Coagulation Hemostasis Research Articles

Distress symptoms development after a single episode of ultrasound exposure

Aim. To study the influence of a single 24-hour episode of exposure to ultrasound waves propagating in air on microcirculation and parameters of hemostasis in rats.
 Methods. The study was performed on 28 Wistar male rats. The experimental group was exposed to ultrasound for 24 hours. Geometric mean frequency was 25 kHz, acoustic pressure was 84.3 dB. Parameters of microcirculation of experimental rats received by laser Doppler flowmetry were compared with those of intact animals. Also comparative analysis of platelet and coagulation hemostasis, anticoagulant and fibrinolytic plasma activity was performed in rats from both groups.
 Results. In experimental rats in response to 24-hour exposure to ultrasound, significant decrease of the studied active and passive factors of blood flow modulation occurred compared to those of intact animals: parameters of microcirculation, flax, endothelial and vasomotor wave amplitude, respiratory and pulse wave amplitude. When studying the parameters of hemostasis, significant hypercoagulation of extrinsic pathway and at the latest stages of coagulation which worsened with anticoagulant plasma activity inhibition along with decrease of fibrinolytic activity. The character of changes of hemostatic parameters confirmed the development of stress-reaction in rats registered during the study of microcirculation.
 Conclusion. 24-hour ultrasound exposure causes significant disorders of microcirculation and unfavorable shifts in hemostasis - the signs of distress.

Features of local pulmonary hemostasis in patients who received surgical treatment for benign peripheral lung tumors

Objectives - to develop a method for prevention of thromboembolic events in small branches of pulmonary artery in post-operative period, based on features of local pulmonary hemostasis in patients who underwent lung surgery for benign tumors. Material and methods. 30 male patients aged 62 ± 2.4 years old were included in the study. All patients underwent lung surgery (mainly lobectomy). Blood was drawn intra-operationally from a. pulmonale (arriving venous blood), v. pulmonale (outflowing blood) and cubital vein. The following parameters of coagulative and thrombocytic-vascular hemostasis were examined: free endogenous heparin was evaluated by protamine titration, platelet count and platelet aggregative properties were registered, using hematology analyzer, activated partial thromboplastin time (aPTT), quantitative analysis of fibrinogen and protein C was performed using CoaLAB 1000 analyzer. Results. Study of hemostasis features in patients, who underwent lung surgery, has revealed an imbalance of coagulation and anticoagulation systems, which manifested itself as dysfunctions in thrombocytic-vascular hemostasis (increase in platelets aggregative properties, most notable in peripheral venous blood), plasma hemostasis (decrease in aPTT, most notable in arterial blood, and increased fibrinogen level) and anticoagulation (modestly decreased protein C and heparin levels in peripheral blood), which is characteristic of hypercoagulation, being the possible basis for development of thromboembolic complications in post-operative period. These changes are most typical for blood taken from cubital vein, which is indicative of increased possibility of clot formation specifically in systemic circulation, which is indicative of increased possibility of clot formation specifically in systemic circulation. The least risk of clot formation was established in pulmonary vein blood (outflowing blood). Moderate correlation between free heparin level in arterial blood and venous blood was established. Conclusion. The derived results have allowed us to develop an individual management plan for patients with increased risk of thromboembolic events, which includes early administration of anticoagulant agents in prophylactic doses.

Impact of some intravenously administered drugs (paracetamol, hydrocortisone, dexamethasone and amikacin) on coagulation hemostasis (in vitro evaluation study)

Background:Normally, the coagulation homeostasis prevents bleeding and retain the blood in the vascular system during periods of injury. Unfortunately, pathological factors, drugs or toxins could affect one or more stages of homeostasis mechanisms leading to bleeding or abnormal thrombi. Evaluation of prothrombin time is a favorable test for the screening of extrinsic coagulation mechanism whilst activated partial thromboplastin time measurement is a global coagulation screening method for intrinsic factor.Material and Methods:Blood samples were withdrawn from healthy adults volunteers for clotting times measurements from collected plasma. The effect of paracetamol, hydrocortisone, dexamethasone, and amikacin at different concentrations on coagulation homeostasis was in vitro investigated and compared to control and positive control.Results:High concentrations of all tested drugs except amikacin prolong significantly activated partial thromboplastin time, whilst the effect on the prothrombin time was conflicting.Conclusions:Paracetamol, hydrocortisone, dexamethasone, and amikacin could prolong clotting time expressed in prolongation of activated partial thromboplastin time comparable to the anticoagulants drugs.

International expert consensus on the management of bleeding during VATS lung surgery.

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.

Platelet and coagulation hemostasis in conditions of the combined cardiac and gallbladder disorders

Platelet and coagulation hemostasis in conditions of the combined cardiac and gallbladder disorders

Disorders of the hemostasis system while doing coronary shunting on a working heart

Objective. To investigate the connection between application of solutions for infusion and parameters of the hemostasis system while the elective operations performance of coronary shunting on the working heart.
 Materials and methods. The results of examination and surgical treatment were analyzed in 80 patients, in whom coronary shunting on the working heart was conducted. The patients were divided into three groups: the Investigation Group I (IG I) – 20 patients, in whom colloidal solution of hydroxyethyl starch (HES) 130/0.4 was applied intraoperatively, the Investigation Group II (IG II) - 20 patients, in whom colloidal 4% solution of gelatin was used intraoperatively, and a Control Group, consisted of 40 patients, in whom only crystalloidal solutions were included in the infusion therapy program. The coagulation hemostasis indices, the blood loss volume and the need for hemotransfusion were compared.
 Results. In the IG I patients the volume of perioperative blood loss was more than in the IG II patients – (615 ± 191) and (438 ± 62) ml, accordingly (p=0.0003), and the coagulation hemostasis indices were trustworthily lower at the operation ending, demanding the erythrocytic mass transfusion doing in 3 (15%) patients. The IG II patients, comparing with the Control Group, suffered more volume of the blood loss - (560 ± 164) and (438 ± 62) ml, accordingly (p=0,02), and the changes in the coagulation indices, similar to changes in patients of the IG I, comparing with the Control Group patients. Any patient from the IG II needed hemotransfusion perioperatively.
 Conclusion. Application of colloidal solutions while doing elective operations of CSH on the working heart leads to disorder of coagulation hemostasis, the intraoperative blood loss and the need for hemotransfusion enhancement.

Dynamics of clinical characteristics and biomarkers of coagulation hemostasis within the application of the endovenous electric welding for varicose disease of the lower extremities

The article presents the results of prospective longitudinal study, in which the dynamics of fibrinogen, D-dimer, the platelet count levels have been evaluated in comparison with clinical changes within the application of endovenous electric welding (EVEW) in automatic mode for varicose vein treatment in 33 patients. The statistical analysis of the results was performed using SPSS Inc. software. (Chicago, IL, USA, version 22.0). One week after the operation, a complete obliteration of the great saphenous vein, as determined by ultrasonography, was observed in 26 patients (78.8%), while in 7 patients, a remaining lumen was registered (21.2%); after 12 months, the complete occlusion of the trunk without signs of recanalization or varicose disease progression was determined in 100% patients. After 1 week, the symptoms of venous stasis (edema, heaviness in the lower extremities) disappeared in 32 (97%) patients; in one case, the edema remained until the day 12. The great saphenous vein occlusion after EVEW application was accompanied by changes in coagulation homeostasis, which reflected in the dynamics of D-dimer, fibrinogen and the platelet count. One week after surgery, these parameters were higher in patients with incomplete occlusion, indicating the maintenance of coagulation activity of the body as a component of treatment aimed to complete the process of insufficient vein obliteration. Gradual decrease in platelet count as one of the markers of cell apoptosis indicates a continuous decrease in the activity of venous wall inflammation. No blood flow impairment in the deep veins of the lower extremities or thrombophlebitic changes in the trunk of the great saphenous vein or its tributaries have been detected.

THE STATE OF HOMEOSTASIS IN PATIENTS WITH INFECTIOUS ECZEMA

The article is devoted to the study of the state of homeostasis systems in patients with infectious eczema and the establishment of the relationship of the hemostatic system and immune status in the patient’s body. Examination of 108 patients with infectious eczema aged 18 to 65 years living in the southern region of Ukraine showed hypercoagulation changes in the hemostatic system and immune imbalance, which depend on the severity of the disease and play an important pathogenetic role in the onset and progression of this pathology. We have established close pathogenetic mechanisms of the relationship between the immune system and the hemostatic system (changes in the vascular-platelet link are associated with changes in humoral immunity – the content of, circulating immune complexes IgE), and coagulation hemostasis disorders – with indicators of cellular immunity (CD3 +, CD4 +, CD8 +, immunoregulatory index). Identified violations of hemostasis and immune status indicate the need to develop a pathogenetically substantiated method of complex individualized therapy for patients with infectious eczema.

PB1842 ROLE OF THROMBOELASTOGRAPHY IN THE MONITORING OF PROPHYLACTIC TREATMENT IN PATIENTS WITH SEVERE HAEMOPHILIA A

Background:According to many experts, during prophylactic treatment, the activity of factor VIII (FVIII) is not a sufficient predictor of the effectiveness of prevention and does not reflect the level of risk of bleeding. During monitoring of the therapy with activated partial thromboplastin time (APTTT) and FVIII activity, the cause of the discrepancy may be unaccounted content of the tissue factor, the amount and the aggregative function of the thrombocytes, which are also involved in the coagulation process. Therefore, global laboratory methods, in particular thromboelastography (TEG), are used to control therapyAims:To study the role of TEG in the monitoring the prophylactic treatment of clotting factors concentrates in patients with haemophiliaMethods:The study was performed in 9 patients with severe haemophilia A, who received prophylactic treatment by prolonged recombinant FVIII concentrate at a dose of 45 ± 5 IU/ kg two times a week. According to international recommendations all the patients were tested for incremental recovery (IR) of the administered concentrate FVIII in a dose of 60 ± 5 IU/kg during their routine visits. Pre‐ and post‐infusion coagulation tests and TEG (TEG 5000® Haemoscope Corp., Niles IL) were performedResults:Pre‐infusion the indicators of coagulation tests that characterized coagulation hemostasis (APTT‐72,9 sec, FVIII‐1,1%) were prolonged. 30 minutes post‐infusion the abnormal value came to the norm. The prothrombin time (PT), the fibrinogen level and quantity of platelets in the IR test did not differ from the corresponding values of healthy individuals. In TEG, the prolonged reaction time to clot formation R (21,9 sec), the time of maximum amplitude TMA (46,5 sec), the time of initial fibrin formation SP (19,1 min), the reduced rate of initial clot strengthening α‐Angel (33,0°), negative value of coagulation index CI (‐3,0) indicate a violation of the enzymatic phase of blood clotting. Post‐infusion of the calculated dose of the medication, all of the abnormal parameters returned to normal. In IR test, TEG parameters that characterize strength, quality, hemostatic capabilities, lysis of the clot and depend on the level of fibrinogen and platelets do not differ from those of healthy individualsSummary/Conclusion:TEG can be a reliable method for monitoring prophylactic treatment and IR in patients with hemophilia A without inhibitors in combination with coagulation tests (APTT, FVIII activity). The following parameters should be analyzed: the reaction time to clot formation R, the time of maximum amplitude TMA, initial fibrin formation SP, the rate of initial clot strengthening α‐Angel, the total coagulation potential CI

New aspects of using biologically active thioterpenoids of pinane series

Pinane sulfi de obtained by the addition of methyl hydrosulfanylacetate at the double bond of β-pinene inhibits platelet receptor activity. It inhibits completely platelet aggregation induced by adrenaline, ADP, collagen, arachidonic acid, and also reduces the eff ect of ristomycin. This compound inhibits both platelet and coagulation hemostasis, which allows one to use it for creation promising antiaggregation drugs and for stabilization blood products.

Disturbances of the ultrastructure of endotheliocytes of sinusoid hemocapillaries of the liver and the hemostasis system in the acute period of cranial injury

Purpose of the study : the role of endothelial cells of the sinusoidal capillaries of the liver in the pathogenesis of the vascular-platelet and coagulation units of the hemostasis system to assess the acute period of traumatic brain injury. Materials and methods . Work is a clinical experimental study. TBI was simulated in animals and the number of blood thrombocytes was determined at 1, 3, 7, 12 days after the alteration. Also on the 3 rd , 7 th and 12 th day after the application of TBI, structural changes in sinusoidal hemocapillaries (SH) were studied in ultrathin sections of the liver. The study of patients was conducted at the Semashko Hospital. Hemostasis systems were evaluated in patients by the indicators: activated partial thromboplastin time, prothrombin and thrombin time, prothrombin index, fibrinogen, antithrombin III, soluble fibrin-monomer complexes, plasma fibrinolytic activity, platelet count in 1-e (on admission) and 3, 7 and 10 days of treating patients. Results . The results of electron microscopic examination of the liver SH and intravascular changes revealed that pronounced damage to endotheliocytes and microcirculation disorders were determined in animals on the 3 rd day of the post-traumatic period. These changes were aggravated on the 7 th day after the injury. Partial restoration of blood flow and endothelium with the preservation of areas of its swelling and edema occurred 12 days after TBI. The number of platelets significantly decreased with a maximum change in the index by day 7 and recovered to the values of intact rats on the 12 th day after TBI. The number of platelets decreased and coagulation hemostasis increased in patients with severe concurrent TBI on the 3 rd and 7 th day after injury compared to the reference intervals of the studied hemostasis parameters. Conclusion . In this way, a combination of non-specific systemic disorders of the structural and functional integrity of the vascular endothelium and activation of the blood coagulation system is observed in the acute period of severe TBI, which dictates the need for targeted prevention and correction of the above disorders in the complex treatment of patients.

ФУНКЦІОНАЛЬНИЙ СТАН СИСТЕМИ ГЕМОСТАЗУ ПРИ ТРАВМАТИЧНІЙ ХВОРОБІ У ПАЦІЄНТІВ З ПІДВИЩЕНИМ ІНДЕКСОМ МАСИ ТІЛА


 
 
 The purpose of our work was to analyze the functional state of the hemostasis system in traumatic illness in patients with increased body mass index, polytrauma, systemic multivariate analysis. (IВMІ). A comprehensive hemostatic study was conducted in 224 patients with IВMІ during the month of stay in a hospital with a diagnosis of "polytrauma" and on the 360th day of an outpatient visit, which included the study of indicators of cellular, plasma units of hemostasis and fibrinolysis. We conducted a systematic multifactorial analysis of the obtained results, which allowed integrating the mathematical model to assess the overall state of the platelet system, coagulation hemostasis and fibrinolysis in patients with IВMІ polytrauma. The general laws of their response to a traumatic illness were determined as well as features that are characteristic for each of the examined groups of patients.
 
 

Indices of coagulation hemostasis in patients with hemorrhagic stroke, associated with essential hypertension, after an early recovery period

Objective: To determine and evaluate indices of coagulation hemostasis in patients with hemorrhagic stroke (HS), associated with essential hypertension (EH), after the early recovery period. Materials and methods. There were formed 2 groups of patients: the basic group included 94 patients (50 women and 44 men, middle age 54.4 ± 8.8 years old) who experienced HS, associated with EH, 6 months and earlier and had no spontaneous normalization of blood pressure over this period; the comparison group consisted of 104 persons (54 women and 50 men, middle age 53.7 ± 8.9 years old) with EH. They were matched groups by the key indicators. All the above-mentioned patients underwent fasted test of venous blood for detecting coagulation indices. Results. Determining the mean values of the coagulation parameters in both groups, there was found that the activated partial thromboplastin time (APTT) in the basic group was greater than in the comparison group — 28.345 ± 3.317 s and 26.629 ± 4.601 s, respectively (p<0.05). The patients of the basic group within 6-11 months after HS onset experienced a higher level of APTT (29.410 ± 3.806 s); and the value of thrombin time (TT) was lower than in the comparison group — 21.740 ± 1.691 s and 23.217 ± 5.740, respectively (p <0.05). In the basic group, Claus fibrinogen test showed a direct noticeable correlation (0.502) according to the Chaddock scale with the number of months after the early recovery period after HS. Conclusions. Hypertensive patients experienced HS have significantly higher value of APTT, indicating that the cascade of hemostasis is slowed down compared with patients with EH without complications. Hypertensive patients experienced HS 6–11 months before have statistically significant greater value of the APTT and lower TT value. In hypertensive patients after HS, there is a direct noticeable correlation between the concentration of Claus fibrinogen in the blood plasma and the number of months after the early recovery period after HS onset.

Влияние хлорида никеля на показатели гемокоагуляции и липопероксидации у крыс в эксперименте

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.

The dynamics of coagulation hemostasis markers in patients with an increased body mass index with polytrauma

The hemostasis system is one of the fast response systems of the body. The aim of the work was to analyze the dynamics of coagulation hemostasis markers in patients with an increased body mass index (IBMI) with polytrauma. A study of complex hemostasiograms was conducted in 224 patients with IBMI during a month of hospital stay with a diagnosis of Polytrauma and on the 360th control day of the outpatient visit. The patients were divided into 3 groups depending on the starting numbers of the BMI. The study included the study of activated partial thromboplastin time, prothrombin index, antithrombin III, plasma tolerance to heparin and fibrinogen. To process the data obtained, Student’s t test and correlation analysis were used. The condition of the coagulation situation in patients with IBMI in group I (BMI≤29.9) included a slight increase in the aggregative capacity of platelets without disturbing their number, non-intensive increases in the hemostatic potential in all coagulation tests, dysfibrinogenemia and the absence of disturbances in the system of natural anticoagulants in the early period of traumatic illness. For patients in group II (BMI 30.0–39.9) in the early stages — up to the 14th day — hyperfibrinogenemia was characteristic, with a decrease in fibrinolytic activity. For patients in group III (BMI≥40.0), it was characteristic: in the first week there was dysfibrinogenemia, a sharp — by 50% decrease in antithrombin III, and a decrease in plasma tolerance to heparin. It should be noted that a significant and growing in dynamics reduction in the amount of antithrombin III was less than 80% unfavorable for the progression of coagulation disorders. Thus, it is necessary to note the clinical and pathogenetic significance of hemostasiological disorders in traumatic disease in patients with IBMI with polytrauma, the nature, intensity, dynamics and direction of which determine the consequences and possible complications, and require specific correction. In the future we plan to study the functional state of the system of immunological protection in traumatic disease in patients with IBMI.

The coagulation hemostasis dynamics in rats in the post-ischemic time

Introduction. Ischemic injury to the endothelium influences on a coagulation hemostasis, worsening hemodynamics of cerebral microcirculation as a result of rheological occlusion. The long-term post-ischemic blood clotting system changes are not studied well by now.The work purpose – to study a coagulation hemostasis and endothelial prostacyclin – synthetic activity of pial vessels within 21 days after single short-term transient cerebral ischemia in rat.Material and Methods. Ischemia was reproduced by means of 12-minute time occlusion of both carotids with the simultaneous arterial hypotension. Post-ischemic changes were investigated in 4 groups of rats: on the 3rd, 7th, 14th and 21st day after ischemia. The state of blood clotting system was estimated on time of clot formation in the blood plasma by an automatic optical method with use of screening tests of definition of prothrombin and thrombin clotting time and concentration of fibrinogen. Endothelial prostacyclin – synthetic activity was estimated by pial vessel reaction to indometacin.Results. On the 3rd day after ischemia the increase in prothrombin time was observed. Level of fibrinogen increased on the 3rd and the 14th days of the post-ischemic time. On the 21st day after ischemia thrombin time decreased. The inverse correlation of pial vessel endothelial prostacyclin – synthetic activity with the fibrinogen level and direct correlation with vessel cross-sectional area of these vessels is established.Conclusions. Short-time global cerebral ischemia causes changes of blood clotting system mechanisms lasting for 21 days of the post-ischemic time. Post-ischemic abnormalities in hemostasis system are connected with changes in endothelial prostacyclin – synthetic activity of cerebral vessels that, along with decreased anti-aggregation ability of vascular system, is also the reason of narrowing of the lumen in pial vessels.

Abstract WP460: Use of Red Cell Microparticles to Limit Hematoma Growth Following Intracerebral Hemorrhage

Currently there is no effective treatment for spontaneous intracerebral hemorrhage (sICH). Limiting hematoma extension in sICH is an attractive therapeutic target. Earlier studies demonstrated that red blood cell-derived microparticles (RMP) enhance platelet function and accelerate coagulation, augmenting both primary and secondary hemostasis. In the present study, we determined the efficacy of RMP in reducing hematoma expansion in a rat model of collagenase-induced sICH. RMPs were prepared from human RBCs using a high-pressure extrusion method. At ~24 hours post-collagenase injection, neurological scores were evaluated, rats were sacrificed, and the hematoma areas on images of brain sections were measured. In an earlier study (presented in an abstract form) we determined optimal RMP dose required to lower hematoma growth following sICH. The hematoma volume was lower by 17, 40 (p&lt;0.001 vs placebo group), and 6% in low dose (7.19 x 10 9 particles / kg b.w.), medium dose (2.55 x 10 10 particles / kg b.w.), and high dose (9.48 x 10 10 particles / kg b.w.) treated groups when compared to placebo group, respectively. For those experiments, total RMP dose was delivered over 2 hours using continuous infusion starting 1 h post-collagenase injection. In the present study we evaluated optimal treatment paradigm using optimal protective (medium) dose as identified above. We evaluated the efficacy of RMP when delivered starting at 1 h post-collagenase injection either via four bolus injections (6.375 x 10 9 particles / kg b.w. per injection) 30 min apart (paradigm B) and when delivered using continuous infusion (2.55 x 10 10 particles / kg b.w.) over 1 hour (paradigm C), and compared with when RMP dose was delivered (2.55 x 10 10 particles / kg b.w.) over 2 hours using continuous infusion (paradigm A). We observed that hematoma volume (mm 3 ) for vehicle, and paradigm A, B and C was 71 ± 3 (n = 35), 43 ± 2 (n = 10, p&lt;0.001 vs vehicle), 60 ± 4 (n = 15, p = 0.057 vs vehicle), and 61 ± 4 (n = 15, p = 0.073 vs vehicle), respectively. We observed that neurological score was lower (all p&lt;0.001) in paradigm A (9.3 ± 0.4, n = 10), B (8.7 ± 0.3, n = 15), and C (9.5 ± 0.4, n = 15) groups as compared to placebo group (10.9 ± 0.1, n = 35). Our results indicate that RMPs have potential to lower hematoma growth in sICH patients.

HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS.

to study the hirudotherapy efficacy in presbyacuzis praecox in clean-up workers (CUWs) of the Chornobyl disaster (ChD) during the post-accident years. From archive data of previously examined 8,136 males' CUWs we selected among them 129 persons with the determined presbyacuzis praecox during the post-accident years. According to the physical dosime- try data the individual radiation of received by CUWs during the work on a rotational scheme in the Chornobyl exclu- sion zone from the end of 1986 to 1992-1994 amounted to 0.21-0.50 Gy. The examinations were carried out using a modern standard set of audiometric, vestibulometric and electrophysiological methods. Two forms of sensory and neural hearing loss in the elderly were distinguished, namely the presbyacuzis and presbyacuzis praecox. Prior to work in the exclusion zone, patients' auditory and vestibular functions were within normal range. Among 129 patients, 68 ones with presbyacuzis praecox were included in two main age groups (aged 40-49 and 50-59 yrs) and were treated using hirudotherapy, taking into consideration their coagulation hemostasis. Other 61 patients of analogical age groups were treated by allopathotherapy. For the analysis of results obtained, techniques of variational statistics were used. Direct correlation (r = 0.71) between inhibitory processes in central areas of the auditory analyzer in pres- byacuzis praecox in CUWs was established by electrophysiology and by speech audiometry data obtained before the treatment. Hyperacusis signs were detected in CUWs of two main and two control groups. Following the use of two treatment schemas, a significant improving of auditory functions was found (p < 0.05) according to tone and speech audiometries. The positive hirudotherapy effect concerning hearing functions was registered in 88% cases (in 59 CUWs among 68 ones); if allopathotherapy had been used, such effect was found in 65% cases (in 45 control patients among 61 ones of control group). The duration of allopathotherapy effect reached 6-9 months comparing to 12-18 months of hiruditherapy one, being twice longer. Improving the patients' coagulation hemostasis, hirudotherapy activated cardiovascular activity favoring the increase of social adequacy in CUWs with presbyacuzis praecox. It has been shown that hirudotherapy as a kind of naturopathy has significant advantages over alopa- totherapy by the absence of side effects, 23.0% higher and twice as long as improvement of auditory functions. Hirudotherapy, as an effective therapeutic and recreational measures, should be more widely implemented in clini- cal practice in order to minimize the development and progression of diseases in the special population of people who have been exposed to ionizing radiation due to the Chornobyl catastrophe to continue their vitality.

Quality Assurance in Interventional Radiology: Preprocedural Care

To review best practices to improve the quality of patient service in the field of interventional radiology prior to performing the procedure. We highlight a checklist of elements that have a potential for improvement and contribution to overall quality of patient care from the time of taking the consult, until the time of the procedure. Our check list includes establishing appropriateness of the procedure, reducing waiting times, patient-centered care, patient education, shared decision making, establishing expectations, informed consent, managing the patient’s medication list, preprocedure diet, prevention of CIN, prevention of contrast reactions, pain control and sedation, and coagulation status and hemostasis risk. Several consensus guidelines are referenced in this chapter. However, individual patients and clinical scenario vary and determine which guideline to follow or modify based in clinical judgment. The clinic is a key component of success in any Interventional Radiology practice, as it provides the space for consultation, patient education, and preprocedural planning.

Features of coagulation and cellular hemostasis in rheumatoid arthritis in patients with cardiovascular pathology

Features of coagulation and cellular hemostasis in rheumatoid arthritis in patients with cardiovascular pathology