Fibrin D-dimer Research Articles

Diagnostic Significance of Fibrin Degradation Products and D-Dimer in Patients With Breast Cancer-Related Lymphedema.

ObjectiveTo find out whether levels of fibrin degradation products (FDP) and D-dimer are increased in breast cancer-related lymphedema (BCRL) as in many vascular diseases. FDP and D-dimer have been used in blood tests to help differentiate deep vein thrombosis in the diagnosis of lymphedema. Levels of FDP and D-dimer are often elevated in patients with BCRL.MethodsPatients with BCRL (group I), non-lymphedema after breast cancer treatment (group II), and deep venous thrombosis (group III) from January 2012 to December 2016 were enrolled. Levels of FDP and D-dimer were measured in all groups and compared among groups.ResultsMean values of FDP and D-dimer of group I were 5.614±12.387 and 1.179±2.408 μg/μL, respectively. These were significantly higher than their upper normal limits set in our institution. Levels of FDP or D-dimer were not significantly different between group I and group II. However, values of FDP and D-dimer in group III were significantly higher than those in group I.ConclusionValues of FDP and D-dimer were much higher in patients with thrombotic disease than those in patients with lymphedema. Thus, FDP and D-dimer can be used to differentiate between DVT and lymphedema. However, elevated levels of FDP or D-dimer cannot indicate the occurrence of lymphedema.

Tactics of treatment of varicose disease, complicated by thrombosis, using miniinvasive methods

Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods.
 Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted.
 Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients.
 In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas.
 Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.

Structural Characteristics and Anticoagulant Property In Vitro and In Vivo of a Seaweed Sulfated Rhamnan.

Great diversity and metabolite complexity of seaweeds offer a unique and exclusive source of renewable drug molecules. Polysaccharide from seaweed has potential as a promising candidate for marine drug development. In the present study, seaweed polysaccharide (SPm) was isolated from Monostroma angicava, the polymeric repeat units and anticoagulant property in vitro and in vivo of SPm were investigated. SPm was a sulfated polysaccharide which was mainly constituted by 3-linked, 2-linked-α-l-rhamnose residues with partially sulfate groups at C-2 of 3-linked α-l-rhamnose residues and C-3 of 2-linked α-l-rhamnose residues. Small amounts of xylose and glucuronic acid exist in the forms of β-d-Xylp(4SO4)-(1→ and β-d-GlcA-(1→. SPm effectively prolonged clotting time as evaluated by the activated partial thromboplastin time and thrombin time assays, and exhibited strong anticoagulant activity in vitro and in vivo. The fibrin(ogen)olytic and thrombolytic properties of SPm were evaluated by plasminogen activator inhibitior-1, fibrin degradation products, D-dimer and clot lytic rate assays using rats plasma, and the results showed that SPm possessed high fibrin(ogen)olytic and thrombolytic properties. These results suggested that SPm has potential as a novel anticoagulant agent.

Sex differences in coronary plaque composition evaluated by coronary computed tomography angiography in newly diagnosed Type 2 diabetes: association with low-grade inflammation.

To determine differences in coronary plaque composition and inflammatory biomarkers between men and women with newly diagnosed Type 2 diabetes without known cardiovascular disease. A total of 88 people with newly diagnosed (<1 year) Type 2 diabetes underwent contrast-enhanced coronary computed tomography angiography. Advanced coronary plaque analysis was performed using semi-automated software. Plasma concentrations of inflammatory biomarkers were determined. There were no significant differences between men (n=60) and women (n=28) regarding age or cardiovascular risk factors (all P>0.05). The median (quartiles) serum levels of fibrinogen [10.9 (9.8-12.6) μmol/l vs 9.7 (8.8-10.9) μmol/l], fibrin d-dimer [0.3 (0.2-0.4) mg/l vs 0.27 (0.2-0.4) mg/l] and C-reactive protein [3.1 (1.1-5.2) mg/l vs (0.8-2.6) 1.6 mg/l] were significantly higher in women (all P<0.05). Overall, men more often had multi-vessel involvement [28 men (47%) vs 4 women (14%)], and higher total plaque burden [median (quartiles) 11.6 (2.3-36.0)% vs 2.0 (0.4-5.4)%; both P<0.05]. The median (quartiles) total plaque volume [269.9 (62.6-641.9) mm3 vs 61.1 (7.6-239.9) mm3 ] and absolute calcified plaque volume [33.5 (8.3-148.3) mm3 vs 4.7 (0.9-17.3) mm3 ] were higher in men (both P<0.05). Women had a lower relative proportion of the calcified plaque component [median (quartiles) 7.8 (4.7-15.4)% vs 23.7 (8.4-31.1)%] and a higher relative proportion (median [quartiles]) of the non-low-density non-calfied plaque component [77.6 (66.0-86.0)% vs 63.6 (54.0-72.9)%; both P<0.05]. In people with newly diagnosed Type 2 diabetes, women had lower absolute coronary plaque volumes but a more unfavourable plaque composition and enhanced systemic inflammation compared with men.

Hepatic microcirculatory thrombosis in acute-on-chronic hepatic failure

BackgroundAcute-on-chronic hepatic failure is an increasing number of identified distinct disorders encompassing an acute deterioration of hepatic functions in patients with chronic liver diseaseAimThe aim was to evaluate the possibility of hepatic microcirculatory thrombosis in acute-on-chronic hepatic failure and the value of plasma fibrin monomer (FM) and D-dimer in the diagnosis.Patients and methodsA total of 50 patients with chronic hepatitis C infection developing new-onset ascites, encephalopathy, and/or jaundice with raised international normalisation ratio (INR) (group 1); group 2 included 30 patients with compensated chronic hepatitis C virus infection who served as the control group. Ascetic fluid examination and culture were done for group 1, in addition to complete blood count, liver enzymes, INR, serum bilirubin and albumin, blood culture, α-fetoprotein, D-dimer, plasma FM, abdominal ultrasound, and Doppler for portal vein were done for all patients groups.ResultsGroup 1was subdivided according to the level of FM into subgroups A and B. FM showed a significant difference between group 1A and other groups; group IB showed nonsignificant elevation of the level of FM and a significant increase in D-dimer compared with the control group. A marked reduction in portal flow mean velocity in group 1A was recorded with further deterioration of portal flow direction after 2 weeks from the admission time. Three months follow-up showed significant reduction of FM, improvement of portal flow mean velocity and direction in group 1A; FM was significantly positively correlated with portal flow mean velocity.ConclusionHepatic microcirculatory thrombosis may occur in acute-on-chronic hepatic disease; determination of the FM and D-dimer level may be useful biomarkers predicting hepatic microcirculatory thrombosis.

Application of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma

Objective To investigate the feasibility and clinical effect of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma. Methods A randomized, placebo controlled trial was carried out on 77 craniocerebral trauma patients [Glasgow Coma Scale (GCS) ≤12 points] enrolled between May 2015 and December 2016. There were 45 males and 32 females, with an average age of 36.5 years (range, 19-73 years). Among the patients, 37 cases were caused by traffic accidents, 19 falling from high places, 11 falling when walking, and ten by being hit. According to the random number table method, they were divided into control group (39 cases) and treatment group (38 cases). The treatment group received 1 g of tranexamic acid by intravenous injection within ten minutes on the scene and another 1 g of tranexamic acid within eight hours at the hospital. The control group received 0.9% isotonic saline. The operation and medication followed the routine process. The arrival time of ambulance and the time of first medication use were recorded. The plasma fibrin degradation products (FDP) and D-dimer at admission and 1 d post-trauma, the percentage of cranitomy operation, case fatality rate, red blood cell transfusion, length of stay in the neurosurgical intensive care unit (NICU), and the Glasgow Outcome Scale (GOS) at day 28 were all recorded and analyzed. Results No significant differences were found between the two groups in gender, age, injury causes, GCS, arrival time of ambulance, and the time of first medication use (P>0.05). The FDP and D-dimer at admission of the two groups were similar (P>0.05). One day after admission, the expression of plasma FDP was significantly lower in treatment group than that in control group [6758 (4732, 13661) μg/L vs. 11740 (8516, 21756)μg/L](P 0.05). However, treatment group showed shorter stay in NICU [4 (1, 12)days vs. 2 (0, 4)days] and higher GOS [4 (3, 5)points vs. 5 (4, 5)points]than control group (both P<0.01). Conclusions Tranexamic acid can be applied conveniently in pre-hospital emergency care of craniocerebral trauma patients. It can effectively realize the synchronization of pre hospital transport and treatment, eventually reducing the time of NICU treatment as well as improving the prognosis. Key words: Brain injuries; Tranexamic acid; Emergency medical services; Prospective studies

The efficacy and safety of multiple-dose oral tranexamic acid on blood loss following total hip arthroplasty: a randomized controlled trial.

To explore the efficacy and safety of multiple-dose oral tranexamic acid (TXA) on blood loss following primary total hip arthroplasty (THA). A total of 152 patients were randomized into three groups to receive 2g of oral TXA two hours pre-operatively (group A), or another bolus of 2g of oral TXA four hours post-operatively (group B), or another three boluses of 2g of oral TXA four, ten, and 16 hours post-operatively (group C). The primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and transfusion rate. The secondary outcomes were haemoglobin (Hb) and haematocrit (Hct) drop, the level of fibrinolysis parameters (fibrin degradation products, D-dimer), and complications (thrombotic diseases, stroke, cardiac infarction, and infection). The mean TBL and HBL in group C were lower than those in group A (p <0.001 and p <0.001) and group B (p = 0.012 and p = 0.029). The Hb drop on post-operative day one (POD1) and POD3 in group C was lower than those in group A (p <0.001 and p = 0.029) and group B (p <0.001 and p = 0.004). The difference was similar regarding Hct drop on POD3 (p <0.001 and p = 0.014). Moreover, fibrin degradation products and D-dimer in group C were lower than in groups A and B on POD1 and POD3 (p <0.001 and p <0.001). The incidence of complications such as venous thromboembolism did not differ significantly among the three groups (p> 0.05). Multiple boluses of oral TXA could further reduce blood loss, Hb and Hct drop, and restrain post-operative fibrinolysis in primary THA without increasing the risk of complications. Therapeutic study.

The lectin pathway and coagulation in lung cancer patients undergoing lobectomy – A randomised controlled trial

BackgroundLectin pathway proteases activate coagulation and may theoretically play a role in the increased thrombosis risk in cancer, which is especially high during surgery. AimsTo investigate lectin pathway proteins during lung cancer surgery, the influence of low molecular weight heparin (LMWH) on lectin pathway proteins, and correlations between lectin pathway proteins and coagulation. MethodsFifty lung cancer patients undergoing video-assisted thoracoscopic surgery lobectomy were randomised to LMWH, n = 26, or no anticoagulant (control), n = 24. Pre-, intra- and postoperative lectin pathway protein concentrations (mannose-binding lectin (MBL), H– and M-ficolin, collectin liver-1, MBL-associated serine protease (MASP)-1, -2 and -3, MBL-associated proteins MAp44 and MAp19) were assessed using a time-resolved immunofluorometric assay, and fibrinogen, fibrin d-dimer, and thrombin generation were analysed. ResultsFor all proteins except MASP-1, concentrations decreased during surgery in both groups; most markedly M-ficolin which decreased 49% (median: 2836 [quartiles:2297–3505] to 1424 [1187–2199] ng/ml) (LMWH group) and 43% (2974 [2539–3510] to 1685 [1391–2076] ng/ml) (control group), while MBL decreased 12% (1936 [823–2801] to 1702 [676–2830] ng/ml) (LMWH) and 23% (1526 [250–2412] to 1175 [229–1947]) (controls). No differences in postoperative change were observed between groups except for MAp19 (p = 0.03) which decreased 9% (401 [337–467] to 364 [288–416] ng/ml) (LMWH) vs 28% (370 [272–468] to 268 [212–379] ng/ml) (controls). No correlation was found between lectin pathway proteins and coagulation (r = −0.23–0.28, p > 0.06) except for M-ficolin and fibrinogen (r = 0.29–0.36, p = 0.01–0.04). ConclusionLectin pathway proteins were influenced by surgery but not by LMWH. No consistent correlation was found between lectin pathway proteins and coagulation.

Low Self-rated Health Is Related to Blood Hypercoagulability in Patients Admitted with Acute Myocardial Infarction.

Self-rated health (SRH) is independently associated with all-cause mortality and adverse cardiovascular outcomes in individuals with and without cardiovascular disease. We examined whether SRH relates to haemostatic factors of a hypercoagulable state with prognostic impact in patients admitted with acute myocardial infarction (MI). We assessed 190 patients (median age: 59 years; all Caucasian; 83% men) within 48 hours of an acute coronary intervention in terms of demographic factors, medical and psychiatric comorbidity, health behaviours, cardiac-related variables and psychosocial characteristics. Patients rated their health state before MI retrospectively with the EuroQol Visual Analogue Scale ranging from 0 ('worst imaginable health state') to 100 ('best imaginable health state'). Circulating levels of fibrinogen, fibrin D-dimer and von Willebrand factor (VWF) antigen were measured the morning after hospital referral. The median score of SRH was 75 (range: 20-100). SRH was inversely associated with fibrinogen (r = - 0.25, p = 0.001) and D-dimer (r = - 0.17, p = 0.021) levels in the bivariate analysis. Stronger relationships emerged for fibrinogen (r = - 0.33, p < 0.001), D-dimer (r = - 0.25, p = 0.001) and also VWF (r = - 0.19, p = 0.015) levels in fully adjusted linear regression models. As for SRH, the Global Registry of Acute Coronary Events (GRACE) risk score was the only covariate showing an independent association with all haemostatic factors (fibrinogen: r = 0.31, D-dimer: r = 0.29, VWF: r = 0.30; all p-values < 0.001). Lower SRH was associated with greater coagulability in patients with acute MI, independent of covariates and comparable with the GRACE risk score. The findings provide a novel psychobiological mechanism that may potentially link SRH with cardiovascular outcome in patients with an acute coronary syndrome.

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

Objective: This study aimed to prospectively evaluate the incidence, characteristics, and risk factors of venous thromboembolism (VTE) development, and the diagnostic value of blood coagulation markers in patients receiving surgery for malignant bone and soft tissue tumor of lower extremity. Methods: A prospective study of 20 patients who were examined using ultrasonography. Serum soluble fibrin monomer complex (SFMC) and D-dimer were measured in the perioperative period. VTE incidence, VTE development time, change in blood coagulation markers, and effect of each risk factor were evaluated. Results: VTE was found in 8 of 20 patients. Four of these 8 patients had the finding of pulmonary embolism (PE) without symptom. Onset time of VTE was from day 1 to 7 after surgery. The cutoff value of SFMC was <3 μg/mL at any measurement point and D-dimer was approximately 2 g/mL in receiver operating characteristic analysis. Body mass index was the only significant risk factor. Conclusion: VTE showed high incidence and often occurred in the early period in only physical prophylaxis after surgery. SFMC or D-dimer was not always useful to detect VTE development. With regard to rehabilitation intervention, risk management is required until 1 week after surgery.

The effects of multiple intravenous tranexamic acid administrations after total knee arthroplasty on fibrinolytic activity and inflammatory response

Objective To explore the effects of multiple intravenous tranexamic acid (IV-TXA) administrations after total knee arthroplasty (TKA) on fibrinolytic activity and inflammatory response in an enhanced recovery after surgery (ERAS) program and to assess the efficacy and safety of IV-TXA. Methods One hundred and forty-one severe knee osteoarthritis patients following primary unilateral TKA from January 2016 to April 2017 were investigated retrospectively. The patients were divided into following three groups based on the dosage of IV-TXA after surgery: 40 patients received ≤3 g IV-TXA after surgery (group T1), 50 patients received 4 g (group T2) and the other 51 patients received ≥5 g IV-TXA (group T3). The total blood loss (TBL), hidden blood loss (HBL), transfusion rate, maximum hemoglobin (Hb) drop, the incidence of intramuscular venous thrombosis, deep vein thrombosis (DVT) and pulmonary embolism (PE), fibrinolysis parameters [fibrin(-ogen) degradation products (FDP), D-dimer], and inflammation markers [C-reactive protein (CRP), interleukin-6 (IL-6)] during perioperative period were evaluated. In addition, correlation analyses between the dosage of IV-TXA and fibrinolysis parameters and inflammation markers were conducted. Results The mean TBL, HBL and maximum Hb drop in group T2 (537.16±270.43 ml, 431.36±271.99 ml, 19.68±10.68 g/L) and T3 (541.31±290.00 ml, 439.94±290.71 ml, 20.24±8.48 g/L) were lower than those in group T1 (748.22±394.34 ml, P=0.012, 0.013; 636.47±388.14 ml, P=0.011, 0.015; 25.88±11.77 g/L, P=0.005, 0.010, respectively). No patient needed transfusion in all groups. There was no statistically difference in the incidence of intramuscular venous thrombosis of lower limbs among three groups (P>0.05). No episode of DVT or PE occurred in any group in two weeks after surgery. There were negative correlation between the dosage of IV-TXA and FDP at postoperative day 1 and day 3 (r=-0.191, P=0.025; r=-0.291, P=0.001) and D-dimer on postoperative day 3 (r=-0.176, P=0.048). Moreover, the CRP (r=-0.184, P=0.036) and IL-6 (r=-0.269, P=0.002) level in serum on postoperative day 1 also showed a negative relationship with the dosage of IV-TXA after surgery. Conclusion The multiple IV-TXA (≥4 g) after surgery can further reduce the TBL, HBL and maximum Hb drop following primary TKA in ERAS program without increasing the risk of thrombotic events. Most importantly, the effect of anti-fibrinolysis will be enhanced and may have an anti-inflammatory effect with the dosage of IV-TXA increased. Key words: Tranexamic acid; Arthroplasty, replacement, knee; Fibrinolysis; Inflammation

Clinical characteristics of spontaneous isolated visceral artery dissection

ObjectiveSpontaneous isolated visceral artery dissection (SIVAD) involving the celiac artery or superior mesenteric artery is rare, but it can be fatal. Given its rare incidence, the clinical characteristics of SIVAD are not fully understood. Therefore, the aim of this study was to investigate the clinical characteristics and prognosis of SIVAD. MethodsWe retrospectively reviewed 39 consecutive patients diagnosed with SIVAD from January 2007 to December 2016. Demographic characteristics, symptoms, vital signs, blood examination results, and computed tomography findings were retrieved through medical record review. ResultsThe median age of the patients was 52 years; 94.9% were male, and 64.1% were symptomatic. Median follow-up duration was 11 months. Overall, hypertension (48.7%) and smoking (79.5%) were frequently observed. There were significant differences between symptomatic and asymptomatic patients in white blood cell count and creatine kinase level but not in fibrin degradation products or D-dimer level. There was a significant correlation between symptoms and length of dissection on computed tomography (P < .01). Conservative treatment was performed in 32 patients (82.1%), and only 7 patients required open surgery or intravascular intervention. Notably, the diameter of affected vessels decreased spontaneously with no rupture or symptom recurrence during follow-up, and mortality was 0% at both 30 days and 1 year. ConclusionsThe utility of blood examination, especially for fibrin degradation products and D-dimer levels, for diagnosis of SIVAD is limited. A high index of suspicion is warranted in patients presenting with persistent severe abdominal pain. Conservative treatment should be considered first-line therapy in patients without any signs of bowel ischemia or rupture.

Diagnostic implication of fibrin degradation products and D-dimer in aortic dissection-author's reply.

Acute aortic dissection (AAD) is a life-threatening disease requiring an early diagnosis and rapid treatment to prevent death. The annual incidence of AAD was about three cases per 100,000, with a high mortality rate of 24.4% for type A and 10.7% for type B without urgent treatment (1). About 20% AAD patients were with non-specific symptoms, and up to 40% of patients were undiagnosed until necropsy (2). Given the atypical presentations and time dependent mortality, sensitive and quicker predictive diagnosis methods are paramount to take rst-aids measures.

351 Hematologic Findings of Venom-Induced Consumption Coagulopathy following Korean Viper (Gloydius Species) Bite

Recent studies have demonstrated that coagulopathy following snake envenomation is a venom-induced consumption coagulopathy (VICC), in which venom activates coagulation factors at specific points rather than an entire pathway. The objectives of this study were to determine what factors are consumed when severe coagulopathy after Korean viper (Gloydius species) bite develops and what factors should be used to monitor the venom activity. We retrospectively investigated the medical records of 244 patients who were admitted to our emergency department (ED) from 2011 to 2016 due to snake envenomation. There were 25 patients (10.2%) of severe coagulopathy defined as international normalized ratio (INR) > 3.0 with or without unmeasurable activated partial thromboplastin time (aPTT) and/or hypofibrinogenemia (< 100 mg/dl). Coagulation factor levels were checked at onset of severe coagulopathy. The onset time, treatment, and recovery time of severe coagulopathy were noted. Most cases of severe coagulopathy (23/25, 88.0%) developed lately (> 12 hours after the bite). All patients (20/20) showed hypofibrinogenemia. Decreased levels of factors II, V, and VIII were observed in 2 (10.5%), 10 (52.6%), and 3 (15.8%) patients, respectively, of the total 19 patients. Among these, 2 patients showed severe coagulation factor deficiency (< 30%) rather than fibrinogen in factor V. Fibrin(ogen) degradation product (FDP) and d-dimer levels were increased in all patients who were tested. Only 2 patients (of 19) showed a mildly decreased anti-thrombin III level. Increase of fibrinogen levels was paralleled by decrease of FDP levels as treatment with antivenin and fibrinogen- rich product were started. This study showed isolated hypofibrinogenemia and hyperfibrin(ogen)olysis are major hematologic findings of VICC following Korean viper bite. We suggest that the FDP level reflect the effect of venom and should be monitored during treatment for severe coagulopathy.

Refractory kaposiform hemangioendothelioma with Kasabach-Merritt syndrome: clinical analysis of 10 cases

Objective: To analyze the clinical value of sirolimus plus prednisone for the treatment of the refractory kaposiform hemangioendothelioma(RKHE) and Kasabach-Merritt syndrome(KMS). Method: Clinical retrospective analysis was carried out for 10 patients recruited in Children's Hospital Affiliated to Capital Institute of Paediatrics from January 2014 to January 2017 who were non responders to or relapsers after the treatment of propranolol, prednisone, pingyangmycin and lauromacrogol(5 cases RKHE, 5 cases RKHE plus KMS, age ranged from 6 days to 9 years); patients were treated with sirolimus at the dosage of 0.035 ml/(kg·d), once a day, for 6-410 days; the diagnosis of 10 patients were confirmed by pathological biopsy and immunohistochemical examination(IHC); the difference of the coagulation parameters and the platelet counts, the size of tumor and ecchymosis at different stages of treatment were recorded and measured by scale and ultrasonography; the side effects of sirolimus were recorded as well. Result: Clinical characteristics of 10 cases (6 male and 4 female) RKHE with KMS were refractory dark red hard hemangioma or ecchymosis, the platelet counts were lower than 30.0×10(9)/L, (15±7)×10(9)/L, coagulation tests were obviously abnormal, fibrinogens were significantly decreased(0.8±0.5)g/L, the fibrin lysates and D-dimer were significantly increased(100±23)mg/L, (10 000±2 200)ng/L, the prothrombin time and activated partial thromboplastin time were prolonged(25.0±2.1)s, (58.0±3.4)s. The pathologic characteristics of the tumors were similar: spindle tumor cells, mass distribution and deeply stained nuclei tumor cells. IHC revealed positive staining for D2-40, CD31 and CD34. Stainings for factor Ⅷ and GLUT-1 were negative. In five cases RKHE plus KMS were treated with sirolimus and prednisone, after (6.5±0.7) days treatment, the platelet counts were obviously increased(72.0±0.6)×10(9)/L, coagulation parameters were obviously improved, fibrinogen significantly increased(1.5±0.2)g/L, the fibrinlysates and D-dimer significantly decreased(7±3)mg/L, (2 300±200)ng/L, the prothrombin time and activated partial thromboplastin time were prolonged(15±2.3)s, (42±3.4) s, and the sizes of tumor and ecchymosis were slightly shrunken 18%±3%, 38%±5%; after (30±5.7) days treatment, the platelet counts and coagulation parameters returned to normal(146±36)×10(9)/L, and the size of tumor and ecchymosis were obviously shrunken 73%±3%, 97%±3%; after (3±0.4) months treatment, the tumor was obviously shrunken by 93%±2% and no longer palpable. In five cases with RKHE without KMS manifested stubborn dark red hard hemangiomatous plaques, coagulation tests and platelet were obviously normal, these patients were treated with sirolimus, after (2.0±0.6) months treatment, the tumor became shrunken 8%±3%, with continuous treatment the tumor shrunk gradually, after (4.0±3.2)months(2-18 mouths) the tumor was not eliminated 51%±7%. Conclusion: RKHE and KMS have typical clinical, laboratory and pathological characteristics, sirolimus plus prednisone have remarkable efficacy and minor side effects, it should be recommended for the treatment of KHE with KMS.

Fibrin and D-dimer bind to monomeric GPVI.

Fibrin has recently been shown to activate platelets through the immunoglobulin receptor glycoprotein VI (GPVI). In the present study, we show that spreading of human platelets on fibrin is abolished in patients deficient in GPVI, confirming that fibrin activates human platelets through the immunoglobulin receptor. Using a series of proteolytic fragments, we show that D-dimer, but not the E fragment of fibrin, binds to GPVI and that immobilized D-dimer induces platelet spreading through activation of Src and Syk tyrosine kinases. In contrast, when platelets are activated in suspension, soluble D-dimer inhibits platelet aggregation induced by fibrin and collagen, but not by a collagen-related peptide composed of a repeat GPO sequence or by thrombin. Using surface plasmon resonance, we demonstrate that fibrin binds selectively to monomeric GPVI with a KD of 302 nM, in contrast to collagen, which binds primarily to dimeric GPVI. These results establish GPVI as the major signaling receptor for fibrin in human platelets and provide evidence that fibrin binds to a distinct configuration of GPVI. This indicates that it may be possible to develop agents that selectively block the interaction of fibrin but not collagen with the immunoglobulin receptor. Such agents are required to establish whether selective targeting of either interaction has the potential to lead to development of an antithrombotic agent with a reduced effect on bleeding relative to current antiplatelet drugs.

A rhamnan-type sulfated polysaccharide with novel structure from Monostroma angicava Kjellm (Chlorophyta) and its bioactivity

A homogeneous polysaccharide was obtained from Monostroma angicava Kjellm by water extraction, preparative anion-exchange and size-exclusion chromatography. Results of chemical and spectroscopic analyses showed that the polysaccharide was a glucuronic acid-containing rhamnan-type sulfated polysaccharide. The backbone mainly consisted of →3)-α-l-Rhap-(1→ and →2)-α-l-Rhap-(1→ residues, partially sulfated at C-2 of →3)-α-l-Rhap-(1→ and C-3/C-4 of →2)-α-l-Rhap-(1→. The branching contained unsulfated or monosulfated 3-linked, 2-linked, 4-linked α-l-rhamnose and terminal β-d-glucuronic acid residues. The polysaccharide had strong antidiabetic activity assessed by glucose consumption, total cholesterol and triglyceride levels using human hepatocellular carcinoma (HepG2) and insulin-resistant HepG2 cells. The polysaccharide exhibited high anticoagulant property by activated partial thromboplastin time and thrombin time assays, and possessed high fibrin(ogen)olytic activity evaluated by plasminogen activator inhibitior-1, fibrin(ogen) degradation products and D-dimer levels using rats plasma. The investigation demonstrated that the polysaccharide from Monostroma angicava Kjellm was a novel sulfated rhamnan and could be a potential antidiabetic and anticoagulant polysaccharide.

Preoperative plasma fibrinogen, but not D-dimer might represent a prognostic factor in non-metastatic colorectal cancer: A prospective cohort study

Cancer progression has been associated with host hemostasis system. Whether preoperative plasma hemostasis factors can predict survival in colorectal cancer is quite intriguing. We conducted a prospective cohort study to validate the prognostic significance of three hemostasis parameters - fibrinogen, fibrin degradation products (FDPs) and D-dimer - in non-metastatic colorectal cancer patients treated with curative resection. All three parameters were positively correlated with C reactive protein (CRP) levels and Glasgow Prognostic scores (GPS). In univariate cox hazards regression model, as continuous variables, both fibrinogen (HR: 1.07, 95%CI: 1.01-1.13) and FDPs (HR: 1.17, 95%CI: 1.05-1.31) were prognostic, while D-dimer levels were not. Patients with hyperfibrinogenemia had a 2.12-fold increased mortality risk compared with patients without hyperfibrinogenemia. Patients with positive FDPs had a 3.68-fold increased mortality risk compared with patients with negative FDPs. In multivariate models, hyperfibrinogenemia was prognostic (HR: 3.39, 95%CI: 1.34-8.67) in patients with normal GPS scores. Preoperative fibrinogen levels appeared as an independent mortality risk factor in non-metastatic colorectal cancer patients with normal GPS scores. Fibrinogen could be a reliable marker to identify high risk patients for those without systematic inflammation responses.

Difference in the changings of blood coagulation fibrinolysis markers before and after spinal surgery in adolescent and elderly patients

AIM: The purpose of this study is to investigate the differences in changing of blood coagulation and fibrinolysis markers before and after spinal surgery in adolescent and elderly patients. MATERIALS AND METHODS: This retrospective two-center study enrolled 56 low-risk patients between October 2012 and April 2015. 27 adolescent idiopathic scoliosis (AIS) patients (3 boys, 24 girls; mean age 15 years) underwent instrumentation for posterior fusion. 29 lumbar spinal canal stenosis (LSCS) patients (15 men, 14 women; mean age 71 years) underwent laminectomy for posterior decompression. Plasma levels of soluble fibrin monomer complex (SFMC), D-dimer, and plasminogen activator inhibitor type 1 (PAI-1) were measured at 1 day preoperatively and on postoperative days (PODs) 1, 3, and 7. RESULTS: The SFMC level showed significant increases on PODs 1 and 3 in the AIS patients and on POD 1 in the LSCS patients. The D-dimer level showed significant increases on PODs 1, 3, and 7 in both groups. The PAI-1 levels showed significant increases on POD 7 in the AIS patients and on PODs 1, 3, and 7 in the LSCS patients. CONCLUSION: The significantly continuously higher postoperative PAI-1 levels in older patients could be associated with the development and progression of symptomatic VTE.

Diagnostic implication of fibrin degradation products and D-dimer in aortic dissection

Fibrin degradation products (FDP) and D-dimer have been considered to be involved in many vascular diseases. In this study we aimed to explore the diagnostic implication of FDP and D-dimer in aortic dissection patients. 202 aortic dissection patients were collected as the case group, 150 patients with other cardiovascular diseases, including myocardial infarction (MI, n = 45), pulmonary infarction (n = 51) and abdominal aortic aneurysm (n = 54) were collected as non-dissection group, and 27 healthy people were in the blank control group. The FDP and D-dimer levels were detected with immune nephelometry. Logist regression analysis was performed to evaluate the influence of FDP and D-dimer for the aortic dissection patients. ROC curve was used to determine the diagnostic value of FDP and D-dimer. The FDP and D-dimer levels were significantly higher in aortic dissection patients than in non-dissection patients and the healthy controls. FDP and D-dimer were both the risk factors for patients with aortic dissection. From the ROC analysis, diagnostic value of FDP and D-dimer were not high to distinguish aortic dissection patients from the non-dissection patients. However FDP and D-dimer could be valuable diagnostic marker to differentiate aortic dissection patients and healthy controls with both AUC 0.863.