Extrinsic Pathway Inhibitor in Elective Surgery: A Comparison with other Coagulation Inhibitors

1989 ◽  
Vol 62 (03) ◽  
pp. 856-860 ◽  
Author(s):  
P M Sandset ◽  
H E Høgevold ◽  
T Lyberg ◽  
T R Andersson ◽  
U Abildgaard
Keyword(s):  
Vascular Surgery ◽  
Protein C ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Acute Phase Reactant ◽  
Hip Surgery ◽  
Albumin Concentration ◽  
Extrinsic Pathway ◽  
Heparin Cofactor Ii ◽  
Coagulation Inhibitors

SummaryExtrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of anti thrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.

“NEW” COAGULATION INHIBITORS LEVELS IN PNEUMONIA DISSEMINATED INTRAVASCULAR COAGULATION AND LIVER DISEASES

1987 ◽  
Author(s):  
T R Andersson ◽  
H Bell ◽  
P M Sandset ◽  
O R Ødegaard ◽  
L-M Aamodt
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Liver Diseases ◽  
Dermatan Sulfate ◽  
Acute Phase Reactant ◽  
Activity Levels ◽  
Extrinsic Pathway ◽  
Heparin Cofactor Ii ◽  
Intravascular Coagulation ◽  
Coagulation Inhibitors ◽  
Low Levels

The activity levels of the “new” coagulation inhibitors, heparin cofactor II (HC II) and extrinsic pathway inhibitor (EPI),have been determined with chromogenic substrates assays, in patients with pneumonia (n=8), disseminated intravascular coagulation (DIC) (n=8) and various liver diseases (n=19). For comparison antithrombin (AT) and Protein C (PC) were also measured. In cases with DIC low values (<50%) for HC II,AT and PC were found, while EPI showed a much greater variation (60-190%). Persistent low values heralds a poor prognosis.In survivors is rapidly normalized. In pneumonia , initially low levels (except HC II),were normalized on day 7. HC II may be an acute phase reactant.Conclusion.In cirrhosis, subnormal HC II values suggests reduced synthesis.High EPI values in cirrhosis suggests extrahepatic synthesis.The mechanisms for reduced HC II in DIC,might besides consumption and reduced synthesis, be the liberation of dermatan sulfate from injured intima with increased consumption. Changes in HC II,AT and PC are similar, whereas EPI seems to have different production and metabolism

EXTRINSIC PATHWAY INHIBITOR (EPI) DURING ELECTUVE SUGERY : A COMPARISON WITH OTHER COAGULATION INHIBITORS

1987 ◽  
Author(s):  
P M Sandset ◽  
T R Anderson ◽  
O R Ødegaard ◽  
M L Larsen
Keyword(s):  
Potent Inhibitor ◽  
Hip Prosthesis ◽  
The Other ◽  
Factor Vii ◽  
Surgical Trauma ◽  
Factor X ◽  
Extrinsic Pathway ◽  
Heparin Cofactor Ii ◽  
Coagulation Inhibitors ◽  
Tissue Thromboplastin

Hypercoagulation after surgical trauma is probably induced by tissue thromboplastin (TP) released into the circulation. EPI, in conjuction with activated factor x (FXa), is a potent inhibitor of the IP-factor VII complex. EPI levels (chromogenic substance assay) were compared to other inhibitors; antithrombin (AT), heparin cofactor II (HCII), andprotein C (PC) in patients undergoing cholecystectomy(n=4), hip prosthesis operation (n=5),and aortic grafts operationa(n=5) Mean AT and PC levels parallelled the decrease in albumin. HCII decreased more suggesting a real consumption ofsurgery. The changes in EPI levels depended on the type ofsurgery. In hip surgery, the decline in EI levels was marked and parallelled HCII. In constrast to the other inhibitors, EPI levels stayed low over the first week after surgery:In cholecystectomy, changes were less marked and all inhibitors behaved similar. During aortic operations, EPI increased from mean 110% preoperatively to 252% peroperatively. It decreased to 86% the first day after operation. It then increased similar to the other inhibitors, but the level stayed higher than expected from the preoperative value. The patients received 3000 IU heparin peroperatively.In conclusion, hip operations produce a sustained drop in EPI activity.In aortic operations injection of heparin induced a dramatic, shortlived increase peroperatively followed by a restoration to high normal levels.

Laboratory Evaluation and Clinical Characteristics of 2,132 Consecutive Unselected Patients with Venous Thromboembolism – Results of the Spanish Multicentric Study on Thrombophilia (EMET*-Study)

1997 ◽  
Vol 77 (03) ◽  
pp. 444-451 ◽  
Author(s):  
José Mateo ◽  
Artur Oliver ◽  
Montserrat Borrell ◽  
Núria Sala ◽  
Jordi Fontcuberta ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Odds Ratio ◽  
Protein C ◽  
Protein S ◽  
Laboratory Evaluation ◽  
Clinical Factors ◽  
Recurrent Thrombosis ◽  
Heparin Cofactor Ii ◽  
Crude Odds Ratio ◽  
History Of

SummaryPrevious studies on the prevalence of biological abnormalities causing venous thrombosis and the clinical characteristics of thrombotic patients are conflicting. We conducted a prospective study on 2,132 consecutive evaluable patients with venous thromboembolism to determine the prevalence of biological causes. Antithrombin, protein C, protein S, plasminogen and heparin cofactor-II deficiencies, dysfibrinoge-nemia, lupus anticoagulant and antiphospholipid antibodies were investigated. The risk of any of these alterations in patients with familial, recurrent, spontaneous or juvenile venous thrombosis was assessed. The overall prevalence of protein deficiencies was 12.85% (274/2,132) and antiphospholipid antibodies were found in 4.08% (87/2,132). Ten patients (0.47%) had antithrombin deficiency, 68 (3.19%) protein C deficiency, 155 (7.27%) protein S deficiency, 16 (0.75%) plasminogen deficiency, 8 (0.38%) heparin cofactor-II deficiency and 1 had dysfib-rinogenemia. Combined deficiencies were found in 16 cases (0.75%). A protein deficiency was found in 69 of 303 (22.8%) patients with a family history of thrombosis and in 205/1,829 (11.2%) without a history (crude odds ratio 2.34, 95% Cl 1.72-3.17); in 119/665 (17.9%) patients with thrombosis before the age of 45 and in 153/1,425 (10.7%) after the age of 45 (crude odds ratio 1.81, 95% Cl 1.40-2.35); in 103/616 (16.7%) with spontaneous thrombosis and in 171/1,516 (11.3%) with secondary thrombosis (crude odds ratio 1.58, 95% Cl 1.21-2.06); in 68/358 (19.0%) with recurrent thrombosis and in 206/1,774 (11.6%) with a single episode (crude odds ratio 1.78,95% Cl 1.32-2.41). Patients with combined clinical factors had a higher risk of carrying some deficiency. Biological causes of venous thrombosis can be identified in 16.93% of unselected patients. Family history of thrombosis, juvenile, spontaneous and recurrent thrombosis are the main clinical factors which enhance the risk of a deficiency. Laboratory evaluation of thrombotic patients is advisable, especially if some of these clinical factors are present.

Preoperative preparation of alcohol and psychoactive substances-addicted patients

2011 ◽  
Vol 58 (2) ◽  
pp. 151-155
Author(s):  
Ivan Dimitrijevic ◽  
Zoran Zoricic ◽  
Miodrag Milenovic ◽  
Ivan Palibrk ◽  
Draga Dimitrijevic ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Psychoactive Substance ◽  
Preoperative Preparation ◽  
Psychoactive Substances ◽  
Key Issues ◽  
Proper Diagnosis

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.

scholarly journals Regional oxymetry provides safety of the patient during cardiaс surgery

2015 ◽  
Vol 18 (3) ◽  
pp. 53 ◽  
Author(s):  
B. A. Akselrod
Keyword(s):  
Cardiac Surgery ◽  
Vascular Surgery ◽  
Oxygen Transport ◽  
State Of The Art ◽  
Perioperative Period ◽  
Risk Groups ◽  
The State ◽  
Ischemic Damage

The state-of-the-art regional oxygenation evaluation during perioperative period in cardiac surgery is presented. The importance of a regional oxymetry method based on NIRS and used to assess hemodynamic efficiency during anesthesia is demonstrated. This method helps to increase the safety of patients during cardiac and vascular surgery due to a decrease of tissue ischemic damage. Regional oxymetry enables to evaluate oxygen transport adequacy, identify the risk groups and modify the therapy used. Disadvantages and limitations of the regional oxymetry method are also discussed.

Prophylaxis Against Postoperative Thromboembolic Complications. A Comparison Between Dextran 70, Dihydroergotamin Heparin and a Sulphated Polysaccarid

1979 ◽  
Author(s):  
D. Bergqvist ◽  
T. Hallböök ◽  
B. Lindblad
Keyword(s):  
Elective Surgery ◽  
Hip Surgery ◽  
Perfusion Scintigraphy ◽  
X Ray ◽  
Vein Thrombosis ◽  
Dextran 70 ◽  
Postoperative Thrombosis ◽  
Fibrinogen Test ◽  
Deep Vein ◽  
Low Dose Heparin

Dextran 70, a fixed combination of dihydroergotamine and low dose heparin (DHEH) and a sulphated polysaccarid (PZ68B) have been compared for prevention of postoperative thromboembolism. The trial has been prospective with separate randomization of patients undergoing elective general surgery, elective hip surgery and hip frecture surgery. Deep vein thrombosis has teen diagnosed with the 125 I-fibrinogen test. In patients undergoing elective hip surgery pulmonary x-ray and perfusion scintigraphy have been made preoperatively and on postoperative day 7, The patients have been followed for 30 days to detect late fatal pulmonary emboli. 253 patients have been studied -(34 exclusions), the main results being as follows:In conclusion there is a good and equal prophylactic effect against postoperative thrombosis of DHEH and PZ68E in elective surgery, and the two methods are as effective as dextran 70 in hip fracture patients.

scholarly journals Unusual association between spinal cord tumour and perioperative arrhythmia

2015 ◽  
Vol 02 (02) ◽  
pp. 127-129
Author(s):  
Vikas Chauhan ◽  
Ashish Bindra ◽  
Parmod Bithal
Keyword(s):  
Elective Surgery ◽  
Perioperative Period ◽  
Spinal Cord Tumour ◽  
Anaesthetic Agents ◽  
Catecholamine Excess ◽  
Intraoperative Period ◽  
Systemic Pathology ◽  
Preoperative Work Up ◽  
Work Up ◽  
Ventricular Ectopics

AbstractThere are multiple causes of perioperative arrhythmias. Some have underlying cardiac disease while others accompany systemic pathology. Use of anaesthetic agents in the intraoperative period is also a known cause of rhythm abnormalities. Preoperative benign arrhythmias may progress to serious ones in intraoperative period. The trigger may be a transient insult such as hypoxemia, cardiac ischaemia, catecholamine excess or electrolyte abnormality. Thus, presence of arrthymia in the preoperative period adds to preoperative work-up and especially in the elective surgery settings, they call for additional opinion and patient evaluation. However, not all arryhthmias are amenable to drug treatment and modalities like pacing, some require just careful watch in the perioperative period. We report a patient with thoracic intramedullary space occupying lesion who presented to us with multiple ventricular ectopics on electrocardiography, which eventually disappeared with tumour removal. The case highlights the association of multiple ectopics with spinal tumour and their management.

PROTEIN C ACTS AS AN ACUTE PHASE REACTANT IN EQUINE LAMINITIS

1987 ◽  
Author(s):  
K W Prasse ◽  
J N Moore ◽  
A Duncan
Keyword(s):  
Acute Phase ◽  
Protein C ◽  
Coagulation Factors ◽  
Acute Phase Reactant ◽  
Normal Range ◽  
Microvascular Damage ◽  
Acute Phase Reactants ◽  
Intravascular Thrombosis ◽  
Phase Reactant ◽  
Equine Colic

Equine Colic Syndrome is a disease of horses whose complications include laminatis.This term describes a situation where microvascular damage to the hoof causes degeneration of the interphalangeal laminae,leading to lameness. Vascular studies have suggested that microthrombosis involving the delicate vessels in the hoof,coupled with changes in the platelet count, coagulation factors & elevated FDP's implicate DIC as a potential etiology. Limited test capability in the horse has limited further evaluation of this hypothesis. We have developed an assay for equine protein C activity,our normal range being 70-60% (Mean+/- 2SD). We studied 12 horses with the disease for 5 consecutive days,drawing 1 blood sample per day. Our expectation was that protein C levels would decrease.if DIC was significant,as would be expected in humans. No significant decrease was noted in any horse. However there was a significant increase in the protein C levels beyond the upper limit of the normal range in 10 of the 12 horses by the third day. Five of the 10 horses maintained this elevation beyond the 5th day. Thus protein C changes were more consistent with an acute phase reactant response,rather than reflecting the decrease we anicipated,if the equine DIC parallels human DIC. We are measuring other acute phase reactants to see if equine protein C parallels those. Since our assay is still being evaluated,more data needs to be obtained in this and other equine disease states before any definative role for protein C in equine pathology can be determined. In our laminitis horses,we are devolping assays for antithrombin III and plasminogen which should allow us to evaluate the disease state more completley for any involement of elements of intravascular thrombosis and fibrinolysis in the equine colic syndrome.

scholarly journals Increased thrombin generation in a child with a combined factor IX and protein C deficiency

Blood ◽  
1993 ◽  
Vol 81 (3) ◽  
pp. 690-695 ◽  
Author(s):  
C Negrier ◽  
M Berruyer ◽  
A Durin ◽  
N Philippe ◽  
M Dechavanne
Keyword(s):  
Protein C ◽  
Factor Ix ◽  
Coagulation System ◽  
Activation Process ◽  
Extrinsic Pathway ◽  
Protein C Deficiency ◽  
Thrombotic Risk ◽  
Repeated Doses ◽  
Factor Ix Deficiency

Abstract We report a quantitative protein C deficiency combined with a factor IX deficiency in a one-year-old boy. The inheritance of the two deficiency states was independent, the factor IX defect coming from the mother and the protein C defect from the father. Both factor IX activity and antigen were below 1%, and protein C activity as well as antigen were close to 27% of normal values. This association raises a real therapeutic and prognostic question. Protein C deficiency is indeed associated with a significant thrombotic risk and some factor IX concentrates seem to carry a potential thrombogenicity, particularly following infusion of repeated doses. We evaluated in this patient the potential activation of the coagulation system by measuring the levels of prothrombin fragment F1 + 2 at the basal state and after a single administration of 20 U/kg of a high purity factor IX concentrate. We found an unexpected basal activation of the hemostatic system before infusion (F1 + 2 = 1.6 nmol/L), which further increased during 8 hours. Despite the clinical predominant expression of the hemophilic trait, our results seem to assess the biologic prevalence of the protein C deficiency. This emphasizes the need for a careful follow-up after infusions of repeated doses of factor IX, as used during a surgical procedure. Furthermore, this raises the question of the prognosis because the risk of thrombotic manifestations associated with a protein C deficiency increases with age. Finally, these results highlight a part of the in vivo activation process of prothrombin in case of failure of the intrinsic pathway of coagulation. The protein C defect seems to be responsible for an upregulation of the prothrombin activation through the extrinsic pathway.

Hypercoagulable State in Five Thalassemia Intermedia Patients

2007 ◽  
Vol 13 (4) ◽  
pp. 422-427 ◽  
Author(s):  
Maitreyee Bhattacharyya ◽  
Meganathan Kannan ◽  
Ved P. Chaudhry ◽  
M. Mahapatra ◽  
H. Pati ◽  
...  
Keyword(s):  
Iron Overload ◽  
Protein C ◽  
Hepatic Dysfunction ◽  
Antithrombin Iii ◽  
Protein S ◽  
Hypercoagulable State ◽  
Laboratory Evaluation ◽  
Thalassemia Intermedia ◽  
Coagulation Inhibitors ◽  
Platelet Hyperaggregation

Fifty-three patients of thalassemia intermedia and 40 controls were studied for clinical evidence of thrombosis and laboratory evidence of hypercoagulable state. Thrombotic episodes were detected in 5 (9.4%) patients. Two of these 5 patients with thrombosis were splenectomized. Laboratory evaluation showed presence of thrombocytosis in 8 (15%), 5 of these were splenectomized. Platelet hyperaggregation was detected in 12 (22.2%) patients. Although rate of aggregation was slow in 7 (13.2%) patients, degree of aggregation was normal in these 7 patients and platelet hypoaggregation was not detected in any patient. Level of coagulation inhibitors protein C and protein S, and antithrombin III were decreased in 31 (58.4%) patients. There was no correlation between low level of protein C and protein S with hepatic dysfunction and iron overload. Antithrombin III level was decreased only in 8 (15%) patients. There was a statistically significant association between the lower level of this inhibitor and hepatic dysfunction. In conclusion, this study provides evidence for the existence of a chronic hypercoagulable state in patients with β thalassemia intermedia, and suggests that expression of a procoagulant surface by thalassemia intermedia red blood cells may be the major underlying factor giving rise to platelet and coagulation inhibitor abnormalities in these patients. These alterations are not related to iron overload or hepatic dysfunction.

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