Seminars in thrombosis and hemostasis
-
Semin. Thromb. Hemost. · Jan 1995
Review Comparative StudyThromboelastography and cardiopulmonary bypass.
The TEG tracks postoperative hemorrhage after CPB and is useful in guiding therapy. Its ability to characterize the overall interaction of all procoagulant participants in a final outcome (clot strength) is unique. Much work in the future is needed to establish the particular applications for TEG monitoring in CPB patients
-
The contribution of platelet dysfunction to the impaired hemostasis after cardiac surgery remains to be established, because there is no sensitive method to assess platelet function. Measurement of the shear-induced pathway of platelet function, an important mechanism in inducing hemostasis, became possible by a novel shear-inducing technique, the in-vitro bleeding test (Thrombostat 4000). By using this test, the changes in platelet function during cardiopulmonary bypass and their contribution to hemostasis were investigated in patients undergoing cardiac surgery. ⋯ These results indicate the significant and variable effects of cardiopulmonary bypass on the shear-induced pathway of platelet function. Moreover, the impairment of this function of platelets appears to be a major cause of excessive bleeding in patients after cardiac surgery. Therefore, the routine use of the shear-inducing test seems helpful to make a proper diagnosis and design the therapy for bleeders after cardiac surgery.
-
Semin. Thromb. Hemost. · Jan 1993
Randomized Controlled Trial Clinical TrialLow molecular weight heparin for the prevention of thromboembolism in outpatients immobilized by plaster cast.
In an open, randomized, prospective, interindividual trial, the incidence of thrombosis with (n = 126) and without (n = 127) LMWH prophylaxis once a day was determined in 253 outpatients immobilized in a plaster cast due to an injury of the lower limb. Furthermore, the influence of possible risk factors on the thrombus formation was determined. The histories of the patients were comparable. ⋯ Crucial risk factors were age over 30 years, obesity, varicose veins, and fractures. Patients without prophylaxis who had fractures developed DVT in 29% in contrast to 11.3% in patients with soft-tissue injuries. This study shows that LMWH prophylaxis should be mandatory for plaster cast immobilized patients regardless of preexisting risk factors for thromboembolism.