Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jan 2011
Carbon monoxide releasing molecule-2 attenuates the anticoagulant and amplifies the hypofibrinolytic effects of hypothermia in human plasma in vitro.
Hypothermia is known to contribute to coagulopathy in trauma and other major surgical procedures. Although the effects of hypothermia on coagulation have been characterized, the effects on fibrinolysis remained to be elucidated. Thus, our goals were to discern the effects of hypothermia on fibrinolysis in human plasma, and secondarily determine if a new procoagulant/antifibrinolytic molecule, carbon monoxide releasing molecule (tricarbonyldichlororuthenium (II) dimer; CORM-2) would modify thrombus growth/disintegration under hypothermic conditions. ⋯ Hypothermia resulted in slower growing, slower lysing thrombi in normal plasma. CORM-2 enhanced coagulation and markedly attenuated fibrinolysis at all temperatures tested. Further investigation is warranted to determine if CORM-2 administration can improve hemostasis in preclinical models of hypothermia and trauma.
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Blood Coagul. Fibrinolysis · Dec 2010
Randomized Controlled Trial Multicenter StudyComparison of tinzaparin and acenocoumarol for the secondary prevention of venous thromboembolism: a multicentre, randomized study.
The objective of the present study was to evaluate the efficacy, safety and healthcare resource utilization of long-term treatment with tinzaparin in symptomatic patients with acute pulmonary embolism as compared to standard therapy. In this open-label trial, 102 patients with objectively confirmed pulmonary embolism were randomized to receive, after initial treatment with tinzaparin, either tinzaparin (175 IU/kg/day) or international normalized ratio-adjusted acenocoumarol for 6 months. Clinical endpoints were assessed during the 6 months of treatment. ⋯ Median hospital length of stay was shorter in the tinzaparin group compared to the acenocoumarol group (7 versus 9 days; P = 0.014). When all the direct and indirect cost components were combined for the entire population, we found a slight, nonstatistically significant (mean difference €345; 95% CI 1382-2071; P = 0.69) reduction in total cost with tinzaparin. Symptomatic acute pulmonary embolism treatment with full therapeutic doses of tinzaparin for 6 months is a feasible alternative to conventional treatment with vitamin K antagonists.
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Blood Coagul. Fibrinolysis · Dec 2010
Targeted ultrasound is the procedure of choice for detecting rudimentary branchial cysts causing jugular and subclavian vein thrombosis.
The aim of this study was to facilitate the imaging diagnosis of branchial cysts leading to combined jugular and subclavian vein thrombosis during ovarian hyperstimulation syndrome (OHSS). Three women developed combined jugular and subclavian vein thrombosis following OHSS related to assisted reproductive technologies. The imaging modalities used for diagnosis were a bimode Doppler ultrasound, MRI of the neck in two women, computed tomography (CT) angiography and venography in one. ⋯ Venography was performed in one patient; it demonstrated the thrombosed vein possibly with some extrinsic compression, but it could not define a cyst. Targeted ultrasound is the simplest and best imaging modality for discerning rudimentary cysts in pregnant women with OHSS who present with jugular and subclavian vein thrombosis following assisted reproductive technology. A search for the cyst at the time of OHSS is important, as early detection could decrease the risk of developing thrombosis.
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Blood Coagul. Fibrinolysis · Oct 2010
Comparative StudyClot formation in canine whole blood as measured by rotational thromboelastometry is influenced by sample handling and coagulation activator.
The objective of the present study was to systematically evaluate the impact of methodology on thromboelastometry with canine whole blood. Thromboelastometry was performed on citrated blood using a variety of combinations of clotting activators [ex-tem (tissue factor or TF), in-tem (ellagic acid), diluted TF from Innovin, or Ca (recalcification only)] and storage times. Thromboelastometry was also performed using diluted TF from Innovin on blood collected into a contact inhibitor. ⋯ Canine blood underwent markedly more ex-vivo contact activation than did human blood. Canine blood undergoes significant ex-vivo contact activation during and after collection, which influences thromboelastometry results when a weak clotting activator (such as low TF or recalcification) is used. Thromboelastometry with a strong activator (such as ex-tem or in-tem) is less influenced by ex-vivo changes, and, therefore, likely to be more reflective of in-vivo hemostatic capabilities and to provide consistently interpretable and comparable results.
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Blood Coagul. Fibrinolysis · Oct 2010
Clinical TrialUse of fibrin-based thromboelastometry for cryoprecipitate transfusion in cardiac surgery involving deep hypothermic circulatory arrest during cardiopulmonary bypass.
We aimed to assess the predictive value of fibrin-based thromboelastometry performed before weaning from cardiopulmonary bypass (CPB) for cryoprecipitate administered to correct the bleeding diathesis after CPB involving deep hypothermic circulatory arrest. Eleven patients undergoing aortic surgery were enrolled. The arterial blood was withdrawn before skin incision, 30 min before CPB weaning (Cweaning), 5 min after protamine reversal (Preversal) and at closure of the sternum to run intrinsically activated INTEM, heparinase-treated HEPTEM, extrinsically activated EXTEM and platelet-inhibited FIBTEM analysis, platelet count, fibrinogen, prothrombin time (international normalized ratio) and activated partial thromboplastin time. ⋯ FIBTEM A10 at Preversal and Cweaning showed correlations as follows: FIBTEM A10 at Preversal = 0.02 + 1.42 × FIBTEM A10 at Cweaning (r² = 0.80). The cut-off value for FIBTEM A10 at Cweaning to determine whether to prepare cryoprecipitate in advance during CPB was calculated to be 3 mm, and the positive and negative predictability for FIBTEM A10 of 3 or less versus more than 3 at Cweaning for the necessity of cryoprecipitate transfusion at Preversal (A10 ≤ 5 versus > 5) were 100 and 80%, respectively. This study showed that fibrinogen reflected in FIBTEM during pump can be used to estimate FIBTEM after Preversal and the amount of cryoprecipitate needed for replacing mainly the fibrinogen could be predicted with high sensitivity and specificity.