques: safety guidelines].

New developments--in the form of emerging clinical settings for regional anesthesia as well as problems arising with the concomitant use of regional techniques and hemostasis-altering drugs--require the ongoing revision of safety guidelines. The annual meeting of ESRA held in Spain in 2003 saw the discussion and clarification of a variety of issues of current concern, including conclusions reached on the estimated risk of spinal hematoma when published safety guidelines are followed or not, precautions to take in epidural anesthesia during cardiac surgery, guidelines for using fondaparinux for thromboprophylaxis, the circumstances under which neuroaxial techniques can be used safely in patients under the effects of platelet aggregation inhibitors such as thienopyridine, and the application of epidural anesthesia in parturients with eclampsia who have received platelet aggregation inhibitors. Conclusions drawn at the meeting enrich and clarify certain important safety issues related to local and regional anesthesia in patients receiving antiplatelet drugs and/or anticoagulants.

Anesthesia, Conduction↗

[The prostacyclin-thromboxane system and thrombocytic-vascular hemostasis in patients with ischemic heart disease in the preoperative period].

Prostacyclin-thromboxane system (PTS) and platelet-vascular hemostasis have been studied in the preoperative period in 35 ischemic patients. A marked PTS disbalance with predominance of plasma thromboxane has been found. It has been established that in patients with postinfarction cardiosclerosis plasma prostacyclin content was significantly higher than in patients without myocardial infarction. The study of platelet function has demonstrated normal platelet aggregation rate and an increased level of beta-thromboglobulin in the blood of ischemic patients. Acetylsalicylic acid (250 mg/daily) was used for the correction of the disturbances observed, it reduced platelet aggregation, but had no effect on PTS and platelet release.

Adult↗

[Infection and hemostasis].

Localised and following systemic inflammatory reaction accompanying progression of infection causes generation of anti-inflammatory cytokines. They activate leucocytes, endothelium, coagulation and fibrinolysis. Sepsis is usually accompanied by already decompensated disseminated intravascular coagulation which significantly affects mortality of patients with this disease. The main cause of hypercoagulation state during sepsis seems to be inhibition of fibrinolysis as a result of overproduction of plasminogen activator inhibitor-1 in later stages of the disease. Some microorganisms have specific properties which affect individual components of hemostasis and thus increase their virulence. Because natural inhibitors of coagulation have not only anticoagulation but also strong anti-inflammatory effect, they seem to be an optimum remedy for fluorid coagulopathy during sepsis. Moreover, their use usually does not increase risk of bleeding.

Blood Coagulation↗

Use of mesh fibrous dressing covered with fibrin glue (TachoComb) in hemostasis after vascular anastomoses in the groin.

We present in this paper application of haemostatic device TachoComb onto bleeding after vascular anastomosis of dacron vascular prosthesis (branch of aortobifemoral or bypass aortofemoral) with common femoral artery in the groin. Hemorrhagic complications have influence onto clinical status of operated patients. Haemostatic TachoComb dressing was applied at 30 cases and results were compared to control group consist of 25 cases, in which gas compresses were applied. Mean loss blood in group I with the usage of TachoComb was statistical characteristic (p < 0.003) smallest than in group II. Also mean time of hemostasis was shortest than in group II (p < 0.01). We proved that use of TachoComb limits bleeding from suture line connecting artery with vascular prosthesis.

Anastomosis, Surgical↗

[The state of hemostasis in patients after mini-invasive aorta and coronary artery bypass surgery].

The paper represents data on the condition of the hemostasis of plasma and platelet chains as well as of the system of natural anticoagulants and fibrinolysis as observed in cardiosurgical patients after mini-invasion coronary artery bypass surgery. An intensified generation of platelets, postoperative hyperaggregation of platelets and a lower level of natural anticoagulants in blood were shown as to be compensated for by an activated system of fibrinolysis.

Blood Coagulation Factor Inhibitors↗

Diagnosis of disseminated intravascular coagulation in sepsis scoring system of a thrombosis-hemostasis center.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a septic complication that is not easily diagnosed. The purpose of the study is to obtain a scoring system to diagnose DIC in sepsis. SUBJECT AND METHODS: An observational study with a cross-sectional design was performed at the Department of Internal Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital from February to August 2002. Subjects were septic patients in the emergency unit or inpatient ward of the Department of Internal Medicine, and were taken consecutively. The criteria of sepsis, severe sepsis and septic shock were based on ACCP/SCCM Consensus 1991. The evaluation conformed to the Thrombosis Hemostasis Center (THC) scoring system, compared with modified Bick scoring system as a gold standard. RESULTS: There were 34 subjects ranging from 19 to 78 years old, 32.4% were septic patients, 41.2% with severe sepsis and 26.5% with septic shock. The most common source of infection was pneumonia, where bacterial pathogens were found in 35.2% of blood aerobic culture and 17.7% in pus or urine culture. Gram negative bacteria was the most common pathogen found. According to a modified Bick and THC scoring system, DIC was found in all subjects, consisting of mild and moderate DIC. No severe DIC was found. There was no difference between both scoring systems, with a p value of 0.125 based on the Mc Nemar test. There was no difference found in mild and moderate DIC in sepsis, severe sepsis and septic shock of modified Bick scoring systems (p value of 0.987) and THC scoring system (p value of 1.000). CONCLUSION: No difference was found between THC and modified Bick scoring system in diagnosing DIC in septic patients. In sepsis, severe sepsis and septic shock, mild and moderate DIC complications can be diagnosed with THC scoring system, which are of the same potency with the modified Bick, with the assumption that the modified Bick scoring system was the same as the Bick scoring system.

Adult↗

Aprotinin and hemostasis monitoring concerns during cardiac surgery.

Aprotinin (Trasylol) is a serine protease inhibitor, isolated from bovine lung that initially was marketed for the treatment of pancreatitis. In the mid 1980s, reports of its ability to decrease hemorrhaging after cardiopulmonary bypass surgery introduced the drug to the realm of cardiac surgery. Unfortunately, its introduction into this arena was followed by the publication of multiple studies and case reports that blamed aprotinin for poor outcomes in the form of early graft closure. More than 17 years have passed since the initial article describing the use of aprotinin during cardiopulmonary bypass, and with time there has been a significant increase in scientific knowledge and clinical experience. Interestingly, modern literature does not support the dogma that aprotinin is a procoagulant. Aprotinin increases the activated partial thromboplastin time (aPTT), as well as the kaolin- and celite-activated clotting time (ACT), regardless of heparin. Aprotinin, because of its ability to inhibit kallikrein, has been found to decrease thrombin antithrombin III complexes, fibrin-split products, fibrinopeptide 1+2, prothrombin fragments, and all markers of thrombin formation. Some authors have suggested that it may have a synergistic effect with heparin to ensure graft patency. Anticoagulation monitoring during the use of aprotinin also has been developed based on early studies. Aprotinin administration does influence the results of various ACT tests, and consequently different methods of testing anticoagulation have been developed. Researchers have demonstrated that the celite ACT is not "artificially" prolonged in the presence of heparin and aprotinin, rather the kaolin ACT is "artificially" shortened. This article will review the scientific literature with regard to aprotinin's anticoagulatory effects and review the current recommendations for hemostasis monitoring during the use of aprotinin.

Aprotinin↗

Development of hemostasis in the fetus.

The fetal hemostatic system is unique in many respects. Many coagulation proteins are expressed early in embryonic development and play roles outside of coagulation in cell proliferation and differentiation. Coagulation mRNA and protein can be detected within hepatic and endothelial cells within the first month of gestation and in fetal plasma during the third month. However, development of levels of most coagulation proteins is halted from mid-gestation until shortly before term onset of labor. The reason for this developmental arrest in plasma protein levels is unknown. The fetus demonstrates an unique balance of procoagulant, anticoagulant and fibrinolytic proteins concentrations which persists for several months postnatally. Fetal coagulation proteins are identical to adult proteins in structure and function with a few notable exceptions. Platelets are expressed early in fetal development and platelet concentrations are within the adult range by mid-gestation. Functional differences can be detected in fetal platelet function but rarely cause bleeding in the healthy fetus and newborn infant. Hemostasis in the fetus and newborn infants is functionally intact and spontaneous bleeding or clotting is rare. However, the neonatal hemostatic system appears to lack reserve capacity, and bleeding and clotting complications are common in the stressed infant, particularly the sick preterm infant.

Blood Coagulation Factors↗

Quantifying platelet gel coagulation using Sonoclot and Thrombelastograph hemostasis analyzer.

Little in vitro research exists discussing platelet gel composition and the resulting strength and degradation characteristics using point-of-care technologies. There must be a quantifiable way of determining the structural integrity of the resulting formed platelet gel thrombus. The Thrombelastograph Hemostasis Analyzer (TEG) and Sonoclot measure the elasticity of a clot as it forms and subsequently degrades naturally. The objective of this study was to determine the application of TEG and Sonoclot technologies as point-of-care devices for technicians using platelet gel therapy. The collected bovine blood was anticoagulated with CPD and processed using a previously published plasma sequestration protocol, using normal saline as a wash solution. The resulting platelet-rich plasma was stored in a sequestration bag in a water bath to maintain the blood temperature at 37 degrees C. Sequestered bovine platelet-rich plasma was made into platelet gel using three different thrombin concentrations. A total of 30 experiments were performed on the platelet gel product using both the TEG and the Sonoclot. We discovered that 6 of the Sonoclot tests and 15 of the TEG tests were valid. None of the TEG clot signatures and nine of the Sonoclot signatures were discovered to be invalid. A chi2 test was performed on the resultant data. The value of the chi2 test was calculated to be 12.86, which translated into a p value of less than 0.001. Despite the vast use and growing popularity of platelet gels, a method in which to quantify platelet gels has yet to be reported. There remains a possibility that gels formed with different concentrations of components may prove useful in different areas of surgery or their uses may expand to a broader spectrum of medicine. However, technology to quantify platelet gels must first be standardized. On the basis of the data collected in this study, it was determined that the TEG and the Sonoclot are not equally capable of analyzing platelet gel clots. The TEG is a valid means for analysis, whereas the Sonoclot provided unreliable analysis based on a Chi-squared test.

Animals↗

The predictive value of the hemostasis parameters in the development of preeclampsia.

In order to find out which hemostasis parameters would have the predictive value for the development of preeclampsia, modified antithrombin III (ATM, representative of the antithrombin III-serine esterase complex), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), beta-thromboglobulin (BTG), antithrombin III (AT III), fibrinogen, fibrin(ogen) degradation product (FDP), FDP D-dimer and euglobulin lysis time (ELT) were measured in 20 normal non-pregnant women, 21 normal pregnant women, 6 high-risk pregnant women, 14 preeclampsia pregnant women, and 5 patients with disseminated intravascular coagulation (DIC). Only tPA and AT III were found significantly different between the preeclampsia and the normal or high-risk pregnant women: tPA was found progressively and significantly increased from the normal pregnant, to the high-risk pregnant, then to the preeclampsia women (p less than 0.05). AT III was significantly lower in the preeclampsia than in the normal pregnant (p = 0.0001) or in the high-risk pregnant women (p = 0.002). In the 2nd trimester, tPA, PAI, fibrinogen and FDP were significantly higher, and AT III was significantly lower in the preeclampsia than in the normal pregnant women, whereas in the 3rd trimester, tPA and AT III were significantly higher or lower, respectively, in the preeclampsia than in the normal pregnant women. No significant difference of ATM could be found between the preeclampsia and the normal or high-risk pregnant women. From the present study, we suggest that tPA and AT III would be used as the main predictors, and FDP and D-dimer as the complementary predictors for the development of preeclampsia and should be detected in the normal or high-risk pregnant women.

Adult↗

[Indirect comparison of changes of parameters of hemostasis during short-term use of ticlopidine and clopidogrel in patients with non-ST elevation acute coronary syndrome].

UNLABELLED: Effects of thienopyridines ticlopidine (TIC) and clopidogrel (CL) on hemostasis in patients (pts) with non-ST-elevation acute coronary syndromes (NSTEACS) have not been compared. AIM: To compare changes of some markers of coagulation and platelet activation during short term use of TIC and CL in pts with NSTEACS. METHODS: Aspirin treated pts with NSTEACS (<48 hours from pain onset, Braunwald class IIIb) were included into 2 consecutive studies: 37 pts receiving unfractionated heparin (UFH) were randomized to open TIC (n=19, 500 mg BID for 2 days and 250 mg BID for subsequent 5 days) or no TIC (n=18); 19 pts receiving enoxaparin were randomized to CL (n=10, 300 mg on day 1 and 75 mg/day for subsequent 6 days) or no CL (n=9). At baseline, on days 1, 3, 7 and 14 (7 days after thienopyridines discontinuation) we measured ADP-induced and spontaneous platelet aggregation (PA), levels of prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), von Willebrand factor (vWF), fibrinogen, tissue type plasminogen activator antigen (tPA), plasminogen activator inhibitor activity (PAI) and D-dimer (Dd), and counted platelet number. RESULTS: Maximal suppression of PA was obtained on 7-th and 3-rd days in TIC and CL groups, respectively. Compared with their controls TIC treated pts in 7 days after TIC discontinuation had lower levels of TAT (3.61 and 2.77 ng/ml, respectively, r<0.05) and fibrinogen (3.84 and 3.16 g/l, respectively, r<0.05). There were no significant differences between intervention and control groups in these parameters in study with CL. Level of vWF in TIC treated pts was lower than in controls on days 3 (163 and 186%, respectively, r<0.05) and 14 (144 and 173%, respectively, p<0.01). In CL treated pts vWF level was lower relative to controls on days 3 and 7 (152 and 185%, r<0.05, 141 and 166%, r<0.05, respectively). tPA levels in study with TIC did not differ between intervention and control groups. tPA in CL treated pts exceeded its level in controls on days 3, 7, and 14 (25.7 and 20.2 ng/ml, 26.5 and 12.9 ng/ml, 24.6 and 15.7 ng/ml, respectively). On the same days level of Dd in pts receiving CL was significantly higher than in control group (969 and 702 ng/ml, 970 and 575 ng/ml, 806 and 484 ng/ml on days 3, 7 and 14, respectively). Activity of PAI in TIC group was higher than in controls on day 7 (13.6 and 8.2 U/l, r<0.05), and at this moment level of Dd was lower in TIC treated patient (770 and 515 ng/ml in control and TIC groups, respectively, r<0.05). CL and control groups had similar PAI activity. Mean platelet volume rose relative to initial level and to control group only in CL treated patients (9.0 and 8.4 fl, 9.6 and 8.4 fl, 9.4 and 8.5 fl in CL and control groups on days 0, 7 and 14, respectively; r<0.05 for comparison between groups on days 7 and 14). CONCLUSION: In pts with NSTEACS both thienopyridines attenuated acute phase elevation of vWF. The use of TIC in UFH treated pts was associated with indirect signs of decreased thrombin activity and some inhibition of fibrinolysis while the use of CL in enoxaparin treated pts was associated with signs of activation of fibrinolysis.

Anticoagulants↗

Abnormal hemostasis and coagulopathy in preeclampsia and eclampsia.

Preeclampsia and eclampsia appear to be a state of increased coagulopathy as evidenced by an increase in fibrin formation, activation of the fibrinolytic system, platelet activation and a decrease in platelet count. Routine tests used to assess decompensated disseminated intravascular coagulopathy are of limited value in the preeclamptic and eclamptic population. More sophisticated tests such as determinations of antithrombin III, thrombin-antithrombin III complex, D-dimer, factor VIII antigen/activity ratio, and beta-thromboglobulin, however, show a compensated coagulopathy in the preeclamptic patient. These hemostatic changes, probably the result of endothelial damage, are implicated in the pathogenesis of this disease. A better understanding about the abnormalities of hemostasis and coagulation in the preeclamptic and eclamptic patient may allow the clinician to provide improved management and possibly peripartum therapy.

Blood Coagulation Disorders↗

The roles of fibrinogen and fibrin in hemostasis and thrombosis.

Proteolytic conversion of fibrinogen to fibrin results in self-assembly to form a clot matrix that subsequently becomes cross-linked by fXIIIa to form the main structural element of the thrombus in vivo. Fibrin formation and assembly lead to new properties that regulate the rate and extent of clotting, cross-linking, and fibrinolysis. These are brought about by the ability of fibrin (1) to bind thrombin at a nonsubstrate site, thus limiting its diffusability but at the same time preserving its catalytic potential; (2) to bind fXIII, regulate its activation to fXIIIa, and limit further activation of fXIII once fibrin cross-linking has occurred; and (3) to bind alpha 2-PI, t-PA, and plasminogen and regulate the initiation and propagation of fibrinolysis. Fibrinogen and fibrin contain several potential platelet binding sites that interact with platelet GPIIb/IIIa receptors, and thus promote their participation in the hemostatic process. Additional, less well-defined interactions, not covered in detail here, such as those between fibrinogen or fibrin and other plasma proteins, cells, or tissue matrix components, suggest other functions that, along with those detailed above, will further define its multiple roles in modulating hemostasis, inflammation, and the wound healing process.

Amino Acid Sequence↗