FIBRINOLYTIC RESPONSE AFTER VENOUS OCCLUSION AND DDAVP IN PATIENTS WITH DEEP VENOUS THROMBOSIS

1987 ◽  
Author(s):  
M Kozak ◽  
D Keber
Keyword(s):  
Hydrostatic Pressure ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Venous Occlusion ◽  
Venous Stasis ◽  
Clot Lysis ◽  
Postthrombotic Syndrome ◽  
Before And After ◽  
The Difference ◽  
Fibrinolytic Potential

After prolonged stimulation venous endothelium becomes refractory to otherwise efficacious stimuli for tissue plasminogen activator (t-PA) release. When the stimulus is removed, the restitution of the response is observed. The distention of the veins distally from the occlusion site in deep venous thrombosis (DVT) could represent such a chronic stimulus. We studied t-PA release in patients with DVT during 20-min venous occlusion (VO) and DDAVP infusion (0,4 ug/kg b.w. in 10 min). t-PA release was estimated as the difference in euglobulin clot lysis time (ECLT in U) and fibrin plates (FP in mm2) before and after VO (fibrinolytic potential). Two groups of patients were studied: 15 recumbent patients with oneside iliofemoral DVT, and 15 patients with oneside postthrombotic syndrome.In both groups the response of legs was lower than that of arms. The comparison of the healthy and the affected leg in postthrombotic group showed no difference in t-PA release after VO. A higher release of t-PA was seen in the acute DVT group in all three tested limbs, explainable by a restitution of fibrinolytic potential due to the reduction of hydrostatic stimulus. However, the response was slightly lower in the diseased leg. In 5 patients from the acute DVT group DDAVP infusion induced higher t-PA release after VO in both legs compared to VO before DDAVP. We can conclude that hydrostatic pressure in upright position is such a strong stimulus that an additional decrease of t-PA release due to chronic venous stasis cannot be expressed. In recumbent patients DVT hinders the restitution of the response to V0 in the diseased leg. DDAVP seems to act independently of hydrostatic pressure and venous stasis.

The Increase of Leg Fibrinolytic Potential After Reduction of Hydrostatic Stimulus

1983 ◽  
Vol 50 (03) ◽  
pp. 731-734 ◽  
Author(s):  
Dušan Keber
Keyword(s):  
Plasminogen Activator ◽  
Venous Occlusion ◽  
Clot Lysis ◽  
The Third ◽  
Lysis Time ◽  
Before And After ◽  
Euglobulin Clot Lysis Time ◽  
The Difference ◽  
Fibrinolytic Potential ◽  
Clot Lysis Time

SummaryEleven patients were studied sequentially from the beginning of recumbency due to trauma up to the complete mobilization. The first blood sampling was performed 12 hr to 4 days after injury, the second after 12 to 33 days of recumbency and the third after one or more months of mobilization. The blood was drawn each time before and after venous occlusion of the arm and the leg for 20 min. Fibrinolytic potential was calculated as the difference between post- and preocclusion values of plasminogen activator activity, measured with the euglobulin clot lysis time (ECLT) and on fibrin plates. The results showed that fibrinolytic potential of legs after the period of recumbency was approaching that of the arms, being ten times higher as measured with ECLT and five times higher as measured on fibrin plates in comparison with the period after mobilization. It was concluded that hydrostatic pressure was the main, if not the only factor responsible for the difference in the content of plasminogen activator in veins of arms and legs and their fibrinolytic potential.

Risk factors of postthrombotic syndrome before and after deep venous thrombosis treatment

2016 ◽  
Vol 32 (6) ◽  
pp. 384-389 ◽  
Author(s):  
Rob HW Strijkers ◽  
Mark AF de Wolf ◽  
Cees HA Wittens
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Treatment Options ◽  
Postthrombotic Syndrome ◽  
Factor X ◽  
Catheter Directed Thrombolysis ◽  
Before And After ◽  
Patient Selection Criteria ◽  
The Moment

Postthrombotic syndrome is the most common complication after deep venous thrombosis. Postthrombotic syndrome is a debilitating disease and associated with decreased quality of life and high healthcare costs. Postthrombotic syndrome is a chronic disease, and causative treatment options are limited. Prevention of postthrombotic syndrome is therefore very important. Not all patients develop postthrombotic syndrome. Risk factors have been identified to try to predict the risk of developing postthrombotic syndrome. Age, gender, and recurrent deep venous thrombosis are factors that cannot be changed. Deep venous thrombosis location and extent seem to predict severity of postthrombotic syndrome and are potentially suitable as patient selection criteria. Residual thrombosis and reflux are known to increase the incidence of postthrombotic syndrome, but are of limited use. More recently developed treatment options for deep venous thrombosis, such as new oral factor X inhibitors and catheter-directed thrombolysis, are available at the moment. Catheter-directed thrombolysis shows promising results in reducing the incidence of postthrombotic syndrome after deep venous thrombosis. The role of new oral factor X inhibitors in preventing postthrombotic syndrome is still to be determined.

Changes in Clotting and Fibrinolytic Parameters Produced by Venous Stasis

1996 ◽  
Vol 2 (1) ◽  
pp. 64-68
Author(s):  
Raul Altman ◽  
Alejandra Scazziota ◽  
Jorge Rouvier
Keyword(s):  
Sodium Citrate ◽  
Vascular Endothelial Cells ◽  
Protein S ◽  
Venous Occlusion ◽  
Venous Stasis ◽  
Clot Lysis ◽  
Before And After ◽  
Fibrinolytic Parameters ◽  
Pai 1

Vascular endothelial cells have thrombosis- prevention properties through the release of some fibri nolytic factors. This capacity of endothelium was studied using the venous occlusion test (VOT) and measuring proteins released during stasis. Blood samples were col lected before and after 10 and 20 min VOT in tubes con taining sodium citrate at pH 7.0 or 4.3. A significant shortening of the euglobulin clot lysis time (ECLT) was obtained 10 and 20 min after VOT in plasma collected in citrate pH 7.0 or 4.3. No statistical difference was noted between results obtained 10 and 20 minutes after VOT. The shortening was related to the increase of tissue plas minogen activator (t-PA) released during VOT. No differ ence was detected in the concentration of tissue plasmin ogen activator inhibitor 1 (PAI-1), but PAI-1 activity mea sured in plasma from blood collected in citrate pH 7.0 decreased progressively from 10.8 ± 9.2 arbitrary units (AU)/ml to 3.76 ± 4.5 AU/ml and 0.8 ± 1.02 AU/ml (p < 0.001) after 10 and 20 min, respectively, of stasis. When the PAI-1 activity was determined in blood collected in citrate pH 4.3 for preventing in vitro complexing of PAI-1 and t-PA, results were different: PAI-1 activity decreased from a basal value of 29.2 ± 15.3 AU/ml to 24.9 ± 12.2 ( p = NS) and 18.7 ± 11.5; p < 0.02) 10 and 20 min after VOT. As result of fibrinolytic activation, other factors were modified: increase of plasminogen activators, de crease of plasminogen, and increase of D-dimer. Fibrin ogen, fibronectin, protein C, protein S, von Willebrand factor, and tissue factor pathway inhibitor concentration remained unchanged after VOT. According to our find ings, VOT can be performed with a stasis of 10 min. Good responders are related to the endothelial capacity for re leasing t-PA and urokinase-type PA (u-PA) and defined as those with an ECLT of <60 min after 10 min VOT when blood was collected in sodium citrate pH 7.0.

IDENTIFICATION OF A FIBRINOLYTIC DEFECT IN TWO FAMILIES WITH A TENDENCY TO THROMBOSIS

1987 ◽  
Author(s):  
H Ostermann ◽  
S Koenig ◽  
H Pollmann ◽  
U Schmitz-Huebner
Keyword(s):  
Venous Thrombosis ◽  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Venous Occlusion ◽  
Fibrinolytic System ◽  
Tissue Type ◽  
Clot Lysis ◽  
Normal Range ◽  
Before And After ◽  
Euglobulin Clot Lysis Time

We identified two families in whom one member each suffered from deep venous thrombosis and subsequent pulmonary emboli at the age of 15 and 17. We were able to investigate several members of both families with regard to their fibrinolytic system. Blood sampling was done before and after ten minutes of venous occlusion. Parameters measured were euglobulin clot lysis time (ECLT), tissue-type plasminogen activator (t-PA) activity, t-PA concentration and plasminogen activator inhibitor (PAI) activity, besides several other constituents of the coagulation and fibrinolytic system commonly associated with thrombophilia.In the first family six persons could be evaluated. A prolonged ECLT was found in four probands. Three of them had no measurable t-PA activity after stasis, t-PA concentration after stasis was below the normal range in two and borderline in one of them.In the second family 13 members could be invest-gated. Three adults were found to have a prolonged ECLT. Two of these had very low t-PA activity after stasis, with normal increase in t-PA antigen. Their PAI was increased above the normal range. Six children showed no measurable PAI and increased levels of t-PA activity before stasis. After stasis four children had a prolonged ECLT. Two of them had low t-PA antigen levels, while all of them showed normal t-PA activity increases.These findings suggest, that there may be hereditary defects related to activators and inhibitors of the fibrinolytic system in the investigated families. These could possibly be responsible for the occurence of venous thrombosis early in life. However, results in the second family show that not all of the prolonged ECLT values can be explained by changes of t-PA and PAI.

scholarly journals Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Hiroto Moriwaki ◽  
Nana Hayama ◽  
Shouko Morozumi ◽  
Mika Nakano ◽  
Akari Nakayama ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Subclavian Vein ◽  
Elevated Serum ◽  
Venous Catheter ◽  
Filling Defect ◽  
Venous Occlusion ◽  
Postthrombotic Syndrome ◽  
Left Shoulder ◽  
Initial Examination

Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT) of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells.

A Plasma Clot Lysis Assay Based on the Release of Fibrin Degradation Products: Application to the Diagnosis of Hypofibrinolytic States

1990 ◽  
Vol 63 (01) ◽  
pp. 076-081 ◽  
Author(s):  
Pascale Gaussem ◽  
Sophie Gandrille ◽  
Pascale Molho-Sabatier ◽  
Loïc Capron ◽  
Jean-Noël Fiessinger ◽  
...  
Keyword(s):  
Degradation Products ◽  
Venous Occlusion ◽  
Lower Limbs ◽  
Clot Lysis ◽  
Plasma Clot ◽  
Vein Thrombosis ◽  
Fibrin Degradation Products ◽  
Before And After ◽  
Euglobulin Clot Lysis Time ◽  
Pai 1

SummaryUsing a monoclonal antibody-based assay, we measured the fibrin degradation product release in the supernatant of plasma clots obtained before and after venous occlusion (VO) in 30 patients with definite or suspected vascular thrombosis (19 definite and 2 suspected deep vein thrombosis, 6 recurrent superficial thrombophlebitis, 3 arterial occlusions of lower limbs). tPA and PAI-1 concentrations were determined using ELISA assays; the post-occlusion values were corrected for haemoconcentration. The increase in tPA during VO was correlated with haemoconcentration (r = 0.74), but 3 patients had ineffective VO (<2% increase in proteins). The fibrinolytic response to VO was evaluated using the shortening of the time necessary for the release of 200 μg of fibrin degradation products per mg of fibrinogen (Δ T 200). Two among the 27 patients with effective VO were bad responders with a Δ T 200 <3 h (whereas all the others had Δ T 200 >10 h). These patients had respectively a deficient tPA release (Δ tPA = 1 ng/ml) and an elevated PAI-1 level at rest (33 ng/ml). Several other patients were bad responders in terms of tPA release or of shortening of the euglobulin clot lysis time but they had a normal Δ T 200. This plasma clot test reflects the ability of free tPA to bind to fibrin (the amount of which depends on the level of tPA and PAI-1), and may be useful in the diagnosis of a hypofibrinolytic state.

Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

1985 ◽  
Vol 53 (02) ◽  
pp. 278-281 ◽  
Author(s):  
H Asbjørn Holm ◽  
Ulrich Abildgaard ◽  
Sigmund Kalvenes
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Thrombin Time ◽  
Heparin Infusion ◽  
Retroperitoneal Bleeding ◽  
Heparin Activity ◽  
The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

PHYSICAL ACTIVITY RELEASES TISSUE PLASMINOGEN ACTIVATOR FROM EXERCISING PARTS OF BODY

1987 ◽  
Author(s):  
I Keber ◽  
K Potisk ◽  
D Keber ◽  
M Stegnar ◽  
N Vene
Keyword(s):  
Physical Activity ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Fibrinolytic Activity ◽  
Venous Occlusion ◽  
Clot Lysis ◽  
Lysis Time ◽  
Tissue Plasminogen ◽  
Euglobulin Clot Lysis Time ◽  
The Difference

To determine the origin of tissue plasminogen activator (t-PA) release during physical activity, we studied the separate and combined effects of venous occlusion and acute physical activity on t-PA release in arm and leg. In 15 healthy volunteers 20 min venous occlusions of arm and leg were performed simultaneously before physical activity ( maximal stress testing on treadmill)(occlusion I), immediately after physical activity and 45 min later (occlusion II). Blood samples were drawn from unoccluded arm before occlusion and after physical activity, and from occluded arm and leg after occlusion. Fibrinolytic activity was measured by euglobulin clot lysis time (ECLT) and t-PA activity assay. The amount of released t-PA during different stimuli (fibrinolytic potential) was calculated as the difference between post- and prestimulation fibrinolytic activity. Before physical activity there was a great increase in fibrinolytic activity due to t-PA in the occluded arm but no increase in the occluded leg. Physical activity itself caused a similar increase of systemic fibrinolytic activity as arm occlusion locally. After physical activity arm occlusion evoked equally good response than before it. Fibrinolytic activity during leg occlusion behaved differently: there was an increase in t-PA activity in the occluded leg which persisted one hour after physical activity, when systemic fibrinolytic activity already fell to initial level.These results demonstrated that walking and running triggered t-PA release from the leg vessels. Since leg occlusion was not a stimulus for t-PA release, it served only as a method to demonstrate the effect of physical activity.

scholarly journals Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome

2017 ◽  
Vol 16 (4) ◽  
pp. 304-307
Author(s):  
Eduardo Simões Da Matta
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Plantar Flexion ◽  
Compression Therapy ◽  
Stiffness Index ◽  
Postthrombotic Syndrome ◽  
Static Stiffness ◽  
Valve Mechanism ◽  
Muscle Strengthening ◽  
Post Thrombotic Syndrome

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

scholarly journals Duplex doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities

2006 ◽  
Vol 59 (1-2) ◽  
pp. 11-14 ◽  
Author(s):  
Viktorija Vucaj-Cirilovic ◽  
Kosta Petrovic ◽  
Olivera Nikolic ◽  
Viktor Till ◽  
Dijana Niciforovic ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Doppler Ultrasonography ◽  
Varicose Veins ◽  
Color Doppler ◽  
Lower Extremities ◽  
Postthrombotic Syndrome ◽  
Duplex Doppler ◽  
Age Range

Introduction. The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. Material and methods. During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619(72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro color doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. Results. 185 (21%) patients had DVT, 366 (42.5%) patients had pre?dominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. Conclusions. Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy. .

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