Management of Hepatic Coagulopathy in Bleeding and Nonbleeding Patients: An Evidence-Based Review

2020 ◽  
pp. 088506662090302
Author(s):  
Nicholas W. Lange ◽  
David M. Salerno ◽  
Karen Berger ◽  
Melissa M. Cushing ◽  
Robert S. Brown
Keyword(s):  
Management Strategies ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
International Normalized Ratio ◽  
Blood Products ◽  
Clotting Cascade ◽  
Clinically Significant ◽  
Pharmacologic Agents

Patients with varying degrees of hepatic dysfunction often present with presumed bleeding diathesis based on interpretation of routine measures of coagulation (prothrombin time [PT], international normalized ratio [INR], and activated partial thromboplastin time). However, standard markers of coagulation do not reflect the actual bleeding risk in this population and may lead to inappropriate administration of hemostatic agents and blood products. The concept of “rebalanced hemostasis” explains both the risk of bleeding and clotting seen in patients with liver dysfunction. The role of pharmacologic agents and blood products for prevention of bleeding during high-risk procedures and treatment of clinically significant bleeding remains unclear. Viscoelastic measurements of the clotting cascade provide information about platelets, fibrinogen/fibrin polymerization, coagulation factors, and fibrinolysis that might better represent hemostasis in vivo and may better inform management strategies. Due to the paucity of available data, firm recommendations for the use of blood products and pharmacologic agents in patients with hepatic coagulopathies are lacking, and thus, these products should not be routinely administered. Traditional laboratory tests such as PT/INR should not be the sole determinant of potential interventions. Rather, clinicians should assess factors such as the severity of bleed or bleeding risk of the procedure, the patient’s risk of thromboembolism, and the strength of available evidence for specific agents and blood products to guide decision-making.

scholarly journals HEMOSTASIS BERLANDASKAN SEL HIDUP (IN VIVO)

2016 ◽  
Vol 19 (3) ◽  
pp. 204
Author(s):  
Liong Boy Kurniawan ◽  
Mansyur Arif
Keyword(s):  
Tissue Factor ◽  
Platelet Activation ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
Cascade Theory ◽  
Classic Theory

Understanding of hemostasis has developed substantially in the last century from stasis in vitro to in vivo concept. Hemostasis theory develops from classic theory, discovery of coagulation factors leading to cascade/waterfall theory, as well as to in vivo cell based theory which explains the limitations of cascade theory. Phases of cell based hemostasis theory include initiation, amplification, propagation and termination with the role of tissue factor, platelet activation and coagulation factors in thrombin and fibrin synthesis. Common hemostasis tests used nowadays are important in evaluating bleeding risk but this matter still can not explain cell based hemostasis theory comprehensively so we need to find new tests to evaluate in vivo hemostasis.

Systemic hemostatic and hemostasiological effects of fibrin monomer in low dose under warfarin action in experiment

2019 ◽  
Author(s):  
В.М. Вдовин ◽  
А.П. Момот ◽  
Д.А. Орехов ◽  
И.Г. Толстокоров ◽  
В.О. Шевченко ◽  
...  
Keyword(s):  
Liver Injury ◽  
Blood Loss ◽  
Prothrombin Complex Concentrate ◽  
Coagulation Factors ◽  
International Normalized Ratio ◽  
Blood Coagulation Factors ◽  
Circulating Blood Volume ◽  
Hemostatic Effect ◽  
Blood Loss Volume

Введение. Ранее было показано, что фибринмономер (ФМ) в низких дозировках обладает системным гемостатическим действием в условиях дозированной травмы. Авторами выдвинута гипотеза, согласно которой ФМ способен оказывать регулирующее гемостатическое действие in vivo на фоне сниженного гемостатического потенциала. Цель исследования: изучение системных гемостатических и гемостазиологических эффектов ФМ на фоне дозированной травмы печени при гипокоагуляции, обусловленной приемом варфарина. Материалы и методы. В работе использовали 40 кроликов породы Шиншилла. Для индукции кумаринобусловленной гипокоагуляции животным per os вводили варфарин в дозе 0,4 0,5 мг/кг 14 дней до достижения международного нормализованного отношения (МНО) более 2,0. Далее животным в краевую вену уха вводили концентрат факторов протромбино вого комплекса (КФПК) в дозе 40 ЕД/кг, ФМ в дозе 0,25 мг/кг или плацебо. Через 1 ч после введения препаратов наносили травму печени и оценивали кровопотерю (в процентах от объема циркулирующей крови). Исследовали число тромбоцитов, активированное парциальное тромбопластиновое время, МНО, содержание фибриногена и Ддимера, оценивали результаты тромбоэластографии крови. Результаты. Объем кровопотери в группах животных после внутривенного введения ФМ и КФПК на фоне приема варфарина был в 9,1 раза и 6,7 раза меньше, соответственно, по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем ФМ не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение КФПК в качестве антидота варфарина сопровождалось нормализацией параметров тромбоэластометрии и коррекцией гипокоагуляционного сдвига по МНО. Заключение. Установлено, что ФМ способен проявлять свое системное гемостатическое действие в условиях сниженного тромбинообразования, обусловленного нарушением синтеза витамин Кзависимых факторов свертывания крови. Данное действие реализуется без признаков восстановления гемостатического равновесия. Introduction. It was shown earlier that fibrinmonomer (FM) in low doses had a systemic hemostatic effect in a controlled injury condition. The authors suggest that FM is able to exert a regulating hemostatic effect in vivo under reduced hemostatic potential. Aim: to study the systemic hemostatic and hemostasiological effects of FM under controlled liver injury during hypocoagulation caused by warfarin administration. Materials and methods. In this study 40 Chinchilla rabbits were used. For the induction of coumarinmediated hypocoagulation, animals were administered per os warfarin at a dose of 0.4 0.5 mg/kg for 14 days, until an international normalized ratio (INR) was more than 2.0. Subsequently, a prothrombin complex concentrate (PCC) at a dose of 40 U/kg, FM at a dose of 0.25 mg/kg or placebo were administered into the marginal ear vein of the animals. An hour later, a liver injury was inflicted and blood loss was assessed (in percents of the circulating blood volume). The number of platelets, activated partial thromboplastin time, INR, levels of fibrinogen and Ddimer were studied and the results of blood thromboelastography were evaluated. Results. Blood loss volume in animals groups after intravenous administration of FM and PPC, under warfarin reception, was 9.1 times and 6.7 times less, respectively, compared to the placebo group receiving the same anticoagulant. However, FM did not affect on coagulogram parameters (no visible hemostasiological effect) and thromboelastogram, whereas the use of PPC as warfarin antidote was accompanied by the normalization of thromboelastometry parameters and hypocoagulation shift correction according to INR. Conclusion. It was found that FM able to manifest its systemic hemostatic effect in conditions of reduced thrombin formation caused by impaired synthesis of vitamin Kdependent blood coagulation factors. This effect is implemented without any signs of recovery of hemostatic balance.

scholarly journals The role of echocardiography in the assessment of hemodynamics in patients with connective tissue dysplasia

2015 ◽  
Vol 14 (2) ◽  
pp. 16-25
Author(s):  
E. V. Fomenko ◽  
S. B. Tkachenko ◽  
N. F. Beresten ◽  
E. S. Pavochkina
Keyword(s):  
Connective Tissue ◽  
Central Hemodynamics ◽  
Cardiac Pathology ◽  
Ultrasound Diagnostics ◽  
Connective Tissue Dysplasia ◽  
Clinically Significant

The article describes the features of ultrasound diagnostics and central hemodynamics in patients with minor heart anomalies. In vivo visualization of these anomalies has become possible after the introduction of echocardiography. The working classification of minor heart anomalies, as well as the description of clinically significant syndromes and abnormalities are considered. The role of connective tissue dysplasia in the development of cardiac pathology is highlighted, and its place in the structure of connective tissue dysplasia syndrome of the heart and heritable disorders of connective tissue is described.

scholarly journals Role of Autophagy in Von Willebrand Factor Secretion by Endothelial Cells and in the In Vivo Thrombin-Antithrombin Complex Formation Promoted by the HIV-1 Matrix Protein p17

2020 ◽  
Vol 21 (6) ◽  
pp. 2022
Author(s):  
Antonella Bugatti ◽  
Stefania Marsico ◽  
Pietro Mazzuca ◽  
Kai Schulze ◽  
Thomas Ebensen ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Matrix Protein ◽  
Coagulation Factors ◽  
Direct Role ◽  
Inflammatory Microenvironment ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Hiv 1

Although the advent of combined antiretroviral therapy has substantially improved the survival of HIV-1-infected individuals, non-AIDS-related diseases are becoming increasingly prevalent in HIV-1-infected patients. Persistent abnormalities in coagulation appear to contribute to excess risk for a broad spectrum of non-AIDS defining complications. Alterations in coagulation biology in the context of HIV infection seem to be largely a consequence of a chronically inflammatory microenvironment leading to endothelial cell (EC) dysfunction. A possible direct role of HIV-1 proteins in sustaining EC dysfunction has been postulated but not yet investigated. The HIV-1 matrix protein p17 (p17) is secreted from HIV-1-infected cells and is known to sustain inflammatory processes by activating ECs. The aim of this study was to investigate the possibility that p17-driven stimulation of human ECs is associated with increased production of critical coagulation factors. Here we show the involvement of autophagy in the p17-induced accumulation and secretion of von Willebrand factor (vWF) by ECs. In vivo experiments confirmed the capability of p17 to exert a potent pro-coagulant activity soon after its intravenous administration.

THE ROLE OF COGNITIVE PROCESSES IN SLEEP DISTURBANCE: A COMPARISON OF JAPANESE AND ENGLISH UNIVERSITY STUDENTS

2002 ◽  
Vol 30 (3) ◽  
pp. 259-270 ◽  
Author(s):  
Allison G. Harvey ◽  
Alice M. Gregory ◽  
Chris Bird
Keyword(s):  
University Students ◽  
Sleep Disturbance ◽  
Cognitive Processes ◽  
Management Strategies ◽  
Cognitive Activity ◽  
Cross Cultural ◽  
Two Cultures ◽  
Japanese Sample ◽  
Clinically Significant

The present study investigated the role of cognitive processes in the maintenance of clinically significant sleep disturbance across two cultures. A questionnaire was administered to 60 Japanese and 60 English university students to assess the presence of sleep disturbance, predominance of pre-sleep cognitive activity, use of thought management strategies to control pre-sleep cognitive activity, and the content of pre-sleep cognitive activity. The results indicated that across both cultures poor sleepers attributed their sleep disturbance to the presence of uncontrollable pre-sleep cognitive activity. Minor differences between the Japanese and English samples included the strategies employed to control pre-sleep cognitive activity. The English participants were more likely to engage in reappraisal whereas the Japanese sample were more likely to engage in punishment and worry. These results are suggestive of the cross-cultural applicability of cognitive models of insomnia.

scholarly journals Clinical Applications, Pitfalls, and Uncertainties of Thrombin Generation in the Presence of Platelets

2019 ◽  
Vol 9 (1) ◽  
pp. 92 ◽  
Author(s):  
Marina Panova-Noeva ◽  
Paola E.J. van der Meijden ◽  
Hugo ten Cate
Keyword(s):  
Thrombin Generation ◽  
Ex Vivo ◽  
Platelet Rich Plasma ◽  
Coagulation Factor ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
Clinical Applications ◽  
Von Willebrand Disease ◽  
Von Willebrand

Platelet-dependent thrombin generation is a helpful tool to assess ex vivo the interaction between platelets and plasma coagulation factors in the initiation, amplification, and inhibition of thrombin generation (TG). This review article discusses the most relevant available data on the clinical applications of fluorogenic TG, the most widely used TG assay, performed in the presence of platelets, i.e., in platelet-rich plasma. With respect to prothrombotic states, arterial hypertension and obesity were the most prominent cardiovascular conditions linked to increased platelet-dependent TG. In addition, platelet-associated hypercoagulability, assessed by the TG assay, has been shown in individuals with active cancer. In terms of bleeding, platelet-dependent TG has been applied to assess bleeding risk in individuals with hemophilia, von Willebrand disease, and Glanzmann thrombasthenia as well as in subjects with other congenital or acquired coagulation factor deficiencies. In addition to risk prediction, a role of the TG assay has been suggested in monitoring antiplatelet therapy in prothrombotic conditions and replacement therapy in bleeding diathesis. Finally, for the routine clinical use and as a biomarker of disease development and progression, better standardization and clinical validation of platelet-dependent TG are still needed.

scholarly journals Phenelzine and Amoxapine Inhibit Tyramine and d-Glucuronic Acid Catabolism in Clinically Significant Salmonella in A Serotype-Independent Manner

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 469
Author(s):  
Raquel Burin ◽  
Devendra H. Shah
Keyword(s):  
Glucuronic Acid ◽  
Energy Scavenging ◽  
The Novel ◽  
Independent Manner ◽  
Salmonella Serotypes ◽  
Clinically Significant ◽  
Nutritional Virulence ◽  
Hydrolysis Of

Non-typhoidal Salmonella ingeniously scavenges energy for growth from tyramine (TYR) and d-glucuronic acid (DGA), both of which occur in the host as the metabolic byproducts of the gut microbial metabolism. A critical first step in energy scavenging from TYR and DGA in Salmonella involves TYR-oxidation via TYR-oxidoreductase and production of free-DGA via β-glucuronidase (GUS)-mediated hydrolysis of d-glucuronides (conjugated form of DGA), respectively. Here, we report that Salmonella utilizes TYR and DGA as sole sources of energy in a serotype-independent manner. Using colorimetric and radiometric approaches, we report that genes SEN2971, SEN3065, and SEN2426 encode TYR-oxidoreductases. Some Salmonella serotypes produce GUS, thus can also scavenge energy from d-glucuronides. We repurposed phenelzine (monoaminoxidase-inhibitor) and amoxapine (GUS-inhibitor) to inhibit the TYR-oxidoreductases and GUS encoded by Salmonella, respectively. We show that phenelzine significantly inhibits the growth of Salmonella by inhibiting TYR-oxidoreductases SEN2971, SEN3065, and SEN2426. Similarly, amoxapine significantly inhibits the growth of Salmonella by inhibiting GUS-mediated hydrolysis of d-glucuronides. Because TYR and DGA serve as potential energy sources for Salmonella growth in vivo, the data and the novel approaches used here provides a better understanding of the role of TYR and DGA in Salmonella pathogenesis and nutritional virulence.

Mitochondrial matrix calcium ions regulate energy production in myocardium: A cytochemical study

1990 ◽  
Vol 48 (2) ◽  
pp. 166-167
Author(s):  
W.A. Jacob ◽  
R. Hertsens ◽  
A. Van Bogaert ◽  
M. De Smet
Keyword(s):  
Energy Metabolism ◽  
Calcium Ions ◽  
Energy Production ◽  
Regulation Of Respiration ◽  
Free Calcium ◽  
Mitochondrial Matrix ◽  
Cytochemical Study ◽  
Nmr Techniques

In the past most studies of the control of energy metabolism focus on the role of the phosphorylation potential ATP/ADP.Pi on the regulation of respiration. Studies using NMR techniques have demonstrated that the concentrations of these compounds for oxidation phosphorylation do not change appreciably throughout the cardiac cycle and during increases in cardiac work. Hence regulation of energy production by calcium ions, present in the mitochondrial matrix, has been the object of a number of recent studies.Three exclusively intramitochondnal dehydrogenases are key enzymes for the regulation of oxidative metabolism. They are activated by calcium ions in the low micromolar range. Since, however, earlier estimates of the intramitochondnal calcium, based on equilibrium thermodynamic considerations, were in the millimolar range, a physiological correlation was not evident. The introduction of calcium-sensitive probes fura-2 and indo-1 made monitoring of free calcium during changing energy metabolism possible. These studies were performed on isolated mitochondria and extrapolation to the in vivo situation is more or less speculative.

Meiotic CENP-C is a shepherd: bridging the space between the centromere and the kinetochore in time and space

2020 ◽  
Vol 64 (2) ◽  
pp. 251-261
Author(s):  
Jessica E. Fellmeth ◽  
Kim S. McKim
Keyword(s):  
Chromosome Segregation ◽  
New Technologies ◽  
Early Prophase ◽  
Unique Role ◽  
Kinetochore Assembly ◽  
M Phase ◽  
In Vivo Analysis ◽  
Meiosis I

Abstract While many of the proteins involved in the mitotic centromere and kinetochore are conserved in meiosis, they often gain a novel function due to the unique needs of homolog segregation during meiosis I (MI). CENP-C is a critical component of the centromere for kinetochore assembly in mitosis. Recent work, however, has highlighted the unique features of meiotic CENP-C. Centromere establishment and stability require CENP-C loading at the centromere for CENP-A function. Pre-meiotic loading of proteins necessary for homolog recombination as well as cohesion also rely on CENP-C, as do the main scaffolding components of the kinetochore. Much of this work relies on new technologies that enable in vivo analysis of meiosis like never before. Here, we strive to highlight the unique role of this highly conserved centromere protein that loads on to centromeres prior to M-phase onset, but continues to perform critical functions through chromosome segregation. CENP-C is not merely a structural link between the centromere and the kinetochore, but also a functional one joining the processes of early prophase homolog synapsis to late metaphase kinetochore assembly and signaling.

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