Immunological and hemostasiological aspects of pathogenesis of obliterating atherosclerosis of arteries of the lower extremities

Objectives to study the changes in the immunological status and hemostatic system in patients with obliterating atherosclerosis of the lower limb arteries with the damage to the femoral-popliteal-tibial segment. Material and methods. A comprehensive study of the cytokine status and hemostatic system in patients with obliterating atherosclerosis of lower limb arteries with lesions of the femoral-popliteal tibia segment was carried out. Results. The progressive course of obliterating atherosclerosis is often associated with an increased content of cytokines (IL-1, IL-6, IL-8, TNF), as well as with the phenomena of hypercoagulation (increased platelet aggregation activity, shortened APTT, CT, TT, increased fibrinogen content), SFMCs, D-dimer). Conclusion. The study of the immunological status and hemostatic system should be performed in all patients with obliterating atherosclerosis of the lower limb arteries in order to adequately medically correct and prevent postoperative complications.

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The Inhibition of Platelet Aggregation by an Aorta Intima Extract

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647710 ◽

1974 ◽

Vol 32 (02/03) ◽

pp. 417-431 ◽

Cited By ~ 14

Author(s):

A. du P Heyns ◽

D. J van den Berg ◽

G. M Potgieter ◽

F. P Retief

Keyword(s):

Platelet Aggregation ◽

Degradation Products ◽

Adenosine Diphosphate ◽

Inhibitory Effect ◽

Protective Role ◽

Vascular Trauma ◽

Wear And Tear ◽

Sequential Addition ◽

Aggregation Activity

SummaryThe platelet aggregating activity of extracts of different layers of the arterial wall was compared to that of Achilles tendon. Arterial media and tendon extracts, adjusted to equivalent protein content as an index of concentration, aggregated platelets to the same extent but an arterial intima extract did not aggregate platelets. Platelet aggregation induced by collagen could be inhibited by mixing with intima extract, but only to a maximum of about 80%. Pre-mixing adenosine diphosphate (ADP) with intima extracts diminished the platelet aggregation activity of the ADP. Depending on the relationship between ADP and intima extract concentrations aggregating activity could either be completely inhibited or inhibition abolished. Incubation of ADP with intima extract and subsequent separation of degradation products by paper chromatography, demonstrated a time-dependent breakdown of ADP with AMP, adenosine, inosine and hypoxanthine as metabolic products; ADP removal was complete. Collagen, thrombin and adrenaline aggregate platelets mainly by endogenous ADP of the release reaction. Results of experiments comparing inhibition of aggregation caused by premixing aggregating agent with intima extract, before exposure to platelets, and the sequential addition of first the intima extract and then aggregating agent to platelets, suggest that the inhibitory effect of intima extract results from ADP breakdown. It is suggested that this ADP degradation by intima extract may play a protective role in vivo by limiting the size of platelet aggregates forming at the site of minimal “wear and tear” vascular trauma.

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Essential Athrombia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647881 ◽

1975 ◽

Vol 33 (02) ◽

pp. 278-285 ◽

Cited By ~ 3

Author(s):

Şeref Inceman ◽

Yücel Tangün

Keyword(s):

Platelet Aggregation ◽

Bleeding Time ◽

Bleeding Tendency ◽

Clot Retraction ◽

Platelet Factor ◽

Prolonged Bleeding Time ◽

Normal Platelet ◽

Aggregation Response ◽

Platelet Disorder ◽

Fibrinogen Content

SummaryA constitutional platelet function disorder in a twelve-year-old girl characterized by a lifelong bleeding tendency, prolonged bleeding time, normal platelet count, normal clot retraction, normal platelet factor 3 activity and impaired platelet aggregation was reported.Platelet aggregation, studied turbidimetrically, was absent in the presence of usual doses of ADP (1–4 μM), although a small wave of primary aggregation was obtained by very large ADP concentrations (25–50 μM). The platelets were also unresponsive to epinephrine, thrombin and diluted collagen suspensions. But an almost normal aggregation response occurred with strong collagen suspensions. The platelets responded to Ristocetin. Pelease of platelet ADP was found to be normal by collagen and thrombin, but impaired by kaolin. Platelet fibrinogen content was normal.The present case, investigated with recent methods, confirms the existence of a type of primary functional platelet disorder characterized solely by an aggregation defect, described in 1955 and 1962 under the name of “essential athrombia.”

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Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651178 ◽

1993 ◽

Vol 69 (01) ◽

pp. 008-011 ◽

Cited By ~ 22

Author(s):

Cedric J Carter ◽

D Lynn Doyle ◽

Nigel Dawson ◽

Shauna Fowler ◽

Dana V Devine

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Utility ◽

Rapid Test ◽

Fibrin Degradation Product ◽

Current Form ◽

Non Invasive ◽

Clinically Significant ◽

D Dimer

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

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Degraded limonoids and quinoline alkaloids from Dictamnus angustifolius G. Don ex Sweet. and their anti-platelet aggregation activity

Fitoterapia ◽

10.1016/j.fitote.2013.07.023 ◽

2013 ◽

Vol 90 ◽

pp. 209-213 ◽

Cited By ~ 15

Author(s):

Jian-Bo Sun ◽

Wei Qu ◽

Pei Wang ◽

Fei-Hua Wu ◽

Li-Ying Wang ◽

...

Keyword(s):

Platelet Aggregation ◽

Quinoline Alkaloids ◽

Aggregation Activity

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Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound

ISRN Radiology ◽

10.1155/2014/519875 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Maryam Rahiminejad ◽

Anshul Rastogi ◽

Shirish Prabhudesai ◽

David Mcclinton ◽

Peter MacCallum ◽

...

Keyword(s):

Risk Factor ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Risk Factor ◽

Diagnostic Pathway ◽

Clinical Diagnostic ◽

Retrospective Audit ◽

Wells Score ◽

D Dimer

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

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Platelet aggregation in patients with chronic heart failure in a "vortex" flow

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.023 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

OKSANA Trubacheva ◽

IRINA Kologrivova ◽

TATYAN Suslova

Keyword(s):

Heart Failure ◽

Platelet Aggregation ◽

Chronic Heart Failure ◽

Vortex Flow ◽

Platelet Rich Plasma ◽

Aggregate Size ◽

Standard Methods ◽

Aggregation Activity ◽

Platelet Hyperaggregation ◽

Epinephrine Concentration

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Исследование выполнено в рамках фундаментальной темы НИИ кардиологии АААА-А15-115123110026-3. Platelet aggregation mechanisms are studied using standard methods without taking turbulence into account. However, in cardiovascular diseases, the blood rheology changes, and the parameters of the turbulent flow acquire strong prothrombotic effects. The adhesion of several platelets creates a "snowball" effect with platelet hyperaggregation, leading to rapid vessel occlusion. Thus, the study of platelet aggregation in patients with cardiovascular diseases in conditions of creating a "vortex" flow in platelet-rich plasma is very relevant. Objective to study the effect of "vortex" flow in platelet-rich plasma on spontaneous and epinephrine-induced platelet aggregation in patients with CHF. Material and method. We studied 15 patients (75% of them men) with CHD, having CHF I-III FC. Platelet aggregation activity was studied using a turbidimetric method using a laser analyzer (220 LA "NPF Biola", Russia). Platelet aggregation activity in platelet-rich plasma (BTP) was estimated by light transmission curves in % and average aggregate size in relative units (Rel. units), with the inducer epinephrine in concentrations of 2 and 10 mg/ml, with constant stirring at 800 rpm. The same parameters were evaluated byour ownproposed approach with a creation ofa "vortex" plasma flow, which were achieved by changing the mixing rate of BTP from 0 to 800 rpm. Aggregation data is presented as a median with an interquartile range (Me (Q1; Q3)). Statistical data processing was performed using SPSS packages (version 19). The differences were considered significant at a significance level of p < 0.05. Results. In patients with CHF, the indicators of spontaneous aggregation measured by the standard method were 3.1 (1.5; 4.0) % and 1.7 (1.1; 2.0) Rel. units. Under the conditions of a"vortex" flow, the aggregate size increased to 5.4 (3.2; 6.1) Rel. units(p = 0.04). The indicators of standard epinephrine-induced aggregation at a concentration of 2 mg/ml were 46.7 (35.8; 66.2) % and 15.0(11.4; 18.9) Rel. units, and when the mixing speed was changed from 0 to 800 rpm, the indicators increased to 52.7 (41.3; 76.5) % (p = 0.003) and 19.4 (17.3; 20.6) Rel. units(p = 0.04). In conditions of increased epinephrine concentration of 10 mg/ml, the indicators were 52.5 (41.9; 74.5) % (p = 0.03) and 15.8 (12.2; 18.4) Rel. units. Under the conditions of"vortex" flow, aggregation indicators were 75.4 (62.0; 80.5)% (p = 0.04), and the size of aggregates increased to 356.0 (230.5; 462.5) Rel. units. Conclusion. Standard methods for studying of platelet aggregation are not always sufficient to detect an increased pro-aggregative potential of platelets. The proposed method for creationof "vortex" flow conditions showed an increase in the size of platelet aggregates and the degree of aggregation against the background of increased epinephrine concentration in patients with chronic heart failure, which proves its effectiveness in detecting platelet hyperaggregation.

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Prognostic Nutritional Index Considering Resection Range Is Useful for Predicting Postoperative Morbidity of Hepatectomy

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-020-04893-z ◽

2021 ◽

Author(s):

Shigeyuki Nagata ◽

Shohei Maeda ◽

Satoko Nagamatsu ◽

Seiichiro Kai ◽

Yasuro Fukuyama ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Procedures ◽

Predictive Value ◽

Surgical Procedure ◽

Major Hepatectomy ◽

Prognostic Nutritional Index ◽

Complication Rates ◽

Immunological Status ◽

Grade Ii ◽

Prognostic Nutrition Index

Abstract Background Poor preoperative nutritional and immunological status are major risk factors for postoperative complications in patients with various malignancies. Lower preoperative prognostic nutrition index (PNI) is associated with higher rates of postoperative complications and poorer prognosis in those patients. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure. Methods This retrospective study included 510 patients who underwent open hepatectomies for HCC. The predictive value of the preoperative nutritional and immunological status for postoperative complications was assessed using the PNI. Postoperative complications were defined as grade II or higher per the Clavien-Dindo classification. Postoperative complication rates were compared according to surgical procedure (major hepatectomy vs minor hepatectomy). Results Patients with postoperative complications had significantly lower PNIs than those without (43.1 ± 5.5 vs 47.0 ± 5.7, P < 0.001). In the multivariate analysis, low preoperative PNI (< 45) was an independent risk factor for postoperative complications after hepatectomy (hazard ratio, 3.85). When patients were classified per their PNI (high vs low) and extent of surgical procedures (major vs minor), there were more complications among patients with low PNI than those with high PNI, regardless of the extent of surgical procedures. Specifically, the group of patients with low PNI who underwent major hepatectomy had significantly higher rates of postoperative complications than the other groups. Conclusions Adding the resection range to the PNI is useful for predicting the postoperative morbidities of hepatectomy patients.

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Personalized approach to procurement of hemocomponents taking into account hemostasis characteristics of donors

Тромбоз, гемостаз и реология ◽

10.25555/thr.2018.3.0852 ◽

2018 ◽

Author(s):

А.Ф. Кубиддинов ◽

Д.С. Саидов ◽

М.З. Тагожонов ◽

А.А. Одинаев ◽

З.Ф. Тагожонов ◽

...

Keyword(s):

Platelet Aggregation ◽

Factor Viii ◽

Blood Clotting ◽

International Normalized Ratio ◽

Blood Components ◽

Transfusion Therapy ◽

At Iii ◽

Personalized Approach ◽

Von Willebrand ◽

Fibrinogen Content

Цель исследования: изучение параметров гемостаза у доноров для оптимизации использования компонентов крови у пациентов с нарушениями свертывания крови. Материалы и методы. Проанализированы результаты коагулологического исследования крови у 200 доноров. Контрольную группу составили 50 человек — здоровые люди (добровольцы), не доноры в возрасте от 20 до 60 лет. Измеряли: время свертывание крови по Ли-Уайту, активированное частичное тромбопластиновое время, международное нормализованное отношение, агрегацию тромбоцитов, антитромбин III (АТ-III), содержание фибриногена по Клаусу, фактор фон Виллебранда (ФВ), активность фактора VIII. Рассчитывали среднюю арифметическую и среднюю ошибку средней арифметической (М ± m), для оценки значимости различий средних величин использовали t-критерий Стьюдента, различия считали статистически значимыми при р < 0,05. Результаты. Оценка показателей гемостаза показала как развитие у доноров склонности к гиперкоагуляции, так и компенсаторную активацию антикоагулянтной системы. В зависимости от возраста и количества кровосдач агрегация тромбоцитов, АТ-III, содержание фибриногена, активность ФВ и фактора VIII в заготовленных компонентах крови получаются различными. Заключение. Трансфузионная терапия коагулопатий может быть оптимизирована за счет применения компонентов крови, целенаправленно заготовленных с учетом характера нарушений свертывания крови у реципиента. Aim: to optimize the usage of blood components in patients with coagulopathy we analyze some hemostasis parameters in donors. Materials and methods. In 200 donors and 50 healthy volunteers (aged from 20 to 60 years old) we analyzed hemostatic parameters: whole blood clotting time, activated partial thromboplastin time, international normalized ratio, platelet aggregation, antithrombin III (AT-III), Claus fibrinogen content, activity of von Willebrand factor (VWF) and factor VIII. The results obtained presented as M ± m. Statistical diff erences by Student test were considered as signifi cant for p < 0,05. Results. All donors had the tendency to hypercoagulation with compensatory activation of anticoagulant system. Depending on the age and number of blood donations, obtained blood components were diff erent in platelet aggregation, AT-III level, fibrinogen content, activity of VWF and factor VIII. Conclusion. Transfusion therapy of coagulopathies can be optimized through the use of blood components purposefully prepared taking into account the nature of blood clotting disorders in the recipient.

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The tannin content and anti platelet-aggregation activity of Cinnamomum sintoc extract

10.1063/1.5062741 ◽

2018 ◽

Author(s):

Tri Wiyono ◽

Arief Nurrochmad ◽

Sitarina Widyarini ◽

Nanang Fakhrudin

Keyword(s):

Platelet Aggregation ◽

Tannin Content ◽

Aggregation Activity

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

BMC Women s Health ◽

10.1186/s12905-021-01456-5 ◽

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.

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