Management of hemostasis in a patient with liver cirrhosis in the perioperative period.

2021 ◽  
Author(s):  
Н.В. Прасолов ◽  
Н.В. Доброва ◽  
Е.М. Шулутко ◽  
Е.А. Киценко ◽  
К.И. Данишян
Keyword(s):  
Liver Cirrhosis ◽  
Therapeutic Dose ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Perioperative Period ◽  
Pulmonary Angiography ◽  
Floating Thrombus ◽  
Heparin Resistance ◽  
At Iii ◽  
The Right

Для пациентов с циррозом печени характерны существенные изменения в системе гемостаза. Описан клинический случай ведения пациента с циррозом печени, портальной гипертензией, варикозными венами желудка, оперированного на высоте желудочно-кишечного кровотечения, на фоне выявленных тромбоэмболических осложнений (тромбоэмболия легочной артерии и тромбоз глубоких вен голеней). В предоперационном периоде был установлен кава-фильтр. В первые двое суток послеоперационного периода в качестве антикоагулянта вводили концентрат антитромбина III (АТ-III) по 1000 ЕД в связи с исходным его дефицитом (64%) и для дальнейшего обеспечения эффективности терапии низкомолекулярными гепаринами (НМГ). По мере увеличения уровня тромбоцитов с 66×109/л до 200×109/л в качестве антикоагулянта был назначен парнапарин натрия в лечебной дозе. Эффективность терапии НМГ оценивали с помощью тромбоэластографии (ТЭГ). На 9-е сутки после операции диагностировано развитие гепаринорезистентности на фоне тромбоцитоза более 1 млн, гиперфибриногенемии, высокой активности фактора VIII и вновь выявленного дефицита АТ-III (53%). Клинически гепаринорезистентность проявилась образованием флотирующего тромба в правой бедренной вене. К максимальной лечебной дозе парнапарина (17000 анти- Ха) добавлен антиагрегант клопидогрел (75 мг) и начато введение концентрата АТ-III по 1000 МЕ в течение 3 сут. Преодолена гепаринорезистентность с нормализацией уровня АТ-III (89%), достигнута дезагрегация тромбоцитов. Через 7 сут диагностирован полный лизис флотирующего тромба в правой бедренной вене. В дальнейшем пациент в течение 1 мес амбулаторно находился на терапии парнапарином (17000 анти- Ха активность в сутки) и клопидогрелом (75 мг/сут). По данным компьютерной ангиопульмонографии: полный лизис тромба в легочной артерии, кава-фильтр удален. Заключение. Мониторинг системы гемостаза у пациента с циррозом печени позволил контролировать адекватность проводимой антикоагулянтной терапии и использовать арсенал имеющихся в распоряжении клинициста препаратов. Patients with liver cirrhosis are characterized by significant hemostasis changes. A clinical case is described of patient management with liver cirrhosis, portal hypertension, stomach varicose veins, operated at the height of gastrointestinal bleeding, with revealed thromboembolic complications (pulmonary embolism and deep vein thrombosis of the lower legs). Cava filter was installed in preoperative period. In the first 2 days of the postoperative period, antithrombin III (AT-III) concentrate was administered as an anticoagulant, 1000 units each due to its initial deficiency (64%) and to further ensure the therapy efficacy with low molecular weight heparins (LMWH). By increasing the platelet count from 66×109/L to 200×109/L, a therapeutic dose of parnaparin sodium was prescribed as an anticoagulant. The efficacy of LMWH therapy was assessed by thromboelastography (TEG). On the day 9 after surgery heparin resistance was diagnosed with thrombocytosis (more than 1 million), hyperfibrinogenemia, high activity of VIII factor and re-identified AT-III deficiency (53%). Clinically, heparin resistance was manifested by floating thrombus in the right femoral vein. The antiaggregant clopidogrel (75 mg) was added to the maximum therapeutic dose of parnaparin (17,000 anti- Xa), and the administration of AT-III concentrate (1000 IU) was started for 3 days. Heparin resistance was overcome with normalization of AT-III level (89%), platelet disaggregation was achieved. Complete lysis of floating thrombus in the right femoral vein was diagnosed after 7 days. Later the patient was treated with parnaparin (17,000 anti- Xa activity per day) and clopidogrel (75 mg/day) during 1 month outpatiently. According to computer pulmonary angiography, complete thrombus lysis in the pulmonary artery was revealed, the cava filter was removed. Conclusions. Hemostasis monitoring in patient with liver cirrhosis made it possible to control the adequacy of the anticoagulant therapy and to use the arsenal of drugs available to the clinician.

Videodensitometry in Rats with Pulmonary Damage Due to Microembolism

1985 ◽  
Vol 26 (6) ◽  
pp. 785-788 ◽  
Author(s):  
G. Wegenius ◽  
T. Wegener ◽  
G. Ruhn ◽  
T. Saldeen ◽  
U. Erikson
Keyword(s):  
Body Weight ◽  
Femoral Vein ◽  
Mean Transit Time ◽  
Pressure Rise ◽  
Pulmonary Angiography ◽  
Valve Mechanism ◽  
Area Of Interest ◽  
Pulmonary Damage ◽  
The Right ◽  
The Impact

Serial pulmonary angiography with videodensitometry was performed in 18 rats with pulmonary damage caused by administration of a fibrinolysis inhibitor, tranexamic acid (200 mg/kg body weight injected intraperitoneally) and bovine thrombin (500 NIH/kg body weight injected into the right femoral vein). The mean transit time (MTT) was calculated from videodensitometry, the observed area of interest consisting of approximately one-third of the right lung, including both central and peripheral parts. The impact of the pulmonary damage was analysed by morphologic methods and correlated to MTT. Although a pressure rise presumably occurred in the pulmonary circulation, no change in MTT was found after induction of pulmonary damage, indicating opening of actual and potential anastomoses between pulmonary arterioles and venules to serve as by-pass portions and as a safety-valve mechanism for the capillary bed and the right heart, respectively. Another explanation to unchanged MTT may be opening of resting capillary beds. Two rats with very severe pulmonary damage showed prolonged MTT. These rats may have suffered from cardiac failure.

Telangiectasia and venous reflux in the Edinburgh Vein Study

2011 ◽  
Vol 27 (6) ◽  
pp. 297-302 ◽  
Author(s):  
C V Ruckley ◽  
P L Allan ◽  
C J Evans ◽  
A J Lee ◽  
F G R Fowkes
Keyword(s):  
Varicose Veins ◽  
Femoral Vein ◽  
Clinical Findings ◽  
Significant Trend ◽  
Duplex Scan ◽  
Catchment Areas ◽  
General Practices ◽  
Scan Data ◽  
The Right ◽  
Good Agreement

Objective The purpose of this study was to correlate the clinical findings in the Edinburgh Vein Study with the results of duplex scanning of the deep and superficial venous systems. Methods An age-stratified random sample of 1566 people (699 men and 867 women) aged 16–64 were selected from computerized age–sex registers of participating practices (twelve general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh). Screening included clinical examination, photography and duplex ultrasonography of the superficial veins and the deep veins down to popliteal level. Telangiectasia and varicose veins were graded 1–3 according to severity. Results Since there was good agreement between the duplex findings of the right versus left legs, the current analyses are based on 1092 subjects (486 men and 606 women) with complete duplex scan data in their left legs. There was no significant trend of increasing incompetence in either the deep veins only ( P = 0.214) or in the combined deep and superficial veins ( P = 0.111) with increasing severity of the telangiectasia. There was a statistically significant trend for increasing incompetence in (a) the superficial veins ( P = 0.006) and (b) either the superficial or deep veins ( P < 0.001) to be associated with advancing grade of telangiectasia. When stratified by gender, significant trends were maintained for male superficial vein incompetence and for either superficial or deep incompetence in both genders. Examination of incompetence in individual venous segments showed that increasing severity of telangiectasia was significantly associated with an increasing proportion of reflux in the upper and lower great saphenous and femoral vein segments. There was no significant association between small saphenous incompetence and increasing grade of telangiectasia. Conclusion There is a significant, but not wholly consistent, association between grade of telangiectasia and reflux in both the deep and superficial systems. This association does not apply to the small saphenous system.

A case of high-output heart failure caused by a femoral arteriovenous fistula after endovenous laser ablation treatment of the saphenous vein

2014 ◽  
Vol 30 (4) ◽  
pp. 290-292 ◽  
Author(s):  
Osamu Hashimoto ◽  
Takuya Miyazaki ◽  
Joji Hosokawa ◽  
Yumi Shimura ◽  
Hiroshi Okuyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Laser Ablation ◽  
Arteriovenous Fistula ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Endovenous Laser Ablation ◽  
Therapeutic Choice ◽  
High Output Heart Failure ◽  
The Right ◽  
High Output

Endovenous laser ablation treatment has become the less invasive therapeutic choice for the treatment of superficial venous insufficiency and varicose veins. A 64-year-old woman presented at our hospital with varicose veins and prior endovenous laser ablation treatment. The patient had high-output heart failure caused by a right femoral arteriovenous fistula. She was treated medically and underwent an open repair of the right superficial femoral artery and the right femoral vein with complete resolution of the arteriovenous fistula and heart failure. Here, we have reviewed the literature and discussed possible causes of the complication of arteriovenous fistula after endovenous laser ablation treatment.

scholarly journals A New Experimental Porcine Model of Venous Thromboembolism

2021 ◽  
Vol 10 (9) ◽  
pp. 1862
Author(s):  
Leszek Gromadziński ◽  
Agnieszka Skowrońska ◽  
Piotr Holak ◽  
Michał Smoliński ◽  
Ewa Lepiarczyk ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Porcine Model ◽  
Femoral Vein ◽  
Severe Disease ◽  
Pulmonary Angiography ◽  
High Morbidity ◽  
Vein Thrombosis ◽  
The Right ◽  
Deep Vein

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a severe disease affecting the human venous system, accompanied by high morbidity and mortality rates. The aim of the study was to establish a new porcine VTE model based on the formation of the thrombus in vivo. The study was performed on 10 castrated male pigs: thrombus was formed in each closed femoral vein and then successfully released from the right femoral vein into the circulation of animals. In six pigs PE was confirmed via both computed tomography pulmonary angiography and an autopsy. Our research presents a novel experimental porcine model of VTE that involves inducing DVT and PE in the same animal in vivo, making it suitable for advanced clinical research and testing of future therapies.

scholarly journals An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada A. Alyousefi
Keyword(s):  
Emergency Room ◽  
Lower Limb ◽  
Varicose Veins ◽  
Hormonal Contraception ◽  
Oral Contraception ◽  
Contraceptive User ◽  
Lower Limb Pain ◽  
The Right ◽  
D Dimer ◽  
Ethinyl Oestradiol

Abstract Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

scholarly journals Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

2007 ◽  
Vol 64 (7) ◽  
pp. 453-457
Author(s):  
Tamara Alempijevic ◽  
Vladislava Bulat ◽  
Nada Kovacevic ◽  
Rada Jesic ◽  
Srdjan Djuranovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Oesophageal Varices ◽  
Digestive Endoscopy ◽  
Liver Lobe ◽  
Albumin Ratio ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Upper Digestive Endoscopy ◽  
The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

scholarly journals Free-floating thrombus in the right common carotid artery

2009 ◽  
Vol 54 (2) ◽  
pp. 304-306 ◽  
Author(s):  
Eiji Taguchi ◽  
Kazuhiro Nishigami ◽  
Takihiro Kamio ◽  
Takashi Honda ◽  
Koichi Nakao
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Floating Thrombus ◽  
The Right

The right ventricle

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Right Ventricle ◽  
Volume Overload ◽  
Perioperative Period ◽  
Final Part ◽  
Accurate Assessment ◽  
Characteristic Features ◽  
The Right ◽  
Rv Function

The first part of Chapter 12 details the relevant anatomy, physiology, and TOE views required for accurate assessment of the RV. Included are several useful imaging planes that are not presented in Chapter 4: Standard views. Next, the techniques for assessing global, regional, and diastolic RV function are outlined. The characteristic features of RV pressure and volume overload are described. The final part of the chapter brings together the information from the previous sections to provide an approach to assessing RV function during the perioperative period.

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