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PubMed2006

Anti-adhesion properties of a thrombin-based hemostatic gelatin in a canine laminectomy model: a biomechanical, biochemical, and histologic study.

STUDY DESIGN: An in vivo study on the effects of an agent for scar prevention in a dog laminectomy model. OBJECTIVE: To examine the anti-adhesion properties of a thrombin-based hemostatic gelatin (FLOSEAL; Baxter International Inc., Deerfield, IL). SUMMARY OF BACKGROUND DATA: Postlaminectomy dural adhesion sometimes causes symptomatic problems. Although a new type of hemostatic agent, a thrombin-based hemostatic gelatin, has been developed, its effect on postlaminectomy scar prevention is unknown. METHODS: A 4-level lumbar laminectomy was performed on 11 adult mongrel dogs. There were 2 levels randomly chosen to receive the thrombin-based hemostatic gelatin treatment, while the remaining levels were untreated (control). Dogs were euthanized 8 weeks after surgery. To assess the tenacity of adhesion between the dura and scar, peel-off testing was performed. Gross, biochemical, and histologic analyses were then used to examine the samples. RESULTS: Peel-off stiffness was significantly decreased in the treatment group (64.8% of the control, P = 0.032; 2-tailed unpaired t test). Histologically, there was significantly less scar tissue formation in the treatment group (P = 0.04). The gross analyses showed a trend toward a smaller amount of scar tissue and tenacity of adhesion between the dura and scar in the treatment group. Biochemically, there was a trend toward a lower collagen cross-links content in the treatment group (P = 0.07). CONCLUSIONS: The thrombin-based hemostatic gelatin decreases the tenacity of adhesion between the dura and scar at laminectomy sites.

Animals↗
PubMed2003

Comparative analysis of hemostatic agents in a swine model of lethal groin injury.

BACKGROUND: Techniques for better hemorrhage control after injury could change outcome. A large-animal model of lethal, uncontrolled hemorrhage was developed to test whether the use of various hemostatic agents would decrease bleeding and improve early survival. METHODS: A complex groin injury was created in 30 Yorkshire swine (42-55 kg) to produce uncontrolled hemorrhage. This injury included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 5 minutes, the animals were randomized to (n = 6 animals per group) no dressing (ND), standard dressing (SD), SD and Rapid Deployment Hemostat (RDH) bandage, SD and QuikClot hemostatic agent (QC), or SD and TraumaDEX (TDEX). Limited volume 0.9% saline (1,000 mL over 30 minutes) resuscitation was started 30 minutes after injury. We measured blood loss, early mortality (180 minutes), and physiologic markers of hemorrhagic shock (e.g., cardiac output, blood pressure, hemoglobin, metabolic acidosis). RESULTS: Application of wound dressing decreased mortality in all groups compared with the ND group (83% mortality). However, this difference was significant (p < 0.05) only for the QuikClot hemostatic agent (0% mortality). Before the application of dressing (first 5 minutes), there were no differences in blood loss between the groups. After application of dressings, the QC group had the lowest blood loss (4.4 +/- 1.4 mL/kg). CONCLUSION: Of the hemostatic agents tested, QuikClot improved survival and decreased bleeding in a swine model of lethal vascular and soft tissue injury.

Animals↗
PubMed2003

Modified rapid deployment hemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury.

BACKGROUND: Hemostasis can be difficult to achieve after blunt abdominal trauma, especially if the patient is coagulopathic. The U.S. Food and Drug Administration has recently approved a hemostatic dressing for treating bleeding after extremity trauma (RDH bandage; Marine Polymer Technologies, Cambridge, MA). It has not been evaluated for internal bleeding after trauma. We redesigned this dressing for internal use, and then tested whether this modified bandage (Miami-modified Rapid Deployment Hemostat) could achieve hemostasis when used as an adjunct to standard laparotomy pad packing in a pig model of severe liver injury with coagulopathy. METHODS: Anesthetized swine (35-45 kg) received an isovolemic 45% blood volume replacement with refrigerated Hextend (6% hetastarch). Core body temperature was maintained at 33-34 degrees C with intra-abdominal ice packs. A coagulopathic condition was documented by thromboelastography. At this point a severe liver injury was induced by the avulsion of the left lateral hepatic lobe, then the pigs were randomized to treatment with either standard abdominal packing (control) or packing plus Miami-modified Rapid Deployment Hemostat. Two series of experiments were conducted. In series one (n = 14), the abdomen was closed and the animals were observed with no resuscitation. After one hour, the abdomen was opened, the packing was removed and the presence of bleeding was noted. In series two (n = 10), the abdomen was closed and the animal resuscitated with one unit of blood plus as much lactated Ringers intravenous fluid (IVF) as required to maintain a mean arterial pressure (MAP) > 70 mm Hg. After one hour, the packing was removed, the abdomen closed, and data were collected for an additional two hours. RESULTS: Series one: 6/7 animals in the control group had continued bleeding at one hour; 1/7 animals in the treatment group had active bleeding (p = 0.0291). Series two: With control vs. Miami-modified Rapid Deployment Hemostat, the three-hour survival was zero vs. 80% (p = 0.0476). The total blood loss was 1.2 +/- 0.1 vs. 0.3 +/- 0.1 mL/kg/min (p = 0.001) and the IVF requirement was 1.6 +/- 0.3 vs. 0.6 +/- 0.3 mL/kg/min (p = 0.026). CONCLUSIONS: The Miami-modified Rapid Deployment Hemostat bandage significantly reduced mortality, blood loss, and fluid requirements when used as an adjunct to standard abdominal packing following severe liver injury in coagulopathic pigs [corrected].

Animals↗
PubMed2003

Potential role of recombinant factor VIIa as a hemostatic agent.

Recombinant factor VIIa (rFVIIa) has been shown to induce hemostasis in hemophilia patients with inhibitors against factor VIII or factor IX independent of factor VIII/factor IX. Factor VIIa binds to tissue factor (TF) exposed at the site of injury and generates, through factor X activation on the TF-bearing cells, enough thrombin to activate factors VIII, V, and XI, as well as platelets. The thrombin-activated platelets provided a perfect template for binding of activated factors VIII, IX, and V, further activation of factor X, and thrombin generation. Factor VIIa in high concentrations binds to thrombin-activated platelets and is capable of activating factor X, thereby generating thrombin independent of the presence of factor VIII or factor IX. Accordingly, rFVIIa has been shown to initiate hemostasis in severe hemophilila patients with inhibitors subjected to major surgery and suffering from serious limb- and life-threatening bleeding. Since rFVIIa enhances thrombin generation-thereby providing the formation of tight, stable fibrin hemostatic plugs resistance to premature lysis-it should be hemostatic in other situations characterized by impaired thrombin generation. A hemostatic effect has been reported in patients with various platelet disorders and factor XI deficiency. Further, a hemostatic effect of rFVIIa has been reported in patients subjected to trauma and extensive surgery who have developed profuse, excessive bleeding resulting in hemodilution and changes in coagulation patterns. rFVIIa was developed to treat bleeding in hemophilia patients with inhibitors against factor VIII or factor IX and has been shown to induce effective hemostasis in most such patients and also in life- and limb-threatening bleeding. It has also been used successfully to stop bleeding in patients who do not have hemophilia but who do have acquired antibodies against factor VIII (acquired hemophilia). rFVIIa initiates hemostasis by forming a complex with TF exposed as a result of vessel wall injury. Pharmacologic doses of rFVIIa can enhance thrombin generation on platelets that are already thrombin-activated, resulting in the formation of full thrombin burst. By enhancing thrombin generation, rFVIIa helps to form tight, stable, fibrin plugs resistant to premature fibrinolysis. This also maintains hemostasis in the absence of factor VIII or factor IX. Pharmacologic doses of rFVIIa may accordingly be of benefit in producing hemostasis in situations other than hemophilia characterized by profuse bleeding and impaired thrombin generation. There is now clinical experience indicating a hemostatic effect in patients with thrombocytopenia and functional platelet defects. rFVIIa has also been successfully used in acute trauma patients with profuse bleedings and in other bleeding situations.

Blood Platelet Disorders↗
PubMed1988

[Clinical application of microfibrillar collagen hemostat (Avitene) in neurosurgical field].

Microfibrillar collagen hemostat (Avitene) is a new absorbable hemostatic agent, of which mechanisms are adhesion to the bleeding site and platelet aggregation. Histopathological examinations revealed that Avitene was biocompatible with cerebral cortex in an animal experiments. Our previous studies indicated that Avitene is very effective and safe to use as a topical hemostatic agent during craniotomy in an experimental animal. Avitene was used as a topical hemostatic agent during craniotomy in 36 patients with intracranial organic lesions. Its effectiveness of hemostasis was revealed in 95%. This agent was especially useful to prevent oozing during craniotomy. Side effect of this agent was not reported in this study. Therefore, Avitene is very effective and safe to use as a topical hemostatic agent in the neurosurgical field.

Brain↗
PubMed2000

Local hemostatic effects of microcrystalline partially deacetylated chitin hydrochloride.

The hemostatic effects of microcrystalline partially deacetylated chitin hydrochloride (DAC-HCl) were compared with those of cotton and collagen hydrochloride (collagen-HCl). The DAC-HCl had excellent physical properties as a hemostatic agent such as its ability to absorb and retain blood. In canine blood it induced the release of substances involved in the process of platelet activation, such as beta-thromboglobulin and platelet factor 4, and it also had excellent hemoagglutinative properties. Moreover, in a hemostatic study on bleeding from cancellous bone in canines it exhibited a hemostatic effect comparable to that exhibited by collagen-HCl. Because it also has an intrinsic promotive effect on wound healing, chitin hydrochloride is considered to be a promising hemostatic material.

Animals↗
PubMed1995

Hemostatic Factors and Ischemic Heart Disease Risk Among Postmenopausal Women.

The following is a review of (largely) epidemiologic evidence on whether changes in plasma hemostatic concentrations occur with menopause and with postmenopausal hormone therapy which may have an impact on risk of ischemic heart disease. To date, only plasma fibrinogen has been positively associated with long-term risk of disease among women; however, data are sparse. Taken together, the evidence supports an impact of endogenous sex hormone levels on thrombotic potential and points to a modest increase in a number of plasma hemostatic factor levels at menopause. Results of studies of estrogen therapy are somewhat conflicting. Observational findings suggest that, except for possibly the Factor VII level, estrogen therapy may prevent the menopause-related rise in plasma hemostatic factors. In contrast, controlled experiments have found increased markers of thrombin generation with use of common formulations of estrogen therapy. The hemostatic effects found with oral preparations do not appear to occur with transdermal forms of estrogen although data are limited. Overall, the evidence shows menopause to have an impact on plasma levels of hemostatic factors which appears to be modified by use of oral estrogen. Whether these alterations in plasma levels have an impact on risk of ischemic heart disease among postmenopausal women remains to be demonstrated.

Journal Article↗
PubMed2002

A new Dual-hemostat technique to facilitate the closure of small laparoscopic trocar incisions.

BACKGROUND: The introduction of any surgical procedure brings with it new technical challenges. The use of laparoscopy offers patients a reduction in pain and better cosmesis. However, over time, new technical challenges associated with laparoscopic surgery are becoming more evident. In particular, the closure of the small trocar site fascial incisions is often awkward and time consuming. The aim of this article is to introduce a closing procedure that facilitates the safe approximation of the abdominal fascia in these wounds. METHOD: One hemostat is used to visualize the fascia of one side of the wound and separate the fascia from the underlying abdominal viscera. Another hemostat retracts the opposite side of the wound. The suture needle is passed through the fascia and between the open tips of the hemostat. The tips of the second hemostat grasp the driven needle and carry it out of the wound. CONCLUSION: The use of two hemostats to close these wounds not only facilitates the closure but is also probably safer than the standard technique.

Humans↗
PubMed1993

Hemostatic changes induced by percutaneous mitral valvuloplasty.

A study was conducted of hemostatic changes in 15 patients with mild-to-moderate rheumatic mitral stenosis who underwent percutaneous mitral balloon valvuloplasty (PMV). The patients were divided into two groups according to the degree of valve dilatation as evaluated by Doppler echocardiography before and 2 to 3 months after therapy: one group (n = 7) with suboptimal valvuloplasty (< 0.5 cm2) and one (n = 8) with optimal valvuloplasty (> or = 0.5 cm2). On the day of echocardiographic evaluation, hemostatic testing of the platelet, coagulation, and fibrinolytic systems was performed. Before PMV there were no differences in the hemodynamic and hemostatic variables between the two groups. No favorable hemostatic changes were achieved by PMV in the suboptimal group. In the optimal group, however, platelet-specific protein levels decreased after PMV; the mean levels of platelet factor 4 and beta-thromboglobulin were moderately elevated before and decreased after PMV from 38.5 +/- 22.2 to 8.13 +/- 5.08 ng/ml (p < 0.01) and from 132.5 +/- 78.6 to 38.8 +/- 19.5 ng/ml (p < 0.02), respectively. Coagulation and fibrinolytic systems were unchanged in this study. These data indicate that PMV produces favorable hemostatic effects when sufficient mitral valve dilatation is achieved. Analysis of our data also discloses that platelet activation plays an important role in the initial step of thrombus formation in patients with rheumatic mitral stenosis.

Blood Coagulation Tests↗
PubMed2001

A double-blind comparative study of the effects of a 23-day oral contraceptive regimen with 20 microg ethinyl estradiol and 75 microg gestodene and a 21-day regimen with 30 microg ethinyl estradiol and 75 microg gestodene on hemostatic variables, lipids, and carbohydrate metabolism.

In this double-blind study we compared the influence of two oral contraceptives, a 23-day regimen with 20 microg ethinyl estradiol and 75 microg gestodene (23-day 20/75) and a 21-day regimen with 30 microg ethinyl estradiol and 75 microg gestodene (21-day 30/75), on hemostatic variables, lipids, and carbohydrate metabolism. The volunteers received the preparations daily for six 28-day cycles. Hemostatic variables and lipids were measured at baseline and after six treatment cycles. Carbohydrate metabolism was assessed by determination of the area under the curve (AUC) of carbohydrate parameters after oral glucose tolerance tests performed at baseline and after three treatment cycles. Data from 33 volunteers in each group were obtained. No significant differences between the effects of both treatments on the hemostatic system were detected. Neither the overall change of all hemostatic variables from baseline to treatment Cycle 6 [defined as primary target variable in the study] nor the change of any of the individual hemostatic parameters differed significantly between the treatment groups. Likewise, no significant nor clinically relevant differences in the effects of both treatments on the volunteers' lipid profiles were detected. The data on carbohydrate variables suggested a slightly more favorable influence of the 23-day 20/75 regimen. The increase of the glucose AUCs after three cycles tended to be stronger with the 21-day 30/75 regimen than with the 23-day 20/75 regimen. In addition, the AUCs for insulin and C-peptide were slightly reduced after three cycles with the 23-day 20/75 regimen but slightly increased with the 21-day 30/75 regimen. Both study treatments were safe and well tolerated by the volunteers as shown by the nature and frequency of adverse events, the routine laboratory examinations, and the physical and gynecological examinations. Both preparations provided adequate contraceptive reliability. The only pregnancy during treatment was attributable to intake errors. In conclusion, the prolongation of the treatment phase of an oral contraceptives with 20 microg ethinyl estradiol does not evoke more pronounced metabolic effects than a conventional 21-day regimen with 30 microg ethinyl estradiol.

Adolescent↗
PubMed1997

Double-blind, randomized, placebo controlled study on the effects of the monophasic oral contraceptive containing 30 micrograms ethinyl estradiol and 2.00 mg dienogest on the hemostatic system.

Forty healthy female volunteers aged between 19 and 35 years (27.3 +/- 4.1 years) with normal menstrual cycles were included in a double-blind, randomized, placebo-controlled study to investigate the influence on the hemostatic system of an oral contraceptive containing 30 micrograms ethinyl estradiol in combination with 2.00 mg dienogest, which is a 19-norprogestin without a 17 alpha-ethinyl group. At baseline and during one treatment cycle, 12 hemostatic parameters were measured on cycle days 7, 14, and 21. The hemostatic parameters were categorized as either procoagulatory, anticoagulatory and profibrinolytic, or antifibrinolytic and indicative of fibrin turnover. Differences between placebo and 30 micrograms ethinyl estradiol and 2.00 mg dienogest of plasma levels of hemostatic parameters on cycle days 21 of the precycle and treatment cycle were chosen as target variables. Prothrombin fragment 1 + 2 (F 1 + 2) was chosen as the main target variable. Equivalence of F 1 + 2 between placebo and active treatment was noted. Among the procoagulatory factors, only factor VII activity was found to be increased over placebo in the active treatment group, but decreased in the placebo group. Protein C activity increased during the treatment with 30 micrograms ethinyl estradiol and 2.00 mg dienogest, and was higher than that of the placebo group in which this parameter decreased during the treatment cycle. There was a corresponding increase in fibrinolytic activity being reflected by higher plasminogen levels in the active treatment group in comparison with placebo. An increase was noted for the fibrinolytic parameter D-dimer. Apart from isolated measurements, the parameters remained in their respective normal ranges. The data combine to suggest that 30 micrograms ethinyl estradiol and 2.00 mg dienogest has a balanced effect on the hemostatic system stimulating both procoagulatory and fibrinolytic activity.

Adult↗
PubMed1998

Snake venoms and the hemostatic system.

Snake venoms are complex mixtures containing many different biologically active proteins and peptides. A number of these proteins interact with components of the human hemostatic system. This review is focused on those venom constituents which affect the blood coagulation pathway, endothelial cells, and platelets. Only highly purified and well characterized snake venom proteins will be discussed in this review. Hemostatically active components are distributed widely in the venom of many different snake species, particularly from pit viper, viper and elapid venoms. The venom components can be grouped into a number of different categories depending on their hemostatic action. The following groups are discussed in this review: (i) enzymes that clot fibrinogen; (ii) enzymes that degrade fibrin(ogen); (iii) plasminogen activators; (iv) prothrombin activators; (v) factor V activators; (vi) factor X activators; (vii) anticoagulant activities including inhibitors of prothrombinase complex formation, inhibitors of thrombin, phospholipases, and protein C activators; (viii) enzymes with hemorrhagic activity; (ix) enzymes that degrade plasma serine proteinase inhibitors; (x) platelet aggregation inducers including direct acting enzymes, direct acting non-enzymatic components, and agents that require a cofactor; (xi) platelet aggregation inhibitors including: alpha-fibrinogenases, 5'-nucleotidases, phospholipases, and disintegrins. Although many snake venoms contain a number of hemostatically active components, it is safe to say that no single venom contains all the hemostatically active components described here. Several venom enzymes have been used clinically as anticoagulants and other venom components are being used in pre-clinical research to examine their possible therapeutic potential. The disintegrins are an interesting group of peptides that contain a cell adhesion recognition motif, Arg-Gly-Asp (RGD), in the carboxy-terminal half of their amino acid sequence. These agents act as fibrinogen receptor (integrin GPIIb/IIIa) antagonists. Since this integrin is believed to serve as the final common pathway leading to the formation of platelet-platelet bridges and platelet aggregation, blockage of this integrin leads to inhibition of platelet aggregation regardless of the stimulating agent. Clinical trials suggest that platelet GPIIb/IIIa blockade is an effective therapy for the thrombotic events and restenosis frequently accompanying cardiovascular and cerebrovascular disease. Therefore, because of their clinical poten tial, a large number of disintegrins have been isolated and characterized.

Amino Acid Sequence↗
PubMed1995

Developmental hemostasis: relevance to hemostatic problems during childhood.

Congenital and acquired hemostatic disorders present during childhood. An accurate diagnosis is critically important in order to implement optimal therapy. Over the last century, several investigators have measured plasma concentrations of hemostatic components in newborns and compared the results to adult values. Clinically significant differences exist for many hemostatic components. Recently, three large studies in more than 400 healthy children have provided reference ranges for hemostatic components throughout childhood. Together, these studies provide insight into the regulation of coagulation and fibrinolysis in children in physiologic and pathologic states. Some examples of the influence of age on hemostasis are: (1) the diagnosis of some congenital factor deficiencies, based on plasma levels, can be difficult due to physiologically low values; (2) despite very low levels of many inhibitors of hemostasis, thrombotic complications are rare; (3) the interaction of anti-coagulants and thrombolytic agents is profoundly influenced by the relative immaturity of hemostasis at birth; and (4) in contrast to the risk of thrombosis, healthy infants are at risk for vitamin K deficiency bleeding due to poor transport of vitamin K across the placenta and plasma concentrations of the vitamin K dependent proteins of less than 50% of adults values. The following review discusses the age dependency of hemostasis during childhood and the effect of the physiologically immature system on the diagnosis and treatment of hemostatic disorders.

Age Factors↗
PubMed1990

Global and molecular hemostatic markers in acute myeloid leukemia.

Patients with acute myeloid leukemia have multiple hemostatic and thrombotic complications, which may or may not result from disseminated intravascular coagulation. Previous studies incorporating routine coagulation analyses failed to detect any clinically useful information in most of these patients. In this study, the first comprehensive evaluation of the various aspects of the hemostatic system in a population of patients with acute myeloid leukemia was performed. Eighteen patients (23-71 years of age) were studied at either diagnosis or relapse. Hemostatic studies were performed at onset and on days 3, 7, and 30 after initiation of therapy. The bone marrow blast counts ranged from 8% to 98%; prothrombin time and activated partial thromboplastin time showed only minor prolongations in a few of these patients. However, in all patients measurement of platelet-associated markers revealed elevated platelet factor 4 and thromboxane B2 and normal 6-keto-prostaglandin F1 alpha levels. Fibrinolytic markers showed an increase in D-dimer and tissue plasminogen activator and a decrease in alpha 2-antiplasmin levels. Plasminogen, plasminogen activator inhibitor, and fibrinogen levels were normal. Coagulation markers demonstrated a decrease in protein C and antithrombin III levels and an elevation of the thrombin-antithrombin complex. The pretreatment values for all hemostatic markers studied were similar to the values obtained on days 3, 7, and 30 during treatment. This investigation demonstrated a subclinical activation of the components of the hemostatic system possibly leading to a hypercoagulable state. Although only six patients (33%) experienced hemorrhagic complications, the risk of bleeding and/or thrombosis was strongly evident in all patients. The significance of finding abnormal levels of specific molecular markers of hemostasis will be established in the future application of such markers in clinical evaluations of leukemic patients known to be at risk for coagulation disorders.

Acute Disease↗
PubMed2002

Hemostatic complications in bone marrow transplantation: a retrospective analysis of 447 patients.

BACKGROUND: Hemostatic complications are not uncommon after bone marrow transplantation (BMT). However, little is known about the frequency, localization, determinants, and outcome of hemostatic events in autologous and allogeneic BMT. METHODS: Four hundred forty-seven patients (364 allogeneic, 83 autologous transplants) were evaluated retrospectively for the presence of hemostatic complications (bleeding, thrombosis, hepatic veno-occlusive disease [VOD], microangiopathic hemolytic anemia) from the start of conditioning therapy until June 2000. RESULTS: A total of 83.2% of the patients presented with at least one hemostatic complication during the investigational period. Most bleeding episodes occurred within the first 4 weeks after transplantation and were relatively mild. However, 27.1% of the patients hemorrhaged severely, generally doubling the overall mortality of the BMT recipients. Fatal gastrointestinal or intracerebral hemorrhages contributed to 1.1% of the events. Bleeding was strongly associated with prolonged thrombocytopenia and graft-versus-host disease (GVHD). Hemorrhagic cystitis may additionally have been triggered by the preceding conditioning regimens containing cyclophosphamide. Thromboembolic events occurred most frequently in allogeneic transplant recipients, for whom the incidence was 14.6%. Chronic GVHD and treatment with steroids were the major determining factors. The incidence of hepatic VOD in 4.7% of the allogeneic transplant recipients was associated with a high fatality rate. Busulfan conditioning increased the VOD risk 2.6-fold. Moderate or severe microangiopathic hemolytic anemia was associated with GVHD and occurred in 14.6% of the allogeneic transplant recipients, leading to an increased overall mortality. CONCLUSION: Hemostatic disturbances, commonly found in the course of transplantation, are associated with a high transplantation risk and closely related to thrombocytopenia and immunologic complications.

Adolescent↗
PubMed1998

Associations between central obesity and indexes of hemostatic, carbohydrate and lipid metabolism. Results of a 1-year intervention from the Oslo Diet and Exercise Study.

The relationships of central obesity and physical fitness to indexes of hemostatic, lipid and glucose metabolism both at baseline and after 1 year of diet and exercise intervention were examined in 209 sedentary middle-aged men and women with increased coronary risk factor levels. Central obesity was measured as either waist circumference or waist/hip ratio. Maximal oxygen uptake was used as a measure of physical fitness. The cross-sectional results show that there were significant correlations between waist circumference and euglobuline clot lysis time (r = 0.23), factor VII (r = 0.16), glucose and insulin before and after 1 h glucose load (r ranging from 0.32 to 0.50). The 1-year intervention gave the following associations between changes in waist circumference and changes in: euglobuline clot lysis time (r = 0.27), factor VII (r = 0.19), carbohydrate variables and lipids (magnitude of r ranging from 0.19 to 0.43). Also the other indexes of obesity and physical fitness showed significant correlations to indexes of hemostatic, lipid and glucose variables, both cross-sectionally and for changes after the 1-year intervention. The associations between changes in central obesity and changes in indexes of hemostatic, carbohydrate and lipids were generally stronger during 1 year of diet and exercise intervention than those found at baseline. Multiple regression analyses with waist circumference, waist/hip ratio, percent body fat and Vo2 max as independent variables and indexes of hemostatic, carbohydrate and lipid metabolism as dependent variables showed that waist circumference was a significant predictor for indexes of the hemostatic, carbohydrate and lipid metabolism, mostly independent of physical fitness. The cross-sectional and 1-year change results support each other and therefore underscore the importance of abdominal obesity as an important risk factor for cardiovascular disease.

Adult↗
PubMedDate not supplied

Fine needle aspiration biopsy of superficial sites in patients with hemostatic defects.

OBJECTIVE: To ascertain the incidence and types of complications of fine needle aspiration biopsies (FNABs) of superficial sites in patients with uncorrected congenital or acquired hemostatic defects. STUDY DESIGN: All patients with hemostatic defects who were seen in a community-based, private fine needle aspiration and medical laboratory practice were identified. Prospectively and retrospectively collected data concerning complications, biopsy findings and laboratory data on the hemostatic defects were collated and analyzed. RESULTS: Twenty-one patients encountered over a period of about nine years were identified. Warfarin sodium therapy was the most common cause of a hemostatic defect (12 patients), and lymph nodes were the most often aspirated structure (7 patients). Other than a small echymosis in one patient, there were no complications. CONCLUSION: FNAB of superficial sites using the technique described is a safe procedure in patients with uncorrected hemostatic defects.

Adult↗
PubMed1996

Visceral fat accumulation and its relation to plasma hemostatic factors in healthy men.

The associations between abdominal visceral fat and the plasma hemostatic system were examined in 38-year-old healthy men (n=52) with a wide range of fatness and fat distribution. Plasma hemostatic factors and metabolic parameters, including glucose tolerance, were measured, and body fatness and adipose tissue distribution were assessed by using computed tomography. The men with more visceral fat (ie, higher than the median value [n=26]) had a less favorable metabolic profile than the men with less visceral fat (n=26). They also had significantly (P<.05) higher plasma fibrinogen, factor VIII clotting activity, tissue-type plasminogen activator antigen, and plasminogen activator inhibitor-1 (PAI-1) activity (19.2+/-2.4 versus 8.5+/-1.6 AU/mL, P<.001) and lower basal tissue-type plasminogen activator activity. After adjustment for plasma insulin, the men with larger abdominal visceral fat area still had significantly higher plasma PAI-1 activity, but no difference was found in any of the other hemostatic factors. In multiple linear regression analysis, abdominal visceral fat area was a positive predictor of plasma PAI-1 activity, but it failed to show any significant association with other hemostatic factors after controlling for plasma insulin. These results suggest the presence of relationships between abdominal visceral fat and several plasma hemostatic factors that are largely mediated by concomitant alterations in plasma insulin concentration. In addition, our results suggest that abdominal accumulation of visceral fat is an independent predictor of plasma PAI-1 activity.

Adipose Tissue↗