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Thirty patients taking anticoagulants received routine dental treatment without altering their prothrombin time values. In a follow-up of 5 years, no serious complications were seen in patients with a prothrombin time value of up to 2.5. A protocol is suggested for dental treatment in these patients.
A relatively simple and reproducible procedure is described for the isolation of functionally and electrophoretically homogeneous prothrombin, factor IX and factor X from clinical Factor IX Concentrates. The procedure involves ammonium sulphate fractionation; then chromatography on DEAE-Sephadex A50, dextran sulphate-Sepharose and heparin-Sepharose. High recovery of all three procoagulants was obtained: 32% for factor IX; 32% for factor X; 29% for prothrombin.
The activation of the prothrombin intermediate, Prethrombin 2, has been studied in order to establish test systems that would enable identification of Prethrombin 2 in serum and Factor IX concentrates. While activation of Prethrombin 2 by Taipan Snake Venom (TSV) was slow and incomplete, inclusion of approximately molar amounts of prothrombin fragments F1 or F1.2 markedly enhanced the amount of thrombin formed by TSV. This effect could also be obtained by the inclusion of serum. Neither normal serum nor Factor V deficient serum contain any identifiable Prethrombin 2. On the other hand substantial amounts of Prethrombin 2 are present in Factor IX concentrates used for the treatment of Christmas Disease (Hemophilia B).
Hydrophobic interaction chromatography on Phenyl-Sepharose for the purification of prothrombin fragment 1 is described. The results suggest that this method is both easier and more effective than the use of anion-exchange chromatography for the purification of fragment 1. In addition, the results presented here suggest that prothrombin has rather extensive hydrophobic properties.
Cathepsin G, isolated from human polymorphonuclear leukocytes, was found to effect rapid and specific degradation and biological inactivation of bovine and human prothrombin in the absence of calcium ions with the formation of two peptide fragments from the N-terminal end of the molecule. Polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulphate indicated that the molecular weights of the fragments were 5,000 and 17,500. Proteolysis of prothrombin by cathepsin G was inhibited by calcium ions. Leukocyte proteinases such as cathepsin G may be responsible for haemorrhagic disorders associated with myelocytic leukaemia and septicaemia.
A 5-Gla prothrombin, adsorbable onto barium oxalate and containing an admixture of one- and two-chain molecules, has been purified from the plasma of steers on a dicoumarol regimen for three years. Double-chain molecules were not detected in any of our six other variants containing zero to nine Gla residues. In this double-chain variant, the peptide bond between Arg52-Asn appears to be missing, as the preparation showed amino-terminal alanine and aspartic acid, and released both double- and single-chain F1 upon digestion with thrombin. The molecular masses of the F1 and its heavy chain were 24,000 and 19,000 daltons, respectively. The double-chain variant was similar to its single-chain counterpart [Malhotra, O.P. (1979) Thromb. Res. 14, 439-448] in that it (a) yielded thrombin equivalent to 30% of normal in three hr, (b) moved in the alpha 1 region in the absence of calcium ions and between the alpha 1 and alpha 2 macroglobulins in the presence of calcium ions, (c) contained five gamma-carboxyglutamyl residues (Gla), and (d) showed comparable antigenic activity with normal prothrombin.
Protocatechuic acid can be oxidized and polymerized to from humic substances (humic acid and fulvic acid). Should AS2O3 occur in the process of oxidative polymerization, humic acid output can increase by 1.5 - 2.3 times and, in the case of fulvic acid, at least 10 times. After protocatechuic acid is oxidized and polymerized, the resultant humic and fulvic acids both exhibit the ability to shorten the prothrombin time of human pool plasma in vitro. This ability becomes more apparent when AS2O3 serves as a promoter in the course of oxidative polymerization as described above. However, AS2O3 or protocatechuic acid alone is unable to shorten the prothrombin time of human pool plasma.
HepG2 cells have been shown to respond to warfarin by 1) enhanced vitamin K-dependent carboxylase activity; 2) enhanced intracellular concentration of the factor X clotting factor precursor and 3) enhanced vitamin K-dependent 14C-labelling of a 74 kDa microsomal protein which has been identified as the factor X precursor. There was no difference in any of these measured parameters whether the cells had been treated for 4 or 24 hours with warfarin. In contrast to the intracellular factor X concentration, the intracellular prothrombin precursor concentration was not affected by the drug which suggests there is a difference in the mechanism of processing of these two clotting factors by HepG2 cells. The data are consistent with the view that warfarin maintains its effect on the vitamin K-dependent carboxylation system in HepG2 cells for 24 hours and support the hypothesis that clotting factor X and prothrombin precursors interact differently with the vitamin K-dependent carboxylase.
The effect of different heparins and a synthetic pentasaccharide on the inhibition of intrinsic prothrombinase and of its generation was studied by a new technique, using a defibrinated prothrombin poor human plasma, supplemented with phospholipids and calcium. Prothrombinase activity was evaluated on purified prothrombin with a chromogenic substrate. This technique is designed to bypass the interference of massive endogenous thrombin generation on the measurement of prothrombinase activity. We first validated the specificity of the technique by using specific Xa and IIa inhibitors. Then, the inhibition of prothrombinase generation and the inhibition of generated prothrombinase were both studied. The results showed that anti-Xa activity measured on exogenous bovine factor Xa added to plasma was not correlated with the inhibition of prothrombinase generation or prothrombinase activity. The concentrations required for unfractionated heparin (the 4th International Standard: 4th IS UH), 1st International Standard Low Molecular Weight Heparins (1st IS LMWH), enoxaparin, Fraxiparine, and pentasaccharide in order to inhibit preformed prothrombinase were significantly higher than those necessary to inhibit prothrombinase generation. These data suggest that anti-Xa activity of unfractionated heparin and its derivatives does not completely reflect the extent of the inhibition of intrinsic prothrombinase generation by UH, LMWH, and pentasaccharide. On the other hand, anti-IIa activity of heparins could be responsible for the inhibition of prothrombinase generation. The action of pentasaccharide devoid of anti-IIa activity on prothrombinase generation appears related to its indirect effect on the formation of initial thrombin traces. This new technique provides a tool to study the essential role played by thrombin during the early steps of coagulation.
A computer-interfaced spectrophotometric kinetic assay for prothrombin activation was developed, coupling the production of thrombin to a thrombin-specific amidolytic chromogenic reaction. As thrombin accumulated initially at constant velocity, the simultaneous release from S-2238 of pNA conformed to an acceleration function. Adherence to the acceleration function of the temporally increasing A400 of pNA was evaluated after transforming the data into linear format which permitted linear regression analysis. High correlation coefficients, routinely greater than 0.99, verified linearity of thrombin production in individual assay mixtures. As prothrombin concentrations were varied, factor Xa exhibited Michaelis-Menten kinetics. Added choline produced a pattern of mixed-type inhibition. Replots of LB slopes and intercepts versus choline concentration gave apparent Ki and Ki' values (mM): 22 +/- 3 and 48 +/- 7 without factor Va, 25 +/- 4 and 41 +/- 4 with factor Va.
A 1466 base pair cDNA for rabbit prothrombin has been isolated and partially sequenced. The deduced amino acid sequence shows considerable homology with the sequences of human and bovine prothrombin. The cDNA extends from the equivalent of nucleotide 516 in the bovine sequence through the coding region and 99 nucleotides in the 3' non-coding region.
The present study was undertaken to elucidate the effect on platelet aggregation of the prothrombin-converting reaction on platelets with or without activated protein C (APC). A reaction mixture of washed platelets from human individuals, Factor Xa and prothrombin markedly induced platelet aggregation; maximum aggregation rates, 31.3-92.5%, and times to reach to maximum aggregation, 11.6 to 20.1 min. This aggregation was inhibited by the addition of APC with 50% inhibition concentration (IC50) value of 14.4 U/ml. APC also inhibited thrombin generation in the reaction mixture in a dose-dependent manner with IC50 value of 0.96 U/ml. However, APC did not inhibit the thrombin (0.1 CU/ml)-induced platelet aggregation at concentrations of up to 30 U/ml. These findings suggest that APC has no direct inhibitory effect on platelet aggregation and that APC inhibits platelet aggregation through inhibition of thrombin generation.
Purified bovine prothrombin has been treated with different mixtures of glycosidases. Upon incubation of the prothrombin for 30 h with a combination of neuraminidase, alpha- and beta-galactosidase and beta-N-acetylglucosaminidase in 4 mM diisopropylfluorophosphate at pH 5.3 and 30 degrees C, about 70% of the carbohydrates were removed without affecting the coagulation activity. All the sialic acid and about half of the mannose, galactose and glucosamine residues were removed by this treatment.
Male Sprague--Dawley rats were fed 2,2'-methylenebis(4-ethyl-6-tert-butylphenol), 2,2'-methylenebis(4-methyl-6-tert-butylphenol), 4,4'-butylidenebis(3-methyl-6-tert-butylphenol) or 4,4'-methylenebis(2,6-di-tert-butylphenol) at a level of 1.135 mmol/100 g in the diet for 1 week. The prothrombin and kaolin-partially thromboplastin time (PTT) indices were significantly decreased to 32% and 37% of control values in rats given 2,2'-methylenebis(4-methyl-6-tert-butylphenol). A slight decrease in prothrombin index of rats given 4,4'-butylidenebis(3-methyl-6-tert-butylphenol) was also observed.
Measurement of the temperature-dependence of thrombin-catalyzed cleavage of the Arg(155)-Ser(156) and Arg(284)-Thr(285) peptide bonds in prothrombin and prothrombin-derived substrates has yielded Arrhenius parameters that are far too large for classical mechanistic interpretation in terms of a simple hydrolytic reaction. Such a difference from the kinetic behavior exhibited in trypsin- and chymotrypsin-catalyzed proteolysis of peptide bonds is attributed to contributions by enzyme exosite interactions as well as enzyme conformational equilibria to the magnitudes of the experimentally determined Arrhenius parameters. Although the pre-exponential factor and the energy of activation deduced from the temperature-dependence of rate constants for proteolysis by thrombin cannot be accorded the usual mechanistic significance, their evaluation serves a valuable role by highlighting the existence of contributions other than those emanating from simple peptide hydrolysis to the kinetics of proteolysis by thrombin and presumably other enzymes of the blood coagulation system.
Structural transitions of the blood coagulation factor prothrombin (extracted from goat blood) in response to reduction of pH were investigated by fluorescence, circular dichroism and light scattering measurements. The study revealed the presence of a partially unfolded state at around pH 3.5, characterized by marked enhancement of fluorescence from ANS bound to the protein, increase of bimolecular rate constant for tryptophan fluorescence quenching and a sharp peak in the light scattering intensity. Further lowering of the pH caused reversal of the trend of variation of these parameters, suggesting that prothrombin folds back to a compact state containing native-like secondary structural elements. The refolded state at low pH (<pH 3) fits the description of the A-state, the end-point of acid-induced denaturation process of several other monomeric proteins, and is a possible candidate for the class of folding intermediates known as molten globules.
There have been case reports suggesting that cranberry beverages may interact with warfarin. To date, no research study has been conducted to examine the potential interaction of cranberry and warfarin. The current study is a randomized, placebo-controlled, double-blind, crossover study to investigate the effect of cranberry juice on prothrombin time as assessed by the international normalized ratio (INR). Seven subjects with atrial fibrillation on a stable dose of warfarin for 3 months were randomized to consume 250 mL of cranberry juice for 7 days, then placebo for 7 days, or vice versa. The washout period was 7 days. The prothrombin time/INR was measured at baseline, and on days 2, 4, 7, 10, 14, 16, 18, 21, and 24. Data were analyzed by the Student t test for paired values. The baseline INR was 2.28+/-0.54 for the cranberry group and 2.13+/-0.50 for the placebo group. For all test points, the INR did not change significantly from baseline. At day 7 on cranberry juice, the INR was 2.23+/-0.53 for cranberry first group and 2.16+/-0.40 for placebo first group. The mean differences between the cranberry and placebo groups were not statistically significant. Our results suggest no significant interaction between the daily consumption of 250 mL cranberry juice and warfarin. When counseling patients on dietary changes necessary during warfarin treatment, it does not seem necessary to eliminate daily cranberry juice consumption at amounts of 250 mL, but the INR should be followed up closely.
Patients with end-stage renal disease are prone to hemorrhagic complications and simultaneously are at risk for a variety of thrombotic complications such as thrombosis of dialysis blood access, the subclavian vein, coronary arteries, cerebral vessel, and retinal veins, as well as priapism. The study was devised for the following purposes: (1) to identify the markers of thrombophilia in hemodialyzed patients, (2) to establish a role for antiphospholipid antibodies in thrombosis of the vascular access, (3) to characterize phospholipid antibodies in hemodialysis patients, and (4) to study the effects of dialysis on coagulation cascade. A group of 20 hemodialysis patients with no thrombotic complications (NTC) and 20 hemodialysis patients with thrombotic complications (TC) were studied along with 400 volunteer blood donors. Patients with systemic lupus erythematosus and those with nephrotic syndrome were excluded. All patients underwent a screening prothrombin time, activated partial thromboplastin time, fibrinogen (Fg), coagulation factors of the intrinsic and extrinsic pathways, antithrombin III (AT-III), protein C (PC), protein S (PS), resistance to activated protein C, prothrombin activation fragment 1+2 (F1+2), plasminogen, tissue type plasminogen activator (t-PA), plasminogen tissue activator inhibitor type-1 (PAI-1), anticardiolipin antibodies type M and G (ACA-IgM and ACA-IgG), lupus anticoagulant antibodies, and antiprothrombin antibodies type M and G (aPT-IgM and aPT-IgG). The study showed that PAI-1, F 1+2, factor VIII, ACA-IgM, and aPT-IgM levels were increased significantly over controls both in TC and NTC, however, they could distinguish patients with thrombotic complications from those without, being increased maximally in the former group. The novelty of the study is represented by the significant aPT increase that was observed in non-systemic lupus erythematosus hemodialysis patients, and particularly in those with thrombotic events. In addition, there was a reduction of factor XII during the treatment. It is possible to assume in the TC group and, to a lesser extent, also in the NTC group that endothelial cells liberate PAI-1 in the vascular lumen, which causes hypofibrinolysis. In addition, an excess of factor VIII is activated by endothelial dysfunction with subsequent activation of the coagulation cascade as shown by increased F1+2 and fibrinogen. ACA-IgM, in turn, is capable of interfering with the system of protein C, a potent anticoagulant factor that inactivates cofactors Va and VIIIa. They also induce the expression of procoagulant factors on the surface of the endothelial cells. In conclusion, the hypercoagulable state caused by alterations of coagulation and fibrinolytic factors is a cause of vascular access dysfunction and thrombosis of other vessels.