Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Apr 2012
Multicenter StudyProthrombin complex concentrate (Octaplex): a Portuguese experience in 1152 patients.
In emergency/clinical practice it is often necessary to restore the balance of blood coagulation: the rapid reversal of oral anticoagulant therapy (OAT) is crucial in cases of serious acute bleeding and emergency surgery in patients with high international normalized ratios (INRs). Coagulation can be normalized via the application of haemostatic products, including fresh frozen plasma (FFP) or prothrombin complex concentrates (PCCs). Guidelines recommend PCCs for the reversal of OAT in preference to FFP in patients with major/life-threatening bleeding and high INRs. ⋯ No adverse drug reactions or thromboembolic events were reported. Octaplex effectively and significantly reduces INR values in patients requiring the restoration of blood coagulation. It effectively reverses the effect of OAT and was efficacious in the majority of bleeding episodes in patients with liver dysfunction.
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Blood Coagul. Fibrinolysis · Mar 2012
Case ReportsSuccessful management of hereditary angioedema during tonsillectomy: a case report.
Hereditary angioedema (HAE) is a rare genetic disorder causing a deficiency in C1 esterase inhibitor (C1-INH) that is manifested through unpredictable oedema. We describe a case of a patient with HAE who had previously been refused surgery for tonsillitis due to the potential for oedema, in whom regular monitoring of C1-INH levels combined with intensified therapy with danazol, tranexamic acid and C1-INH concentrate enabled an uncomplicated procedure with no oedema crisis. However, clinicians should be alerted that higher overall dosages of C1-INH concentrate for perioperative prophylaxis may be required than those typically used to treat acute HAE attacks.
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Blood Coagul. Fibrinolysis · Mar 2012
Application of thrombelastography in liver injury induced by endotoxin in rat.
Liver injury developing in patients with sepsis may lead to an increased risk of mortality. Thrombelastography (TEG) is generally applied to evaluate hemostatic disturbance in patients undergoing liver transplantation or cardiopulmonary bypass. The aim of this study was to investigate the development of liver injury and coagulopathy in a lipopolysaccharide (LPS)-induced animal model and to assess the relationship between TEG variables and liver injury. ⋯ Thereafter, α-angle and maximal amplitude were decreased progressively, demonstrating that endotoxin induced coagulation disturbances. Furthermore, there were strong positive correlation between K-time and natural log (Ln)(ALT) (r = 0.823, P = 0.001); also, there were strong negative correlations between α-angle and Ln(ALT) (r = -0.762, P = 0.002) as well as maximal amplitude and Ln(ALT) (r = -0.732, P = 0.004) at 6 h after LPS infusion. These results demonstrated that TEG could be a potential tool to evaluate the development of liver injury in endotoxemia.
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Blood Coagul. Fibrinolysis · Dec 2011
Egyptian experience of reliability of 4T's score in diagnosis of heparin induced thrombocytopenia syndrome.
To evaluate the utility of the 4Ts clinical scoring system as a pretest probability method for detection of heparin-induced thrombocytopenia (HIT). Medical and surgical inpatients and outpatients at Kasr El Eini hospital. This single-centre series of 50 HIT testing referrals assessed combination of clinical score (thrombocytopenia, timing, thrombosis, other causes of thrombocytopenia not evident; 4T's), Heparin platelet factor 4 (H-PF4) rapid particle gel immunoassay (PaGIA) and 14C serotonin release assay (SRA) to develop a practical and well tolerated diagnostic strategy for HIT. ⋯ The negative predictive value of a low 4T's score was 100%, effectively ruling out HIT. A low 4Ts score supports low probability of HIT based on the results of the PaGIA and SRA. Overall, the interrater reliability of the scoring system was fair.
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Blood Coagul. Fibrinolysis · Dec 2011
Carbon monoxide and nitric oxide modulate α₂-antiplasmin and plasmin activity: role of heme.
Cigarette smoke and carbon monoxide (CO) released from tricarbonyldichlororuthenium (II) dimer (CORM-2) attenuate fibrinolysis. The purpose of the present study was to determine whether CO diminished fibrinolysis by enhancement of α₂-antiplasmin via a putative heme group. Plasma, isolated α₂-antiplasmin and isolated plasmin were exposed to CO released from CORM-2 and nitric oxide (NO) via a NO donor to induce carboxyheme and metheme states, respectively. ⋯ CO elicits hypofibrinolysis by enhancing α₂-antiplasmin activity and decreasing plasmin activity. On the basis of the responses to NO and LC-MS/MS data, it is highly likely that both enzymes are modulated by attached heme groups. Efforts to develop methods to detect CO-mediated hypercoagulability are ongoing, with the goal of identifying populations at risk of thrombotic morbidity secondary to cigarette smoking.