Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Oct 2015
Randomized Controlled TrialOvine platelet function is unaffected by extracorporeal membrane oxygenation within the first 24 h.
This study investigated platelet dysfunction during short-term extracorporeal membrane oxygenation (ECMO) and secondarily to determine if hyperoxaemia contributes to this dysfunction. Healthy sheep were anaesthetized and maintained on ECMO for either 2 or 24 h, with or without induction of smoke inhalation acute lung injury. A specialized animal-operating theatre was used to conduct the experimentation. ⋯ However, dysfunction in ADP-dependent platelet activity may have continued to develop if observed beyond 24 h. Hyperoxaemia during ECMO does appear to affect how platelets react to ADP and may contribute to this developing dysfunction. Long-term animal models and investigation in clinical animals are warranted to fully investigate platelet function during ECMO.
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Blood Coagul. Fibrinolysis · Oct 2014
Randomized Controlled TrialAdministering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty.
This study aimed to compare the efficacy and safety of aspirin, rivaroxaban and low-molecular-weight heparin (LMWH) for post total knee arthroplasty (TKA) deep vein thrombosis (DVT) prophylaxis. Between July 2011 and July 2013, a prospective randomized controlled trial was performed on 324 patients with osteoarthritis who underwent primary unilateral TKA. Twelve hours after the surgery, Group A was given oral rivaroxaban at a dose of 10 mg/day. ⋯ Rivaroxaban has a positive anticoagulation effect but leads to increases in both postoperative blood loss and wound complications in patients. Hence, clinicians using rivaroxaban for anticoagulant therapy should closely monitor the changes in the hemoglobin level and wound healing and promptly supplement blood volume and provide other symptomatic and supportive treatments. No significant difference in post-TKA DVT prophylaxis was found between aspirin and LMWH, and the former can be used as part of a multimodal anticoagulation therapy.
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Blood Coagul. Fibrinolysis · Apr 2014
Randomized Controlled TrialContinuous or discontinuous tranexamic acid effectively inhibits fibrinolysis in children undergoing cardiac surgery with cardiopulmonary bypass.
Tranexamic acid is given continuously or discontinuously as an anti-fibrinolytic therapy during cardiac surgery, but the effects on fibrinolysis parameters remain poorly investigated. We sought to assess the effects of continuous and discontinuous tranexamic acid on fibrinolysis parameters in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat surgery by sternotomy with CPB for congenital heart disease were randomized to receive either continuous or discontinuous tranexamic acid. ⋯ Tranexamic acid inhibited the CPB-induced increase in D-dimers, with a similar potency between continuous and discontinuous regimens. Time courses for tPA, fibrin monomers, and fibrinogen were also similar for both regimen, and there was a significant difference in tPA-PAI1 complex concentrations at the end of surgery, which may be related to a significantly higher tranexamic acid concentration. Continuous and discontinuous regimen are suitable for an effective inhibition of fibrinolysis in children undergoing cardiac surgery with CPB, but the continuous regimen was previously shown to be more effective to maintain stable tranexamic acid concentrations.
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Blood Coagul. Fibrinolysis · Sep 2013
Randomized Controlled TrialCorrelation between D-dimer levels and coronary artery reperfusion in acute myocardial infarction patients after thrombolytic treatment.
The correlation between plasma D-dimer level and reperfusion has not been clarified yet in thrombolytic therapy applied for acute myocardial infarction patients. The aim of this study was to investigate whether there is a relationship between reperfusion and fibrinolytic activity in acute myocardial infarction patients treated with thrombolytic therapy. Fibrinolytic activity was reflected by plasma D-dimer levels. ⋯ D-dimer levels were markedly high after thrombolytic therapy versus before (155 mg/dl, 362 mg/dl, P<0.005). We compared the D-dimer values before and after thrombolytic therapy between reperfused group and the nonreperfused group (189-409 mg/l in reperfused group, P=0.086; 82-258 mg/l in the nonreperfused group, P=0.173). In conclusion, in this study, D-dimer levels were elevated markedly in patients with ST elevation myocardial infarction after thrombolytic therapy, but no significant difference was seen in D-dimer levels between the reperfused and nonreperfused groups.
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Blood Coagul. Fibrinolysis · Oct 2012
Randomized Controlled TrialResidual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery: effects on clinical hemostatic and ex-vivo rheological parameters.
The study compared the effects of three blood concentration techniques after cardiopulmonary bypass on clinical hemostatic and ex-vivo rheological parameters. Residual blood of patients undergoing elective cardiac surgery was processed by centrifugation, cell salvage or ultrafiltration, and retransfused (n = 17 per group). Study parameters included blood loss, (free) hemoglobin, hematocrit, fibrinogen and erythrocyte aggregation, deformability and 2,3-diphosphoglycerate content. ⋯ Cell salvage resulted in the lowest hemolysis levels in the transfusion bag. Retransfusion of cell saver blood induced the largest gain in postoperative patient hemoglobin levels when compared to centrifugation and ultrafiltration, and was associated with the largest increase in 2,3-diphosphoglycerate when compared to ultrafiltration (Δ2,3-diphosphoglycerate 1.34 ± 1.92 vs. -0.77 ± 1.56 mmol/l; P = 0.03). Cell salvage is superior with respect to postoperative hemoglobin gain and washout of free hemoglobin when compared to centrifugation or ultrafiltration.