Determination and Treatment of Disorders of Primary Haemostasis

1999 ◽  
Vol 19 (04) ◽  
pp. 168-175 ◽  
Author(s):  
M. Weippert-Kretschmer ◽  
V. Kretschmer
Keyword(s):  
Platelet Function ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Bleeding Tendency ◽  
Platelet Counts ◽  
Platelet Function Disorders ◽  
Perioperative Bleeding ◽  
Before And After ◽  
Low Sensitivity

SummaryPerioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl2 = TST-CaCl2 and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl2 became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl2 proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

Changes in Platelet Function and Platelet Counts During Substitution Therapy in Haemophiliacs and Produced by Plasmapheresis in Patients Suffering from Inhibitors

1979 ◽  
Author(s):  
E. Dumitrescu ◽  
I. Ambrus ◽  
Kh. Nienhaus ◽  
B. Podolsak ◽  
E. Wenzel
Keyword(s):  
Factor Viii ◽  
Platelet Function ◽  
Clinical Signs ◽  
Bleeding Complications ◽  
Substitution Therapy ◽  
Drug Induced ◽  
Platelet Counts ◽  
Before And After ◽  
Factor Viii Concentrates ◽  
Laboratory Investigations

We noticed a systematic increase in small platelets (evaluated by electronical analysis of platelet volune distribution, using the Coulter Counter equipment, Wenzel 1977) during substitution therapy in patients suffering from haemophilia (N = 60). Laboratory investigations on these patients were performed before substitution and then 30 min., 60 min., 120 min. and 24 hours after infusion of factor-VIII-concentrationa (Inmuno, Schwab, Behring, factor-VIII-concentrates 20 U/kg b.w.). The same investigations were performed before and after plasmapheresis using a Hemonetric cell separator (N = 7}. in 48 of the patients, the clinical signs were insignificant (bleeding time, according to Duke, was found to be normall, although the platelet changes ware considerable (decrease in platelet count and increase of the percentage of platelets smaller than 4.5 μ3). However, significant test results were noticed in a haemophiliac patient suffering from inhibitory- and drug-induced platelet disorders during and after plasmapheresis. We observed bleeding complications only in 2 cases (Duke; 7 min. and 9 min.). Yet, a coneiderable decrease in platelet counts was observed as well as a significant increase in the percentages of small platelets (4.5 μ3, N = 48) in all cases. Controlling platelet function in haemophiliacs following substitution therapy could be essential as well as controlling the usual hemolysis parameters after plasmapheresis.

Hemostaseological Management of Urological Operations in Patients Taking Aspirin Using the Thrombostat 4000

1995 ◽  
Vol 21 (S 02) ◽  
pp. 52-58 ◽  
Author(s):  
Berthold Ulshöfer ◽  
Vera Dorst ◽  
Volker Kretschmer ◽  
Horst Köhl ◽  
Hubertus Riedmiller
Keyword(s):  
Clinical Study ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Platelet Function ◽  
Bleeding Complications ◽  
Bleeding Tendency ◽  
Platelet Function Disorders ◽  
Hemorrhagic Disorders ◽  
History Of ◽  
Bleeding History

A clinical study was started in order to examine the suitability of the Thrombostat (in vitro bleeding test) (IVBT) as a diagnostic tool to prevent perioperative bleeding due to aspirin (ASA) and/or platelet function disorders of other origins. This report is based on preliminary data. Eighty three patients who had ingested ASA in the last two weeks and/or with a history of bleeding and/or documented hemorrhagic disorders requiring distinct urological operations, were included in the study. In all patients the IVBT with CaCl2 , in addition to common coagulation tests, were performed. Thirteen patients stopped ASA ingestion until IVBT became normal and did not show any increased bleeding tendency. The residual patients were classified by the various operations. The following operation groups were formed: Male genitals (n = 11), inguinal/suprapubic operations (n = 7), transurethral tumor resections of the bladder (TURB) (n = 17), transurethral prostate resection (TURP) (n = 12), tumor nephrectomy (n = 8), radical prostatectomy (n = 9). Thirty six patients with a history of ASA use, but normal IVBT, served as control group (C). Thirty one patients with a history of ASA ingestion had normal in vivo bleeding times (BT) and abnormal IVBT with CaCl2 (A). Seven patients had a bleeding history and/or documented hemorrhagic disorders (B). None of the patients (A) with abnormal IVBT but normal BT displayed clinically relevant bleeding. However, the blood loss was somewhat higher compared to the controls (C), especially in patients with TURB and radical prostatectomy (not significant). The only real bleeding complication occurred in an ASA patient (TURB), who was subjected to surgery by error. Anesthesia had already started, when abnormality of BT (>15 min) and IVBT (m“infinite ”) were measured. Operative revision was necessary and revealed that the blood loss (>3 L) was based on diffuse microvascular bleeding. The majority of the patients with a bleeding history and/or documented hemorrhagic disorders (B) showed an increased bleeding tendency, which could be managed without relevant blood loss, except in two patients, one with factor XIII deficiency (25%) and ASA intake, and the other with undetected mild congenital platelet disorder (storage pool disease?). The IVBT proved suitable as screening test for platelet function disorders. Major bleeding complications could be prevented by its use. A history of low-dose ASA ingestion without prolongation of BT, but abnormal IVBT, also seemed to increase the bleeding tendency; however, the clinical relevance has to be demonstrated by an extended clinical study.

Thrombopoietin Receptor Agonists in Patients with Chronic Liver Disease

2020 ◽  
Vol 46 (06) ◽  
pp. 682-692
Author(s):  
Saro Khemichian ◽  
Norah A. Terrault
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Invasive Procedure ◽  
Bleeding Risk ◽  
Chronic Liver ◽  
Bleeding Complications ◽  
Invasive Procedures ◽  
Platelet Counts ◽  
Receptor Agonists ◽  
Platelet Transfusions

AbstractThrombocytopenia is one of the most common hematologic complications in cirrhosis. Despite limited data linking platelet count and bleeding risk in patients with cirrhosis, the use of platelets transfusions for invasive procedures has been a common practice. Recently, thrombopoietin (TPO) receptor agonists have been approved for use in patients with chronic liver disease (CLD) undergoing invasive procedures. The aim of this study was to review current literature on bleeding risk in patients with cirrhosis and the use of platelet transfusions and TPO receptor agonists in the context of invasive procedures. PubMed search was conducted to find articles relating to cirrhosis, thrombocytopenia, and new novel treatments for this condition. Search terms included CLD, cirrhosis, thrombocytopenia, bleeding, thrombosis, coagulopathy, hemostasis, and TPO receptor agonists. Romiplostim, eltrombopag, avatrombopag, and lusutrombopag are approved TPO receptor agonists, with avatrombopag and lusutrombopag specifically approved for use in patients with CLD undergoing invasive procedures. In patients with platelet counts < 50,000/mm3, avatrombopag and lusutrombopag increased the platelet counts above this threshold in the majority of treated patients and reduced the frequency of platelet transfusions. At the approved doses, incidence of thrombosis was not increased and therapies were well tolerated. Studies were not powered to assess whether risk of bleeding complications was reduced and the fundamental question of whether correction of thrombocytopenia is warranted in patients undergoing invasive procedures remains unanswered. The use of TPO receptor agonists has resulted in less requirement for platelet transfusions. In patients with cirrhosis undergoing invasive procedures for whom platelet transfusion is planned, TPO receptor agonists are an alternative and avoid the risks associated with transfusions. However, there is need for a thoughtful approach to manage bleeding risk in patients with cirrhosis undergoing procedures, with the consideration of a comprehensive hemostatic profile, the severity of portal hypertension, and the complexity of the invasive procedure to guide decisions regarding transfusions or use of TPO receptor agonists.

The Role of Platelets in the Pathogenesis of Thrombosis and Hemorrhage in Patients with Thrombocytosis

1977 ◽  
Vol 38 (04) ◽  
pp. 1085-1096 ◽  
Author(s):  
Peter N. Walsh ◽  
Scott Murphy ◽  
William E. Barry
Keyword(s):  
Platelet Function ◽  
Bleeding Complications ◽  
Platelet Counts ◽  
Normal Platelet ◽  
Coagulant Activity ◽  
Hemorrhagic Complications ◽  
Myeloproliferative Diseases ◽  
Thrombotic Complications ◽  
Preliminary Study

SummarySome patients with thrombocytosis due to myeloproliferative diseases or other etiologies experience thromboembolic complications and others may bleed excessively. It seems unlikely that elevations in platelet count per se are a direct cause either of thrombosis or of hemorrhage. In an effort to ascertain whether variations in platelet function might determine whether an individual patient experiences thrombotic or hemorrhagic complications we have evaluated platelet function in 22patients with thrombocytosis due to a variety of etiologies. The results of platelet counts, bleeding time determinations, and studies of platelet aggregation were similar in patients with thrombosis, in patients with bleeding and in patients with neither complication. Therefore, detailed studies of platelet coagulant activities were carried out in 8patients. The results of platelet coagulant activity assays were normal in all 3patients with thrombocytosis and neither thrombotic nor bleeding complications and an additional 3patients with myeloproliferative diseases, normal platelet counts and no thrombohemorrhagic complications. In 2patients with thrombotic complications significant elevation of platelet coagulant activities concerned with the early phases of intrinsic coagulation were observed whereas in 2patients with severe hemorrhagic complications deficiences of either contact forming activity or collagen-induced coagulant activities were evident. This preliminary study suggests the possibility that variations in platelet coagulant activities concerned with the early stages of intrinsic coagulation may determine whether patients with thrombocytosis will experience bleeding or thrombotic complications.

Protein Z Deficiency in Patients with Bleeding History. Is It a Coagulopathy?.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2227-2227 ◽  
Author(s):  
Frauke Bergmann ◽  
Andreas Czwalinna ◽  
Arndt Groening
Keyword(s):  
Platelet Function ◽  
Conflicts Of Interest ◽  
Factor Xa ◽  
Postoperative Hemorrhage ◽  
Bleeding Tendency ◽  
Normal Range ◽  
Protein Z ◽  
Platelet Function Disorders ◽  
Diagnostic Work ◽  
Bleeding History

Abstract Abstract 2227 Introduction: Protein Z (PZ) is a vitamin K-dependent protein. In hemostasis PZ has two functions: together with Factor Xa it forms an inhibiting complex with the PZ- dependent protease-inhibitor and it enhances binding of Thrombin to phospholipid surfaces. Therefore, low PZ levels may induce thrombosis or bleeding. The latter has been questioned by Vasse 2008 and in 1995 Kemkes-Matthes reported in 58% of patients (pts) with a bleeding history PZ deficiency as the only abnormality. Aim of the study: To evaluate if low PZ levels are associated with a bleeding tendency, we reviewed data of pts referred to or laboratory. PZ determination is part of our diagnostic work up, including whole blood count, PT, PTT, VWF/FVIII-complex, FXIII and platelet function studies. Material and Methods: Over a 1 year period we investigated PZ level in 173 pts. PZ concentration was determined by ELISA (Asserachrom Protein Z; Diagnostica Stago), a sandwich immunoassay using a mouse monoclonal antibody against PZ, normal range 1600 – 3300 μg/l, mean 2600 μg/l published by Miletich. Our normal range obtained by 62 donors 990–2490, mean 1740μg/l (+/− 2SD). PZ <1000μg/l is considered to be abnormal. Results: In 75/173 (43%) pts with a bleeding history (e.g. postoperative hemorrhage, epistaxis, menorrhagia) no coagulation abnormality was detected. In 41/98 (42%) low PZ level was the only abnormality (mean PZ 642, range 195–994). 57/98 (58%) were diagnosed with vWD n=17; platelet function disorders n=10 or ASA/drugs causing platelet dysfunction n=20, others n=10. In 21/57 (37%) low PZ level was detected additionally (mean PZ 699μg/l; range 219–949) and in the remaining 36/57 (mean PZ 1689; range 1036–2842). Conclusion: Surprisingly, in 24% of pts with a bleeding history the only abnormality was PZ deficiency. Therefore, we consider PZ determination a useful parameter in patients with a bleeding history after ruling out more common disorders. Low PZ levels may cause a coagulopathy in some pts. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum: Case report

2013 ◽  
Vol 60 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Tjasa Ivosevic ◽  
Nevena Kalezic ◽  
Svetlana Barovic ◽  
Ivan Palibrk ◽  
Vesna Karapandzic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Total Colectomy ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Perioperative Bleeding

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn?t increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial infarction as a consequence of aspirin withdrawal before total colectomy.

Is Beta-thromboglobulin a useful indicator of thrombosis in nephrotic syndrome?

1979 ◽  
Author(s):  
K. Andrassy ◽  
D. Deppermann ◽  
E. Walter ◽  
J. Koderisch ◽  
E. Ritz ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Disease ◽  
Serum Albumin ◽  
Platelet Function ◽  
Before And After

In nephrotic Syndrome (NS), thrombotic episodes are common and this is thought to result from altered platelet function. In the present study we tried to correlate beta-thromboglobulin (TG) cone, with parameters of platelet function, - Patients and methods - In 26 pt. with NS platelet aggregat. test (PA) and TG were analysed before and after 2 weeks treatm. with ASA/Dipyridamole. None of the pat. had diseases with known platelet consumption or medication which interferes with platelets. - Results - Although, none of the pat. had clinically overt thrombosis (Doppler, phlebo-gr.) PA was increased in all pat.(PAT I and III, collagen/ADP ind. aggregate,, PF 4). There was an inverse correlat. between platelet abnormality and serum albumin cone, and a pos. correlat. with the elevation of cholesterol, TG cone, in NS did not differ signif. from control individ. without renal disease and from pat. with chron. glomerulonephr.(33.4±11.1 vs 33.9±9.7 vs 31.«±13.2 ng/ml). ASA/Dipyrid. did not change TG cone. - Conclusions - TC cone, in vivo do not reflect the degree of platelet abnorm, in vitro in pat. with NS. This finding may indicate that TG is not sensitive enough to monitor plat, abnorm, short of overt thromb. or else may indicate the fact, that TG is lost in the urine in NS.

scholarly journals Adrenaline Improves Platelet Reactivity in Ticagrelor-Treated Healthy Volunteers

2019 ◽  
Vol 119 (05) ◽  
pp. 735-743 ◽  
Author(s):  
Sukhi Singh ◽  
Tor Damén ◽  
Andreas Nygren ◽  
Caroline Shams Hakimi ◽  
Sofia Ramström ◽  
...  
Keyword(s):  
Platelet Reactivity ◽  
Clinical Importance ◽  
Receptor Activation ◽  
Clot Formation ◽  
Bleeding Complications ◽  
Impedance Aggregometry ◽  
Perioperative Bleeding ◽  
Adrenaline Infusion ◽  
Induced Aggregation

Background Administration of agents that enhance platelet reactivity may reduce the perioperative bleeding risk in patients treated with the adenosine diphosphate (ADP)-receptor antagonist ticagrelor. Adrenaline potentiates ADP-induced aggregation and activation in blood samples from ticagrelor-treated patients, but it has not previously been evaluated in vivo. Methods Ten healthy male subjects were included in an interventional study. A loading dose of ticagrelor (180 mg) was administered, followed 2 hours later by a gradually increased intravenous adrenaline infusion (0.01, 0.05, 0.10 and 0.15 µg/kg/min; 15 minutes at each step). Blood pressure, heart rate, platelet aggregation (impedance aggregometry), platelet activation (flow cytometry), clot formation (rotational thromboelastometry) and adrenaline plasma concentration were determined before and after ticagrelor administration and at the end of each adrenaline step. Results Infusion of adrenaline increased ADP-induced aggregation at all doses above 0.01 µg/kg/min. The aggregation increased from median 17 (25−75th percentiles: 14−31) to 25 (21−34) aggregation units (p = 0.012) at 0.10 µg/kg/min. Adrenaline infusion also increased ADP-induced fibrinogen receptor activation (from 29 [22–35] to 46 [38−57%]) and P-selectin expression (from 3.7 [3.0−4.3] to 7.7 [4.7−8.6%]), both p = 0.012. Adrenaline infusion reduced clot formation time (97 [89−110] to 83 [76−90] seconds, p = 0.008) and increased maximum clot firmness (59 [57−60] to 62 [61−64] mm, p = 0.007). Conclusion Infusion of adrenaline at clinically relevant doses improves in vivo platelet reactivity and clot formation in ticagrelor-treated subjects. Adrenaline could thus potentially be used to prevent perioperative bleeding complications in ticagrelor-treated patients. Studies in patients are necessary to determine the clinical importance of our observations. Trial Registry Number ClinicalTrials.gov NCT03441412.

scholarly journals Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

2020 ◽  
Vol 9 (7) ◽  
pp. 2064
Author(s):  
Gregorio Tersalvi ◽  
Luigi Biasco ◽  
Giacomo Maria Cioffi ◽  
Giovanni Pedrazzini
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Clinical History ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Coronary Syndrome

Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.

Sign in / Sign up

Export Citation Format

Share Document