Hemostatic Assessment of Patients before Tonsillectomy: A Prospective Study

1994 ◽  
Vol 111 (6) ◽  
pp. 733-738 ◽  
Author(s):  
Heidi L. Close ◽  
Thomas C. Kryzer ◽  
John H. Nowlin ◽  
Barbara M. Alving
Keyword(s):  
Prospective Study ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Postoperative Bleeding ◽  
Bleeding Disorder ◽  
Activated Partial Thromboplastin Time ◽  
Severe Bleeding ◽  
Coagulation Disorder ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease

The purpose of this prospective study in patients undergoing tonsillectomy was to determine whether perioperatve bleeding could be predicted by use of a standardized questionnaire concerning bleeding risk combined with measurement of the activated partial thromboplastin time and prothrombin time. Of the 96 patients enrolled in the study, none had a history of a severe bleeding disorder, but 6 (6%) had histories suggestive of a mild bleeding disorder. Further evaluation showed possible von Willebrand's disease in one of these patients. Of the 90 patients with negative questionnaires, 16% had prolongation of the activated partial thromboplastin time. One of these patients had possible von Willebrand's disease. However, none of the patients with positive questionnaires or a prolonged activated partial thromboplastin time bled after surgery. Bleeding that resulted in additional hospital use occurred in 2% of patients, and blood-tinged sputum was described by 4% after discharge; all of these patients had negative questionnaires and normal screening studies. The data provide further evidence that routine measurement of the activated partial thromboplastin time and prothrombin time in asymptomatic patients is not useful for predicting postoperative bleeding. In addition, histories suggestive of a mild bleeding disorder are also not accurate predictors of postoperative bleeding. Excessive bleeding associated with tonsillectomy is usually not a result of an identifiable coagulation disorder.

Efficacy of Peri- and Postoperative Treatment in 95 Patients with Von Willebrand’s Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4075-4075
Author(s):  
Charis von Auer ◽  
Kathrin Lotter ◽  
Sandra Heinsdorf ◽  
Inge Scharrer
Keyword(s):  
Thoracic Surgery ◽  
Postoperative Bleeding ◽  
Postoperative Treatment ◽  
Bleeding Complications ◽  
Major Surgery ◽  
Coagulation Disorder ◽  
Substitution Therapy ◽  
Von Willebrand's Disease ◽  
Surgical Interventions ◽  
Von Willebrand’S Disease

Abstract Von Willebrand’s disease (VWD) is the most common inherited bleeding disorder in humans, exhibiting quantitative and qualitative defects in the von Willebrand factor. To investigate the quality of treatment during the peri- and postoperative course of patients with VWD, we conducted a retrospective data analysis. We analyzed data of 95 patients with VWD who went for 173 surgical interventions in our center between 1981 and 2003. Peri- and postoperative courses with regard of bleeding complications were reviewd. 59 Patients had type1 VWD (two severe, three moderate, 54 mild). 16 patients had type 2 VWD (14 2A, one 2B, one 2N) and 11 patients type 3 VWD. Nine patients with type1 VWD had an additional factor deficiency (five FXII-, two FVII- and two FV-deficiencies). We analyzed the course of 54 orthopedic surgeries, 41 abdominal surgeries, 15 angiographies, 12 endoscopic surgeries, 10 ear-nose-throat interventions, 11 mamma surgeries, 10 neurological surgeries, 8 soft tissue surgeries, 7 thorax surgeries, 3 thyroid gland surgeries and 2 biopsies. Most patients (108/173) were treated with Humate P, 33 patients with DDAVP (33/173) and 9 patients received both products during the pre- peri- and postoperative period. Three patients received other plasmatic FVIII- concentrates, 20 patients had no therapy for their coagulation disorder. 16 patients (9, 2%) had peri- or postoperative bleeding complications. Most of them were seen in patients with VWD type 2B and 3 and in patients who underwent major surgery and who received only DDAVP. Humate P was used for 9 interventions (9/108 = 8, 3%) and DDAVP for four interventions (4/33 = 12, 1%) with bleeding complications, three patients had no therapy. Most of these complications were reported in thoracic surgery (2/7 = 28%), gynecological (3/11 = 27%) and otolaryngological surgery (2/10 = 20%). Retrospectively 15 bleeding complications could be explained by surgical technique, thromboprophylaxis, inefficient substitution therapy or additional thrombocytopenia. In conclusion our findings show a low frequency of bleeding complications in VWS patients with surgical interventions. Our evaluation reveals the necessity of special hemostaseologic care and laboratory controls for these patients. Substitution therapy should depend on type of VWD and type of surgical intervention. Especially during thoracic surgery, gynecological and otolaryngological surgery a careful peri- and postoperative hemostaseologic management as well as careful hemostyptic techniques of the surgeon are required.

The Spectrum of von Willebrand’s Disease

1967 ◽  
Vol 18 (01/02) ◽  
pp. 040-056 ◽  
Author(s):  
E. J Walter Bowie ◽  
P Didisheim ◽  
J. H Thompson ◽  
C. A Owen
Keyword(s):  
Factor Viii ◽  
Bleeding Time ◽  
Severe Bleeding ◽  
Platelet Adhesiveness ◽  
Platelet Activity ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
The Third ◽  
Generation Test

SummaryPatients (from 5 kindreds) with variants of von Willebrand’s disease are described. In one kindred the depression of factor VIII was moderate (20 to 40% of normal) and transfusion of 500 ml of normal plasma led to an increase higher than anticipated and to an almost normal level of factor VIII 17 to 24 hrs later. This represents the usual type of von Willebrand’s disease.In the second kindred the concentration of factor VIII was less than 2 % of normal in the son and daughter, who had severe bleeding and hemarthroses.The third kindred was characterized by reduction of factor VIII and a long bleeding time as well as by a serum defect in the thromboplastin-generation test comparable to that seen in patients with hemophilia B, yet with normal levels of factors IX, X, and VII. The severity of the serum defect, the positive result with the Rumpel-Leede test, and the reduced platelet activity in the thromboplastin-generation test are all compatible with the diagnosis of thrombopathy or ‘‘thrombopathic hemophilia.” In two other kindreds, one patient had a long bleeding time and normal levels of factor VIII and another had a normal bleeding time and decrease of factor VIII. The last patient had the type of response to transfusion usually seen in von Willebrand’s disease.In four kindreds, platelet adhesiveness in vivo was found to be strikingly abnormal (virtually absent).It would appear, therefore, that von Willebrand’s disease forms a spectrum, and whether the kindreds reported simply reflect variations of a single genetic disease state or represent separate entities will be answered only by clarification of the underlying etiology of that disease.

EFFECTS OF NICKEL CHLORIDE ON INDICES OF HEMOCOAGULATION AND LIPID PEROXIDATION IN RATS

2019 ◽  
pp. 83-90
Author(s):  
Э.М. Гаглоева ◽  
В.Б. Брин ◽  
С.В. Скупневский ◽  
Н.В. Боциева ◽  
Т.В. Молдован
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Enzymes ◽  
Platelet Aggregation ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Nickel Chloride ◽  
Activated Partial Thromboplastin Time ◽  
Fibrinogen Concentration ◽  
Thrombin Time ◽  
Hemostasis System

Цель исследования - изучить состояние системы гемостаза при хронической интоксикации хлоридом никеля, исследовать взаимосвязь показателей гемокоагуляции с процессами липопероксидации у крыс в эксперименте. Методика. Опыты проводили на крысах-самцах Вистар (n=50, 230-250 г). Раствор NiCl2 (5 мг/кг) вводили внутрижелудочно ежедневно в течение 2 нед, 1 и 2 мес. По завершении эксперимента исследовали состояние тромбоцитарного и коагуляционного звеньев гемостаза, антикоагулянтную и фибринолитическую активность крови, а также определяли активность процессов перекисного окисления липидов и антиоксидантных ферментов. Результаты. Установлено, что через 2 нед и 1 мес интоксикации у крыс отмечались гиперкоагуляционные изменения показателей свертывающей системы крови: повышение агрегационной активности тромбоцитов, увеличение концентрации фибриногена, снижение активированного частичного тромбопластинового времени (АЧТВ) и протромбинового времени. В этот период регистрировалось увеличение антитромбиновой и фибринолитической активности крови. Через 2 мес наблюдалось подавление активности клеточного звена гемостаза - тромбоцитопения, ослабление степени АДФ-индуцируемой агрегации тромбоцитов. Выявлялась тенденция к уменьшению концентрации фибриногена. На фоне снижения АЧТВ и тромбинового времени отмечалось увеличение протромбинового времени. В то же время регистрировалось угнетение противосвертывающего звена системы гемостаза (снижалась активность антитромбина III), наблюдалось истощение резервных возможностей фибринолитического звена (замедление фXIIа-зависимого эуглобулинового лизиса) и увеличение содержания растворимых фибрин мономерных комплексов, что свидетельствует о наличии тромбинемии. Через 2 нед, один и два месяца интоксикации у животных выявлялись корреляционные связи между основными показателями системы гемостаза и активностью процессов перекисного окисления липидов и антиоксидантных ферментов. Заключение. Полученные данные подтверждают наличие взаимосвязи активности процессов липопероксидации и системы гемостаза, в том числе при хронической никелевой интоксикации. Результаты исследования позволяют рекомендовать применение антиоксидантов для разработки способов коррекции гемостатических сдвигов при воздействии на организм тяжелых металлов. The aim. To study the state of the hemostasis system in chronic nickel intoxication and to investigate the relationship between hemocoagulation indices and lipoperoxidation processes in rats. Methods. Experiments were carried out on male Wistar rats (n=50, 230-250 g). A solution of nickel chloride (5 mg/kg) was administered daily intragastrically for two weeks, one and two months. At the end of the experiments, indices of platelet and coagulation hemostasis systems, anticoagulant and fibrinolytic activity of blood plasma, and activities of lipid peroxidation and antioxidant enzymes were studied. Results. Hypercoagulative changes in indices of the coagulation system were observed in rats after two weeks and one month of intoxication, including increased platelet aggregation and fibrinogen concentration and shortened activated partial thromboplastin time and prothrombin time. During the same period, increased antithrombin and fibrinolytic activities were observed. The depressed activity of the cellular component of hemostasis evident as thrombocytopenia and impaired ADP-induced platelet aggregation was detected after two months of intoxication. A tendency to decrease in fibrinogen concentration was observed. The shortened activated partial thromboplastin time and thrombin time were associated with prolonged prothrombin time. At the same time, inhibition of the anticoagulant component of hemostasis (decreased antithrombin III activity), exhaustion of the fibrinolysis system reserve (delayed fXIIa-dependent euglobulin lysis), and a significant increase in soluble fibrin monomeric complexes indicative of thrombinemia were observed. After two weeks, one and two months of nickel intoxication, a correlation was found between the major indices of the hemostasis system and the activities of lipid peroxidation and antioxidant enzymes. Conclusion. The study confirmed a relationship between the lipid peroxidation activity and the hemostasis system, specifically in chronic nickel intoxication. This result allows to recommend the use of antioxidants in developing methods for correction of hemostatic induced affected by heavy metals.

Antihemostatic Effect of Hsien-Ho-T'sao (Agrimonia pilosa)

1984 ◽  
Vol 12 (01n04) ◽  
pp. 116-123 ◽  
Author(s):  
Jih-Pyang Wang ◽  
Mei-Feng Hsu ◽  
Che-Ming Teng
Keyword(s):  
Prothrombin Time ◽  
Blood Coagulation ◽  
Partial Thromboplastin Time ◽  
Bleeding Time ◽  
Fibrinogen Level ◽  
Platelet Rich Plasma ◽  
Water Extract ◽  
Activated Partial Thromboplastin Time ◽  
Thrombin Time

Bleeding time in rats was markedly prolonged after the adminstration of the water extract of Hsien-Ho-T'sao. This antihemostatic effect was more marked in the group of i.p. injection of the drug than in the group of p.o. administration for 2 to 7 consecutive days. Blood coagulation studies showed that plasma prothrombin time, activated partial thromboplastin time and stypven time were prolonged, while thrombin time adnd fibrinogen level were not changed. The thromboelastographic recording showed that reation time was prolonged and maximal elasticity of clot was decreased. In addition, ADP- and collagen- induced aggregations of platelet-rich plasma was suppressed. In conclusion, the prolongation of the bleeding time might be due to both anticoagulant and antiplatelet action of the drug.

scholarly journals ASSESSMENT OF COAGULATION PROFILE IN PATIENTS WITH LIVER CIRRHOSIS AND ATRIAL FIBRILLATION

2021 ◽  
Vol 121 (1) ◽  
pp. 22-31
Author(s):  
Alіna Baylo ◽  
Vadym Shypulіn ◽  
Volodymyr Chernyavskyi ◽  
Luiza Parunyan
Keyword(s):  
Atrial Fibrillation ◽  
Liver Cirrhosis ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Fibrinolytic System ◽  
Thrombin Time ◽  
Group I ◽  
D Dimer

The comorbid course of liver cirrhosis and atrial fibrillation causes higher levels of hospitalizations, mortality and ischemic stroke. According to current data, hemostasis in patients with liver cirrhosis is in a rebalanced dynamic state, but there are no data on the effect of atrial fibrillation on the hemostasis in patients with liver cirrhosis. Aims of the study. To assess abnormalities in primary, secondary haemostasis and fibrinolytic system in patients with liver cirrhosis and atrial fibrillation by using standard laboratory coagulation parameters and to investigate their changes depending on the stage of liver cirrhosis A, B, C according to Child-Pugh score. Materials and methods. A cross-sectional prospective study was conducted with the inclusion of 106 patients aged 42 to 83 years: group I (n = 70) - with liver cirrhosis and atrial fibrillation, II (n = 36) - with liver cirrhosis, which were distributed depending on the Child-Pugh score stages of cirrhosis and 20 healthy individuals. The levels of platelets, activated partial thromboplastin time, international normalized ratio, prothrombin time, thrombin time, fibrinogen, D-dimer were assessed on a Steellex M200 coagulometer. Statistical analysis (IBM SPSS Statistics) was performed. Results. The level of platelets in patients of group I was reduced by 37.4% (200 ± 8.33 vs. 274.7 ± 3.4; p,000.001), an activated partial thromboplastin time was prolonged by 38.6% (44.35 ± 1.39 vs. 32.01 ± 0.63, p˂0.001), prothrombin time was prolonged by 73.5% (19.4 ± 0.87 vs. 11.18 ± 0.53, p˂0.001), thrombin time was prolonged by 2.07 (25, 7 ± 1.31 vs. 12.4 ± 0.66, p˂0.001), the international normalized ratio was increased by 24.3% (1.38 ± 0.04 vs.1.11 ± 0.01, p˂0.001) compared to control. The fibrinogen level was 20.9% higher (4.17 ± 0.17 vs. 3.45 ± 0.11, p˂0.001) than in control group and was 83.7% higher (4.17 ± 0.17 vs. 2.27 ± 0.13, p˂0.001) than in group II. The D-dimer level was 83% higher than in control (675 ± 22.3 vs. 368.8 ± 21.85, p˂0.001) and 44% higher (675 ± 22.3 vs. 469 ± 37.18, p ˂0.001) compared with group II. Conclusions. In patients with liver cirrhosis and atrial fibrillation abnormalities of primary hemostasis are detected due to decrease of platelets on the background of portal hypertension. At the secondary stage of hemostasis indicators of external and internal coagulation mechanisms are prolonged due to the reduced synthesis of coagulation factors by the liver. Increased level of fibrinogen is determined at the stage of compensated and subcompensated cirrhosis with a gradual decrease at the stage of decompensation. The high activity of the fibrinolytic system is observed due to increase in the D-dimer levels, which may indicate a prothrombotic state in these patients.

scholarly journals MOLECULAR ASPECT CORRELATION BETWEEN GLYCATED HEMOGLOBIN (HBA1C), PROTHROMBIN TIME (PT) AND ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) ON TYPE 2 DIABETES MELLITUS (T2DM) (Aspek molekuler Hubungan Kadar Hemoglobin Terglikasi (HbA1c), Prothrombin Time (PT) dan Activated Partial Thromboplastin Time (APTT) di Diabetes Melitus Tipe 2)

2018 ◽  
Vol 23 (1) ◽  
pp. 1
Author(s):  
Indranila KS
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Glycated Hemoglobin ◽  
Activated Partial Thromboplastin Time ◽  
Molecular Aspect ◽  
Diabetes Melitus

Diabetes Melitus (DM) memerlukan pengendalian glikemia yang dapat diketahui dengan melakukan pemeriksaan hemoglobinterglikasi (HbA1c). Semakin tinggi kadar hemoglobin terglikasi (HbA1c), semakin tidak terkendali kadar gula darah pasien DM tipe2. Hal ini dapat menyebabkan terjadinya proses hiperkoagulasi dan gangguan mikrovaskular maupun makrovaskular. PemeriksaanProtrombin Time (PT) dan Activated Partial Thromboplastin Time (APTT) diharapkan dapat mendeteksi secara dini adanya gangguankoagulasi di pasien DM tipe 2. Penelitian potong lintang terhadap 72 orang pasien DM tipe 2 yang berusia diatas 18 tahun diperiksakadar HbA1c dan dikaji koagulasi (PT dan APTT). Pasien dengan penyakit penyerta seperti anemia dan kelainan hemoglobin, keganasanatau kelainan hematologis, pasca bedah, hipertiroid, perempuan hamil, riwayat penyakit hati dan pasien yang mengkonsumsi obatobatanyang mengganggu fungsi koagulasi dikeluarkan dari penelitian ini. Uji normalitas data menggunakan Kolmogorov-Smirnovdan analisis hubungan menggunakan uji Pearson. Analisis kenasaban terdapat hubungan antara kadar hemoglobin terglikasi denganProthrombin Time negatif lemah (r= -0,179; p=0,132) dan dengan Activated Partial Thromboplastin Time positif sangat lemah (r=0,016;p=0,892). Berdasarkan telitian ini terdapat hubungan negatif lemah yang bermakna antara kadar hemoglobin terglikasi dengan PTdan hubungan positif sangat lemah yang tidak bermakna dengan Activated Partial Thomboplastin Time.

scholarly journals Mixing Studies in Patients With Prolonged Activated Partial Thromboplastin Time or Prothrombin Time

2019 ◽  
Vol 128 (6) ◽  
pp. 1089-1096 ◽  
Author(s):  
Honorio T. Benzon ◽  
Meghan Park ◽  
Robert J. McCarthy ◽  
Mark C. Kendall ◽  
Paul F. Lindholm
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time

Effects of a Pneumatic Tube System on Routine and Novel Hematology and Coagulation Parameters in Healthy Volunteers

2007 ◽  
Vol 131 (2) ◽  
pp. 293-296
Author(s):  
Alexander Kratz ◽  
Raneem O. Salem ◽  
Elizabeth M. Van Cott
Keyword(s):  
Healthy Volunteers ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Tube System ◽  
Blood Samples ◽  
Pneumatic Tube ◽  
The Mean ◽  
Clinically Significant ◽  
Pneumatic Tube System

Abstract Context.—Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. Objective.—To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Design.—Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. Results.—No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Conclusions.—Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

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