Hemostatic System In Patients Research Articles

Disorders of hemostasis as the main pathogenetic mechanism in the development of menopausal abnormal uterine bleeding

The article presents our own clinical observations of cases of abnormal uterine bleeding in postmenopausal women, where the main cause was the pathology of hemostasis: a patient after liver transplantation for cirrhosis with chronic viral hepatitis C, and a patient with primary idiopathic thrombocytopenic purpura which manifested at a later age. Among the most common causes of abnormal uterine bleeding in postmenopausal women are hyperplasia and endometrial cancer, leiomyoma, are adenomyosis are distinguished. Pathology of the hemostasis system as the main cause of abnormal uterine bleeding, prevails in the pubertal and reproductive period. In the literature available we did not find any publications concerning uterine bleeding in postmenopausal patients against the background of the pathology of the blood coagulation system. This article illustrates the significance of hemostasis disorders both secondary and primary in the origin of abnormal bleeding in postmenopausal period. Careful collection of anamnesis, an indication of the occurrence of petechial rash, gingival bleeding should alert the doctor. It should also be remembered that “suddenly arisen” immune cytopenias and late-onset thrombosis are often manifestations of the hematological paraneoplastic syndrome and require the exclusion of neoplasia, first of all, of the hematopoietic system. These clinical observations allow recommending a mandatory examination of the hemostatic system in patients with postmenopausal bleeding.

CHANGES IN THE HAEMOSTASIS SYSTEM OF PATIENTS WITH ALCOHOLIC CIRRHOSIS OF THE LIVER ASSOCIATED WITH NON-ALCOHOLIC FATTY LIVER DISEASE


 
 
 The purpose of the research was to study the changes in haemostatic system in patients with alcohol liver disease (ALD) associated with NAFLD. The decrease in the synthetic function of the liver and the development of hypersensitivity syndrome in patients with ALC in combination with NAFLD is accompanied by more pronounced changes in the various parts of the haemostasis of the corresponding Child-Pugh class, which manifests itself in the decrease in the number of blood corpuscles, PI levels, and growth of indicators for D-dimers, INR, Von Willebrand factor, PT, TT, APTT. Such changes lead to hypo- and hypercoagulation states, which may be accompanied by complications such as thrombosis and bleeding.
 
 

Возрастные изменения показателей плазменного гемостаза при туберкулезной инфекции на фоне применения химиопрепаратов

A study of plasma hemostasis in 49 patients suffering from bone tuberculosis before and after chemotherapy has been conducted. It was established that in the group of patients older than 50 years after treatment with chemotherapy drugs, there is a moderate hypocoagulation shift in the hemostasis system, expressed in a decrease in the prothrombin index, a decrease in the level of fibrinogen, an increase in the prothrombin time. The aim of the study was to study the indicators of the hemostatic system in patients of different age groups with tuberculous infection of the bone apparatus before and after chemotherapy.

Risk factors of thrombotic complications in patients with single functional ventricle

Objective: to analyze the parameters of the hemostasis system and the results of molecular genetic testing in patients with a single functional ventricle. The study included 102 patients. All the patients underwent a staged surgical hemodynamic correction of a single functional ventricle. The authors performed a retrospective analysis of patient records in order to identify the episodes of thrombosis. The incidence of thrombotic complications at different stages of hemodynamic correction in the examined patients with a single functional ventricle was 12.7%. The indicators of plasma link hemostasis in the observed patients have been characterized by a balance of hemostatic reactions in the group of children with thrombosis and without. The results of a molecular genetic study demonstrated that the carrier of the heterozygous genotype of 20210GA factor II gene in patients with a single functional ventricle increased the risk of thrombotic complications 16 times (15.4% in patients with thrombosis versus 1.1% in the group without thrombosis; odds ratio 16.0; 95% confidence interval 1.34–191.24; p=0.028). All patients with thrombosis in the history revealed a homozygous condition according to variant 10976GG factor VII gene (p=0.017). Conclusion: molecular genetic analysis of polymorphic variants of the hemostatic system in patients with a single functional ventricle is required to predict the risk, timely prevention and correction of thrombotic complications during the surgical treatment of congenital heart disease.

The Coagulopathy of Acute Type A Aortic Dissection: A Prospective, Observational Study

To evaluate the hemostatic system in patients undergoing surgery for acute type A aortic dissection (ATAAD) compared with those undergoing elective aortic procedures. This was a prospective, observational study. The study was performed at a single university hospital. Twenty-five patients with ATAAD were compared with 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. No interventions were performed. Platelet count and levels of fibrinogen, D-dimer, prothrombin time/international normalized ratio, activated partial thromboplastin time, and antithrombin were analyzed perioperatively and compared between the 2 groups. Patients with ATAAD had lower preoperative levels of platelets (188 [156-217] × 109/L v 221 [196-240] × 109/L; p = 0.018), fibrinogen (1.9 [1.6-2.4] g/L v 2.8 [2.2-3.0] g/L; p = 0.003), and antithrombin (0.81 [0.73-0.94] kIU/L v 0.96 [0.92-1.00] kIU/L; p = 0.003) and significantly higher levels of D-dimer (2.9 [1.7-9.7] mg/L v 0.1 [0.1-0.2] mg/L; p < 0.001) and prothrombin time/international normalized ratio (1.15 [1.1-1.2] v 1.0 [0.93-1.0]; p = 0.001). Surgery caused significant changes of the coagulation system in both groups. Intraoperative bleeding volumes were larger in the ATAAD group (2,407 [1,804-3,209] mL v 1,212 [917-1,920] mL; p < 0.001), and patients undergoing ATAAD surgery received significantly more transfusions of red blood cells (2.5 [0.25-4.75] U v 0 [0-2.75] U; p = 0.022), platelets (4 [3.25-6] U v 2 [2-4] U; p = 0.002), and plasma (2 [0-4] U v 0 [0-0] U; p = 0.004) compared with the elective group. This study demonstrates that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients, but also in patients undergoing elective surgery of the ascending aorta or the aortic root.

P179 Changes in the haemostatic system in patients with ulcerative colitis depending on the degree of activity of the disease

P179 Changes in the haemostatic system in patients with ulcerative colitis depending on the degree of activity of the disease

The condition of the hemostatic system in acute severe peritonitis during remaxol therapy

To evaluate the effectiveness of the Remaxol in the correction of hemostatic system in patients with severe acute peritonitis. 52 patients with acute peritonitis of different severity were examined, and divided into 4 groups: I - mild, II - moderate, III - severe. The patients of these groups had treated using standard therapy. The IV group had patients with severe peritonitis, who received an additional Remaxol. The hemostasis system was evaluated using a TEG 5000 thromboelastograph and biochemical tests. It has been established that the acute peritonitis is accompanied by significant hemostatic disorders - hypercogulation and hyperfibrinolysis, independently of the disease severity. In the severe peritonitis, disorders of the coagulation-lytic system were especially expressed. The use of the Remaxol in patients of this group led to a decrease the blood coagulation disorders.

Thromboelastography does not predict outcome in different etiologies of cirrhosis

Unlabelled Box BackgroundNew laboratory tests that measure global hemostasis indicate generally preserved hemostatic function in patients with cirrhosis. It is not known whether normal hemostatic function is maintained across various subsets of patients. ObjectivesIn the present study, we investigated clot generation and clot lysis kinetics in a large group of patients with different etiologies of disease. Patients/MethodsBlood samples of 270 patients with cirrhosis were studied using thromboelastography (TEG), which measures the dynamic and physical properties of clot formation and lysis in whole blood. TEG parameters of different subsets of the patient population were compared. Correlations with routine laboratory tests as well as clinical outcomes were explored. ResultsOverall, TEG parameters were normal and similar between underlying disease etiologies. A proportion of subjects showed hypocoagulable features, with the exception of patients with cholestatic cirrhosis in whom TEG readings showed hypercoagulable features. In all groups, K‐time, α‐Angle, and MA correlated well with platelet counts and fibrinogen plasma levels. After a mean follow‐up of 2 years and 11 months, 31 patients had experienced a bleeding event, 8 had developed thrombosis, and 173 patients (64%) had undergone liver transplantation and/or had died. TEG baseline parameters were similar between patients subdivided according to outcome. ConclusionsTEG parameters reflected generally preserved function of the hemostatic system in patients with cirrhosis, with hypo‐ and hypercoagulable features in subsets of patients with specific underlying disease etiologies. Abnormalities in TEG parameters did however not predict bleeding, thrombosis, or risk of liver transplantation and/or death.

Changes in peripheral blood indicators and hemostatic system in patients with uterine fibroids

Changes in peripheral blood indicators and hemostatic system in patients with uterine fibroids

The hemostatic disturbance in patients with acute aortic dissection: A prospective observational study.

Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection.The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study. The perioperative biomarkers of hemostatic system were evaluated using standard laboratory tests and enzyme-linked immunosorbent assays (ELISAs) at 5 time points: anesthesia induction (T1), lowest nasopharyngeal temperature (T2), protamine reversal (T3), 4 hours after surgery (T4), and 24 hours after surgery (T5).The ELISAs biomarkers revealed activation of coagulation (thrombin-antithrombin III complex [TAT] and prothrombin fragment 1 + 2 [F1 + 2] were elevated), suppression of anticoagulation (antithrombin III [AT III] levels were depressed), and activation of fibrinolysis (plasminogen was decreased and plasmin-antiplasmin complex [PAP] was elevated). The standard laboratory tests also demonstrated that surgery resulted in a significant reduction in platelet counts and fibrinogen concentration.Systemic activation of coagulation and fibrinolysis, and inhibition of anticoagulation were observed during the perioperative period in patients with acute aortic dissection. Indeed, these patients exhibited consumption coagulopathy and procoagulant state perioperatively. Therefore, we believe that this remarkable disseminated intravascular coagulation (DIC)-like coagulopathy has a high risk of bleeding and may influence postoperative outcome of patients with acute aortic dissection.

ФАКТОРИ РИЗИКУ ГЕМОСТАТИЧНОГО ДИСБАЛАНСУ У ХВОРИХ НА ЗАПАЛЬНІ ЗАХВОРЮВАННЯ ТА НОВОУТВОРЕННЯ ЛОР-ОРГАНІВ

To undertake a comparative study of some components of haemostatic system in patients with inflammatory diseases and tumors of URT for clarification of their role in pathologic process and for reveal of their informative value for evaluation of the pathologic process' flow. The indices of prothrombine pool, content of tissue activator of plasminogen, inhibitor of plasminogen's acnivator PAI-1, and von Willebrandt factor were tested in groups of patients with inflammatory diseases and tumors of URT-organs in contrast of the same ones in the group healthy donors as well as dependently to the kind and stage of disease. The informative value of all the tested indices as well as their dependence of the kind and the stage of disease were proved. Their differences from the norm prove for deep alterations in haemostatic system's functioning at considered diseases. Obtained data seems to be promising for complex evaluation of the state of patients with inflammatory diseases and tumors of URT-organs.

Photomatrix LED therapy in patients with post-stroke arthropathy of the shoulder joint

To assess the impact of quasi-monochromatic partially coherent infra-red radiation on the dynamics of recovery of the affected joint and the hemostatic system in patients with post-stroke arthropathy of the shoulder joint. Fifty-five patients in the early, late and residual period of ischemic stroke were studied. Group I consisted of 27 patients who underwent 10 sessions of photomatrix therapy (wavelength 600 nm) on the affected joint, lasting for 10 minutes. In patients of group II (n=28), the duration of photomatrix therapy was 20 minutes. Patients of the comparison group (n=20) did not receive photomatrix therapy. The results pointed to a significant reduction in the severity of pain, increase in the range of motion in the shoulder joint. All this was combined with a decrease in the severity of anxiety and depression, followed by a mild hypocoagulation effect and improvement of blood circulation in the paretic limb. The authors point out to the prospect of using this method for the prevention and treatment of post-stroke arthropathy.

Changes in the Hemostatic System of Patients With Acute Aortic Dissection Undergoing Aortic Arch Surgery

Aortic arch surgery for patients with acute aortic dissection is frequently complicated by excessive bleeding and transfusion of allogeneic blood products. However, the physiopathology of acute aortic dissection and surgery-induced coagulopathy has never been precisely studied. The aim of the present study is to describe the changes of the perioperative hemostatic system in patients with acute aortic dissection undergoing aortic arch surgery. Sixty-two patients undergoing emergent aortic arch surgery for Stanford type A acute aortic dissection were enrolled in this study from January 2013 to September 2014. The hemostatic system was evaluated using standard laboratory tests, plasma fibrinogen levels, and thromboelastogragh at 5 time points: anesthesia induction (T0), lowest nasopharyngeal temperature (T1), protamine reversal (T2), 4 h after surgery (T3), and on the first postoperative day (T4). The study results revealed that clotting factors had a tendency to be consumed in the preoperative period. Surgery and hypothermia resulted in a progressive reduction in clotting factors, platelet counts, and function, as well as fibrinogen concentration and function. After hemostatic therapy, although platelet counts were constantly low, clotting factors and platelet function returned to nearly preoperative levels. In contrast, fibrinogen concentration and function were still significantly lower than preoperative levels. The results of this prospective analysis showed that acute aortic dissection itself activated the hemostatic system even before surgery. After hemostatic therapy, fibrin formation was more impaired than platelet function. In this setting, we proposed that hemostatic therapy should focus on rapid and sufficient supplementation of fibrinogen. Thus, we recommend further increases in fibrinogen concentration to improve coagulopathy in patients with acute aortic dissection.

Rebalanced Hemostasis in Patients with Acute Liver Failure.

Patients with acute liver failure (ALF) have substantial alterations in their hemostatic system. Since an international normalized ratio of ≥ 1.5 is part of the definition of the syndrome, it has long been believed that patients with ALF had a hemostasis-related bleeding tendency. Recent data, however, show that spontaneous bleeding in ALF is rare. In addition, thrombotic complications may be more common than spontaneous bleeding complications. Laboratory studies have suggested that patients with ALF may be in hemostatic balance as a result of a commensurate decline in pro- and anti-hemostatic factors. The unstable nature of the hemostatic balance in ALF may explain the occurrence of both bleeding and thrombotic complications. The hemostatic profile of patients with ALF includes hypercoagulable features, including von Willebrand factor/a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 unbalance, elevated levels of highly procoagulant, platelet-derived microparticles, and a profound hypofibrinolytic status. These hypercoagulable features may contribute to systemic thrombotic complications, but may also drive intrahepatic clot formation. Studies in experimental animal models of ALF have demonstrated that intrahepatic clot formation contributes to disease progression. The clinical consequences of these new insights in the hemostatic system of patients with ALF will be discussed in this review.

Character of changes of system of a hemostasis at sick of a cirrhosis

Since there were doubts as to the causes of hemorrhagic complications in liver cirrhosis it is actual a topical study both pro- and anticoagulant hemostasis. Aim. To evaluate the hemostatic system in patients with liver cirrhosis. Material and methods. 190 patients with cirrhosis were under examination: 123 have gastrointestinal bleeding, 67 - refractory ascites. 84 patients died during examination. The duration of examination was from 2-3 weeks to 2.5-3 years. Estimation of procoagulant unit include determining the number of platelets, prothrombin index, activated partial thromboplastin time, blood-coagulation factor F VIII, fibrinogen levels, B and D-dimer fibrinogen. Anticoagulant system was evaluated by activity of coagulation inhibitor of protein C. Results. In 71.5 % of discharged patients with bleeding and 60.0% of deaths, the activity of blood-coagulation factor F VIII exceeded normal levels. Increased activity of F VIII in patients with ascites was at 66.7% and 92.0%, respectively. In the dynamics of the percentage of patients with elevated F VIII in all groups increased, reaching 85.8 %–94.0 % (p<0.01). The activity of protein C anticoagulant factor for 71.4% -88.0% of patients, which hospitalized with complications of LC, was reduced, accounting for less than 70%. Low activity of protein C remained in dynamics such as those discharged and deceased patients, 68.0% and 75.0%, respectively, at DH and 90.0% -94.0% - at ascites, (p <0.01). Confirmation of the presence of thrombophilia in cirrhotic patients is to determine the level of D-dimer. At 75.0% -97.0% of patients hospitalized with complications of the LC, the content of D-dimer in serum at admission was 5-8 times higher among patients subsequently discharged and 8-12 times among the dead, not decreasing over time ( p <0,01). Conclusions. 1. Hemostasis of compensated cirrhotic patients is characterized by an imbalance toward hypercoagulation, as evidenced by the decrease in the activity of protein C with normal or increased activity of blood-coagulation factor FVIII. 2. Decompensated patients have varying degrees of hypocoagulation severity characterized by laboratory thrombocytopenia, decrease of prothrombin index, fibrinogen, increase of APTT, production of fibrin degradation products (D-dimer), which clinically defines hemorrhagic syndrome in liver cirrhosis.

Особенности системы гемостаза у пациенток с эндометриоидными кистами яичников

Objective: evaluation of the hemostatic system in patients with endometrioid ovarian cysts before and after treatment of various types of surgical exposures.Materials and methods. 90 patients with with endometrioid ovarian cysts were operated, depending on the method of surgical treatment and therefore divided into two groups. The study was prospective in nature. The patients then underwent a complete clinical and laboratory examination, genotyping of the most significant thrombophilic polymorphisms.Conclusions. The analysis showed a reduction in performance of hemostasiogram compensatory mechanisms even in the absence of pronounced changes of hemostasis. In such a situation it is very important to choose the least traumatic method of surgical treatment, which allows not only to preserve ovarian reserve, but also reduce the level of response to the hemostatic system of interventions.

Russian

russian

MicroRNA-19b functions as potential anti-thrombotic protector in patients with unstable angina by targeting tissue factor

The activation of a hemostatic system plays a critical role in the incidence of acute coronary events. Hemostatic proteins may be regulated by microRNAs (miRNAs). Microparticles (MPs) are the major carrier of circulating miRNAs. The aim of this study was to determine the potential role of miRNAs in regulating gene expression involved in the hemostatic system in patients with unstable angina (UA). MiRNA expression profiles in the plasma from patients with UA (UA group, n=9) compared with individuals with clinical suspicion of coronary artery disease (CAD) but negative angiography (control group, n=9) showed that among 36 differentially expressed miRNAs, miR-19b was the most obvious one. Using real-time PCR, 5 selected miRNA levels in plasma (UA group, n=20; control group, n=30) and plasma MPs (UA group n=6; control group n=6) were proved to be consistent with the miRNA array. Flow cytometry analysis indicated that the amounts of plasma endothelial microparticles (EMPs) were increased in UA patients (UA group, n=4) compared to controls (control group, n=4). In cultured endothelial cells (ECs), TNF-α increased miR-19b release and expression. Tissue factor (TF) was predicted to be the target of miR-19b by bioinformatics analysis. Luciferase reporter assays demonstrated that miR-19b binds to TF mRNA. Overexpression of miR-19b inhibited TF expression and procoagulant activity. This study indicates that in UA patients, the increase of miR-19b wrapped in EMPs due to endothelial dysfunction may partially contribute to the circulating miR-19b elevation and miR-19b may play an anti-thrombotic role by inhibiting the expression of TF in ECs.

Effect of combination therapy of metformin and fenofibrate on the hemostatic system in patients with impaired glucose tolerance

Effect of combination therapy of metformin and fenofibrate on the hemostatic system in patients with impaired glucose tolerance

Hemostasis in acute liver and kidney failure: nothing is as it seems

Very little is known about the behavior of the hemostatic system in patients with acute kidney injury (AKI) associated with acute liver failure (ALF). Agarwal and colleagues show that patients who suffer from both ALF and AKI exhibit a higher degree of hemostasis impairment than those with normal renal function. Both anticoagulant and procoagulant factors were impaired. The development of AKI appears to displace the hemostatic equilibrium toward a more prothrombotic pattern.