scholarly journals The System of Blood Coagulation in Normal and in Liver Transplantation (Review)

2018 ◽  
Vol 14 (5) ◽  
pp. 58-84 ◽  
Author(s):  
V. I. Reshetnyak ◽  
S. V. Zhuravel ◽  
N. K. Kuznetsova ◽  
V. М. Pisarev ◽  
E. V. Klychnikova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Blood Coagulation ◽  
Liver Diseases ◽  
Significant Risk ◽  
Perioperative Period ◽  
Coagulation System ◽  
Hemostatic System ◽  
Time Changes ◽  
Mechanisms Of Development ◽  
Hemostatic Disorders

The review dwells on the problem of hemostatic disorders in patients undergoing liver transplantation and their correction in the perioperative period. The physiology of the hemostatic system, disorders of the blood coagulation system in patients at various stages of liver transplantation, correction of hemostatic disorders during and after orthotopic liver transplantation are discussed. Liver transplantation is performed in patients with liver diseases in the terminal stage of liver failure. At the same time, changes in the hemostatic system of these patients pose a significant risk of developing bleeding and/or thrombosis during and after liver transplantation. The hypothesis is suggested that the personalized correction of hemostasis disorder in liver transplantation should be based on considerating the nosological forms of the liver damage, mechanisms of development of recipient’s hemostatic disorders, and the stage of the surgery.

THROMBOELASTOGRAPHY IN EXPRESS ESTIMATION OF HEMOSTATIC SYSTEM IN PATIENTS WITH ACUTE PANCREATITIS

2019 ◽  
pp. 15-24
Author(s):  
A.P. Vlasov ◽  
Sh-A.S. Al'-Kubaysi ◽  
T.A. Muratova ◽  
V.V. Vasil'ev ◽  
N.A. Myshkina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Blood Coagulation ◽  
Maximum Amplitude ◽  
Coagulation System ◽  
Biochemical Tests ◽  
Hemostatic System ◽  
Group 2 ◽  
Serious Disease ◽  
Α Angle ◽  
Lytic System

The problem of diagnostics and treatment of acute pancreatitis (AP) is relevant for emergency surgery. Both clinicians and specialists in paraclinical disciplines thoroughly examine pathogenesis of this serious disease, as their observations will contribute greatly to targeted therapy. The problem of hemostatic disorders still remains one of the poorly studied. The aim of the work is to assess the hemostatic system in patients with acute pancreatitis of various severity upon admission to the clinic. Materials and Methods. The authors examined 48 patients with acute pancreatitis, who were divided into two groups: group 1 (control, n=24) consisted of patients with mild AP; Group 2 (comparison, n=24) included patients with severe AP. Moreover, healthy individuals were also examined during the trial (norm, n=14). Disease severity is determined according to APACHE II Scoring System and national clinical guidelines. Blood coagulation-lytic system was evaluated by a number of biochemical tests (APTT, IPT, and fibrinogen) and according to some thromboelastography parameters (reaction time, coagulation time, α-angle and maximum amplitude) (TEG® 5000 Thrombelastograph®, USA). Results. It was found out that on admission thromboelastography allows clinicians to get an integrated picture of the blood coagulation system in the shortest possible time and on a full scale. These data significantly supplement the information on the coagulation-lytic system obtained by the biochemical method. It turned out that on admission patients with acute pancreatitis demonstrated significant disorders of the hemostatic system humoral component, such as hypercoagulemia and fibrinolytic inhibition. It is shown that disorders of the hemostatic system are associated with the severity of pathology. Conclusions. The information obtained can serve as the key element for targeted timely vector therapy in correction (prevention) of hemostatic derangements, the most important link in microcirculatory disorders. Keywords: hemostasis, coagulation, acute pancreatitis, thromboelastography. Проблема диагностики и лечения острого панкреатита (ОП) остается актуальной для неотложной хирургии. Усилия клиницистов и специалистов параклинических дисциплин направлены на углубленное изучение патогенеза этой тяжелой болезни, результаты которого обеспечат проведение целенаправленной терапии. Одним из малоизученных является вопрос гемостатических нарушений. Целью работы явилась оценка состояния системы гемостаза у больных ОП различной тяжести при поступлении в клинику. Материалы и методы. Проведено исследование 48 пациентов с острым панкреатитом, разделенных на группы: І группа (контроль, n=24) – пациенты с ОП легкой формы; ІІ группа (сравнение, n=24) – пациенты с ОП тяжелой степени. Для сравнения были обследованы здоровые лица (норма, n=14). Степень тяжести заболевания определена с помощью шкалы АРАСНЕ-ІІ и в соответствии с национальными клиническими рекомендациями. Состояние коагуляционно-литической системы крови оценено по ряду биохимических тестов (АЧТВ, ПТИ и фибриноген) и при помощи некоторых параметров (реакционное время, время коагуляции, величина α-угла и максимальная амплитуда) тромбоэластографии (TEG® 5000 Thrombelastograph®, USA). Результаты. Выявлено, что проведение тромбоэластографии при госпитализации позволяет получить интегральную картину состояния свертывающей системы крови в кратчайший срок и в полном объеме. Эти данные существенно дополняют сведения о состоянии коагуляционно-литической системы, полученные биохимическим путем. Оказалось, что при поступлении в клинику у больных ОП регистрируются значительные расстройства гуморального компонента системы гемостаза в виде гиперкоагулемии и угнетения фибринолиза. Показано, что расстройства в системе гемостаза сопряжены с тяжестью патологии. Выводы. Полученные сведения могут служить основой для целенаправленной своевременной векторной терапии при коррекции (предупреждении прогрессирования) гемостатических расстройств – важнейшего звена нарушения микроциркуляции. Ключевые слова: гемостаз, коагуляция, острый панкреатит, тромбоэластография.

scholarly journals Liver Disease and Hemostasis (Review) Part 2. Cholestatic Liver Disease and Hemostasis

2019 ◽  
Vol 15 (6) ◽  
pp. 80-93 ◽  
Author(s):  
Vasiliy I. Reshetnyak ◽  
Igor V. Maev ◽  
Tatiana M. Reshetnyak ◽  
Sergei V. Zhuravel ◽  
Vladimir M. Pisarev
Keyword(s):  
Liver Disease ◽  
Critical Illness ◽  
Liver Diseases ◽  
Multiorgan Failure ◽  
Phospholipid Composition ◽  
Current Data ◽  
Coagulation System ◽  
Cholestatic Liver Disease ◽  
Liver Disorders ◽  
Hemostatic Disorders

The presence or development of liver disorders can significantly complicate the course of critical illness and terminal conditions. Systemic hemostatic disorders are common in Intensive Care Units patients with cholestatic liver diseases, so the study of the mechanisms of their development can contribute to the understanding of the development of multiorgan failure in critical illness.The review discusses current data on changes in hemostatic parameters in patients with cholestatic liver diseases, proposes a mechanism for the development of such disorders, which involve interactions of phospholipids with platelet and endotheliocyte membranes. It is suggested that a trend for thrombosis in patients with cholestatic liver disease is due to increased accumulation of bile acids in the systemic circulation. Available data demonstrate that the antiphospholipid syndrome may predispose to the formation of blood clots due to alterations of phospholipid composition of membranes of platelets and vascular endothelial cells by circulating antiphospholipid antibodies. Clarifying the mechanisms contributing to changes of the blood coagulation system parameters in liver disorders will aid to development of optimal correction of hemostatic disorders in patients with chronic liver diseases.

scholarly journals USING THE THROMBODYNAMICS TEST IN THE INTEGRATED PERIOPERATIVE MONITORING OF THE BLOOD COAGULATION SYSTEM IN SURGICAL PATIENTS

2018 ◽  
Vol 25 (6) ◽  
pp. 44-49
Author(s):  
I. V. [email protected]; ◽  
G. K. Karipidi ◽  
A. G. Barishev ◽  
U. P. Savchenko ◽  
S. B. Bazlov ◽  
...  
Keyword(s):  
Blood Coagulation ◽  
Abdominal Cavity ◽  
Statistical Processing ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Coagulation System ◽  
Thromboembolic Complications ◽  
Integrated Monitoring ◽  
Blood Coagulation System ◽  
Venous Thromboembolic

Aim.The research was conducted to evaluate the possibilities of the "Thrombodynamics" test in the integrated monitoring of the blood coagulation system and the choice of the method of prophylaxis of thromboembolic complications in the postoperative period in surgical patients.Materials and methods. 123 patients were operated for acute surgical pathology of abdominal organs. The "Thrombodynamics" test was used in a complex assessment of the state of the blood coagulation system. After the statistical processing by the methods of variation statistics, the results were used to predict the risk of the occurrence and changes in the volume of therapy for thromboembolic complications, taking into account the current understanding of the thrombodynamic properties of the fibrinous clot. Correction of the hemostasis system was based on "Russian Clinical Recommendations for the Diagnosis, Treatment and Prevention of Venous Thromboembolic Complications" approved by the Expert Meeting on May 20, 2015.Results.It was found that 101 (82.1%) patients had abnormalities in the blood coagulation system after the surgery for acute abdominal cavity diseases complicated by peritonitis. We established the direct dependence of the predicted risk of thromboembolic complications on the degree of severity of secondary peritonitis. 52 (42.3%) patients needed a correction of thromboprophylactic therapy, which made it possible to exclude the occurrence of venous thromboembolic complications.Conclusion. The use of the "Thrombodynamics" test in the complex evaluation of the qualitative characteristics of the blood coagulation system in surgical patients with a complicated course of the disease in the perioperative period makes it possible to objectively assess the risks of the thromboembolic complications and to correct a thromboprophylactic therapy to exclude the thromboembolic complications. 

The course of pregnancy and blood coagulation system

2016 ◽  
Vol 3 (4) ◽  
pp. 181-187
Author(s):  
A. V Murashko ◽  
Yuliya S. Drapkina ◽  
N. S Koroleva
Keyword(s):  
Tissue Factor ◽  
Blood Coagulation ◽  
Coagulation Factors ◽  
Medical Intervention ◽  
Coagulation System ◽  
Protein Z ◽  
Blood Coagulation System ◽  
High Prevalence ◽  
Thrombotic Complications ◽  
Hemostatic Disorders

Pregnancy represents the procoagulant state, giving rise in the high prevalence rate of thrombotic complications. An imbalance between coagulation and anticoagulation systems of blood during pregnancy can lead to the development of pre-eclampsia, intrauterine growth retardation, preterm labor, premature rupture offetal membranes and fetal death. These complications are mostly caused by the impaired generation of thrombin as well as changes in the concentration and activity of tissue factor TFPI (tissue factor pathway inhibitor), TAT III complex and protein Z. Nevertheless, it should be noted that the thrombotic complications during pregnancy depend not on the elevation of the concentrations of specific coagulation factors or lack of the activity of anticoagulant proteins, but on the shift in the whole system toward the procoagulant state. These disorders most of all lead to thromboses ofplacental vessels, causing disorders ofperfusion of the affected area. Placental pathology can develop as from the maternal as from the fetal side. Despite the fact that changes in the blood coagulation system occur from the very beginning of pregnancy, and often are adaptive in nature, i.e., do not require special medical intervention, the prompt diagnosis and treatment of hemostatic disorders as main pathogenetic link in the development of thrombosis is extremely important.

scholarly journals Liver Diseases and the Hemostasis (Rewiew) Part 1. Non-Cholestatic Diseases of the Liver and Hemostasis

2019 ◽  
Vol 15 (5) ◽  
pp. 74-87 ◽  
Author(s):  
V. I. Reshetnyak ◽  
I. V. Maev ◽  
T. M. Reshetnyak ◽  
S. V. Zhuravel ◽  
V. M. Pisarev
Keyword(s):  
Liver Failure ◽  
Liver Damage ◽  
Liver Diseases ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Coagulation System ◽  
Hemostasis System ◽  
Almost All ◽  
Hemostatic Disorders ◽  
Cholestatic Diseases

In liver diseases, most commonly in the terminal stage of liver failure, a variety of hemostatic defects affecting almost all parts of the blood coagulation system are developing. This leads to diminishing the capabilities of patients with liver diseases to correctly maintain the hemostatic balance.The severity of hemostatic disorders depends on the nosological form and degree of a liver damage. Depending on the imbalance of the hemostasis system and accumulated clinical/laboratory data, patients with liver diseases can be subdivided into three groups as exhibiting: 1. non-cholestatic liver damage; 2. cholestatic liver damage and 3. liver damage of vascular origin.The first part of the review discusses multiple alterations in the hemostasis system in patients with noncholestatic liver diseases, which are commonly accompanied by hypocoagulation.

scholarly journals The influence of veno-veno bypass on blood coagulation system in liver transplantation procedure.

1987 ◽  
Vol 20 (8) ◽  
pp. 1871-1876
Author(s):  
Hidetoshi MATSUNAMI ◽  
Atsuyoshi ONITSUKA ◽  
Tadashi FUKUTOMI ◽  
Yoshihiro YANO ◽  
Yutaka OZEKI ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Blood Coagulation ◽  
Coagulation System ◽  
Blood Coagulation System

scholarly journals The rationale for the effectiveness of enteral nutrition in treatment of patients with liver disease

2019 ◽  
pp. 29-34
Author(s):  
S. S. Batskov ◽  
A. V. Gordienko ◽  
E. D. Pyatibrat
Keyword(s):  
Quality Of Life ◽  
Enteral Nutrition ◽  
Blood Coagulation ◽  
Body Mass ◽  
Liver Diseases ◽  
Nutritional Support ◽  
Fire Service ◽  
Coagulation System ◽  
Self Assessment

Relevance. The high incidence of diseases of the liver and other organs of digestion in employees of State Fire Service of EMERCOM of Russia results from exposure to harmful chemical factors when performing professional tasks. Currently, the growing interest of the medical scientific community and practitioners is the nutritional support for the treatment of diseases of the digestive system. Therefore, the study aimed at substantiating the effectiveness of nutritional support in the treatment of liver diseases is certainly relevant.Intention. To scientifically substantiate effectiveness of enteral nutrition in the treatment of patients with liver diseases. Method. From 2015 to 2018, 237 patients, middle-aged men (56.4 ± 9.4) years, with liver diseases and trophic insufficiency of moderate severity were examined. All subjects were divided into 2 groups, the first group consisted of 121 people receiving enteral nutrition with Nutricomp HEPA liquid, the second group consisted of 116 people treated without enteral support. To assess the effectiveness of enteral nutrition in the treatment of liver diseases, the following were analyzed: trophological status, biochemical parameters of the protein fraction of peripheral blood, proteins of the blood coagulation system and the activity of transaminases. The indicators of self-assessment of quality of life before and after treatment were also analyzed.Results and Discussion. Nutraceuticals, compared to no enteral nutrition, significantly reduced the concentrations of ammonia, increased concentrations of albumin, product of protein metabolism, indicators of blood coagulation and the activity of transaminases. They have significantly increased body mass index, and body mass deficit decreased. After treatment with enteral nutrition in patients, self-assessment of quality of life was significantly higher than in the group not receiving enteral nutrition.Conclusion. Thus, the use of nutraceuticals for enteral support of patients with reduced trophological status can significantly improve the effectiveness of therapy, promotes faster recovery and reduces time spent in hospital. 

A Re-Appraisal of the Role of Blood Coagulation and Platelets in the Generalized Shwartzman Phenomenon

1966 ◽  
Vol 15 (03/04) ◽  
pp. 519-538 ◽  
Author(s):  
J Levin ◽  
E Beck
Keyword(s):  
Blood Coagulation ◽  
The State ◽  
Coagulation System ◽  
Renal Lesions ◽  
Intravascular Coagulation ◽  
Renal Glomeruli ◽  
Coagulation Mechanism ◽  
Shwartzman Phenomenon ◽  
Do So

SummaryThe role of intravascular coagulation in the production of the generalized Shwartzman phenomenon has been evaluated. The administration of endotoxin to animals prepared with Thorotrast results in activation of the coagulation mechanism with the resultant deposition of fibrinoid material in the renal glomeruli. Anticoagulation prevents alterations in the state of the coagulation system and inhibits development of the renal lesions. Platelets are not primarily involved. Platelet antiserum produces similar lesions in animals prepared with Thorotrast, but appears to do so in a manner which does not significantly involve intravascular coagulation.The production of adrenal cortical hemorrhage, comparable to that seen in the Waterhouse-Friderichsen syndrome, following the administration of endotoxin to animals that had previously received ACTH does not require intravascular coagulation and may not be a manifestation of the generalized Shwartzman phenomenon.

scholarly journals Tailored Prediction Model of Survival after Liver Transplantation for Hepatocellular Carcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2869
Author(s):  
Indah Jamtani ◽  
Kwang-Woong Lee ◽  
Yun-Hee Choi ◽  
Young-Rok Choi ◽  
Jeong-Moo Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Prediction Model ◽  
Risk Group ◽  
Significant Risk ◽  
Risk Scores ◽  
Accurate Information ◽  
Survival Prediction ◽  
Good Prediction ◽  
Recurrence Rates

This study aimed to create a tailored prediction model of hepatocellular carcinoma (HCC)-specific survival after transplantation based on pre-transplant parameters. Data collected from June 2006 to July 2018 were used as a derivation dataset and analyzed to create an HCC-specific survival prediction model by combining significant risk factors. Separate data were collected from January 2014 to June 2018 for validation. The prediction model was validated internally and externally. The data were divided into three groups based on risk scores derived from the hazard ratio. A combination of patient demographic, laboratory, radiological data, and tumor-specific characteristics that showed a good prediction of HCC-specific death at a specific time (t) were chosen. Internal and external validations with Uno’s C-index were 0.79 and 0.75 (95% confidence interval (CI) 0.65–0.86), respectively. The predicted survival after liver transplantation for HCC (SALT) at a time “t” was calculated using the formula: [1 − (HCC-specific death(t’))] × 100. The 5-year HCC-specific death and recurrence rates in the low-risk group were 2% and 5%; the intermediate-risk group was 12% and 14%, and in the high-risk group were 71% and 82%. Our HCC-specific survival predictor named “SALT calculator” could provide accurate information about expected survival tailored for patients undergoing transplantation for HCC.

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