To clarify the role of TAFI in hypertensive disorders in pregnancy, 22 subjects, including 10 with pre-eclampsia （PE） and 12 with gestational hypertension were examined for the levels of TAFI and thrombin-antithromb...To clarify the role of TAFI in hypertensive disorders in pregnancy, 22 subjects, including 10 with pre-eclampsia （PE） and 12 with gestational hypertension were examined for the levels of TAFI and thrombin-antithrombin （TAT） complex. Thirty normal pregnant women served as controls. ELISA was employed for the detection. The results showed that the TAFI antigen levels in normal pregnancy group, gestational hypertension group and PE group were （85.35±24.69）%, （99.65±18.27）%, （110.12±23.36）%; （97.06±21.40）%, （114.08±27.76）%, （125.49±24.70）%; （106.6±19.21）%, （129.2±25.07）%, （139.1±30.12）%, in the 1st, 2nd and 3rd trimester respectively. No significant differences were found between the normal pregnancy group and gestational hypertension group but significant difference existed between normal pregnancy group and PE group in each trimester （P〈0.05）. TAT complexes were significantly higher in patients with PE than that in controls （P〈0.05）, but no correlation was found between TAT and TAFI. It is concluded that TAFI may contributed to the impairment of fibrinolysis in the patients with PE and may serves as a sensitive indicator for PE, but it may not help in the diagnosis of the gestational hypertension.展开更多
Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 y...Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.展开更多
Objective To investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent peri-cardial constriction in patients with infectious exudative pericarditis. Methods A total of 94 pa...Objective To investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent peri-cardial constriction in patients with infectious exudative pericarditis. Methods A total of 94 patients diagnosed as infectious exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous pericarditis, the disease courses of all patients were less than 1 month), 44 males and 50 females, aged from 9 to 66 years (mean 45.4 ± 14.7 years), were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment in study group, or conventional treatment alone (including pericardiocentesis and drainage) in control group. The dosage of urokinase ranged from 200 000 to 600 000 U (mean 320 000 ± 70 000 U). The immediate effects were detected by pericardiography with sterilized air and diatrizoate meglumine as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The duration of following-up ranged from 8 to 120 months (mean 56.8 ± 29.0 months). Results Percutaneous intrapericardial urokinase irrigation promoted complete drainage of pericardial effusion, signifi-cantly reduced the thickness of pericardium (from 3.1 ± 1.6 mm to 1.6 ± 1.0 mm in study group, P < 0.001; from 3.4 ± 1.6 mm to 3.2 ± 1.8 mm in control group, P > 0.05, respectively), and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication was observed. In follow-up, there was no cardiac death, and pericardial constriction events were observed in 9 (19.1%) of study group and 27 (57.4%) of control group. Cox analysis illustrated that urokinase could significantly reduce the occurrence of pericardial constriction (relative hazard coefficient = 0.185, P < 0.0001). Conclusion The early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction in patients with infectious exudative pericarditis.展开更多
<strong>Objective</strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:Verdana;"> To investigate the correlation be...<strong>Objective</strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:Verdana;"> To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU),</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">and the </span><span style="font-family:Verdana;">fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) </span><span style="font-family:Verdana;">method and </span><a name="OLE_LINK12"></a><span style="font-family:Verdana;">automatic hemagglutination analyzer.</span><b><span style="font-family:Verdana;"> Results</span></b></span><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group,</span><span style="font-family:""> </span><span style="font-family:Verdana;">the difference w</span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> statistically significant (P < 0.01)</span><span style="font-family:Verdana;">,</span><span style="font-family:""> <span style="font-family:Verdana;">while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy</span><span style="font-family:Verdana;"> grou</span></span><span style="font-family:Verdana;">p, </span><span style="font-family:Verdana;">and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.</span>展开更多
The intraglomerular distribution of alpha 2-plasmin inhi-bitor (α2-PI), plasminogen (PLG), fibronectin (FN) andfibrinogen related antigen (FRA), were examined in 118 ca-ses of primary or secondary glomerular disease ...The intraglomerular distribution of alpha 2-plasmin inhi-bitor (α2-PI), plasminogen (PLG), fibronectin (FN) andfibrinogen related antigen (FRA), were examined in 118 ca-ses of primary or secondary glomerular disease by immuno-fluorescence method. The plasma concentrations of α2-PI,PLGand FRA were also measured simultaneously. The results ofthis study indicated that there was significant correlationbetween the deposition of α2-PI, PLG, FN, FRA and thedegree of histopathological changes in patients with severeglomerulonephritis. There was no significant correlation be-tween the intensity of α2-PI, PLG, FN and FRA depositionin glomeruli and the serum levels of α2-PI, PLG and FRA.展开更多
Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogen...Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogenesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic administration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre-and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 cases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P > 0.05). The rate of normal hearing following treatment in G3 was 70% or 7 / 10, higher than in G1(41.7% or 5 / 12) and G2 (54.5% or 6 / 11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8 / 10 in G2 and G3, respectively, higher than that in G1(50.0% or 6 / 12)(P < 0.05). Conclusions Therapeutic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In addition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.展开更多
Platelet adhesion depends on the platelet membrane glycoprotein Ib (GPIb) and plasma von Willebrand Factor (vWF), which can be reflected by ristocetin-induced aggregation. Here we report damage effect of fibrinolysis ...Platelet adhesion depends on the platelet membrane glycoprotein Ib (GPIb) and plasma von Willebrand Factor (vWF), which can be reflected by ristocetin-induced aggregation. Here we report damage effect of fibrinolysis and preserving effect of aprotinin on platelet function. Addition of 40 U/ml urokinase and 0.3 U/ml plasmin to PRP or washed platelets made the ristocetin-induced aggregation decline to 31.6% and 38.5% of control value respectively. The extent of declining was positively correlated with the concentration of urokinase and plasmin. Meanwhile, the platelet GPIb decreased to 76.4% of control value. The results showed that the fibrinolysis impaired the platelet function and this effect may be associated with the hydrolysis of GPIb. Further research found that by adding the same dose of urokinase or plasmin to aprotinin-pretreated PRP or washed platelets, the aggregation did not change statistically and decrement of GPIb is much less marked. We concluded that the aprotinin could relieve the platelet dsfunction effectively by its inhibitory effect on fibrinolytic activity.展开更多
Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with sing estradiol cypionate) and other /orly--five women, as control,received oral contraceptive pill (Ortho--Novum 1/35, containing noreth...Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with sing estradiol cypionate) and other /orly--five women, as control,received oral contraceptive pill (Ortho--Novum 1/35, containing norethisterone enantate ling and estradiol valerate 35fig) for nine months. Blood samples were taken during the follicular and luteal phases o/preu treatment, and for Cyclofem group, immediately prior to the 3rd and gth injections and 1 and 3 weeks a/ter the 3rd and gth injections, for Ortho Novum group, blood samples were taken on the irst day o[.the 3rd and gth pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle.Coagulation and librinolysis parameter were detected including hemoglobin,platelet count, prothrombin time, APTT, fibrinogen, factor Vll, [actor X,plasminogen, in PAl, AT Ill (functional and immunological assays) and protein C.In the Cyclolem group, hemoglobin, platelet count, fibrinogen and /Octor X were not changed. Factor Vll significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-- PAl and AT 11.1 increased. These changes showed a dynamic balance between coagulatioll and fibrinolysis. In Ortho---Novum 1/35 group, platelet count, jactor X and [ibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagulation system, plasminogen increased as well as protein C, but AT Ill declined. Those changes showed a tendency o[ hyper-coagulabllity state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight 'changes on coagulation and [ibrinolyls is in Cyclofem injectable contraceptive users.展开更多
Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type...Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.展开更多
Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with...Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hours： sham, （1.05±0.05） ng/ml; control, （1.13±0.06） ng/ml; APC, （1.06±0.06） ng/ml; P 〈0.05）. However, APC failed to prevent the decrease in PaO2/FiO2 ratio. APC-treated rabbits showed no significant difference in platelet count and antithrombin but exhibited less D-dimer production than did the controls. Moreover, APC limited the histopathological score of lung injury （2.6±0.8 in control, vs 1.4±0.6 in APC group, P〈0.01）. Conclusion Anti-coagulation and pro-fibrinolysis activity may be two of the possible mechanisms by which activated protein C attenuated endotoxin-induced ALI.展开更多
Objective：To explore the influence of the combination of Shuxuetong（SXT）and aspirin on coagulation and fibrinolytic system of rats.Methods：Suture method was applied to establish focal cerebral ischemia-reperfusion...Objective：To explore the influence of the combination of Shuxuetong（SXT）and aspirin on coagulation and fibrinolytic system of rats.Methods：Suture method was applied to establish focal cerebral ischemia-reperfusion injury models in rats.SD rats were randomly divided into sham group,middle cerebral artery occlusion/reperfusion（MCAO/R）group,aspirin group,SXT group,and SXT＋aspirin group（S＆A）.The neurological deficits were assessed according to Longa’s grade 5 scoring method.The cerebral edema was detected by measuring the content of water in brain tissue.The volume of cerebral infarction was observed by 2,3,5-Triphenyltetrazolium chloride（TTC）staining.Blood plasma was collected by abdominal aortic method to test maximum platelet aggregation rate and four blood coagulation.CD61,CD62p,6-keto prostaglandin F1αantithrombinⅢ（AT-Ⅲ）,D-dimer,plasminogen activator inhibitor-1（PAI-1）,tissue factor（TF）,tissue plasminogen activator（t-PA）,platelet thromboxaneand von Willebrand factor（v WF）content in rat plasma were detected by ELISA.Results：SXT combined with aspirin could improve the neurological deficits,alleviate cerebral edema,and decrease the cerebral infarct value.Compared with the sham operation group,fibrinogen（FIB）,6-AT-III,and t-PA in model group were significantly decreased;Compared with the model group,the above-mentioned indexes in SXT and aspirin treatment group were significantly increased.The prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）,D-dimer,PAI-1,TF,TXB2,and v WF of the model group were significantly increased;The above-mentioned indexes in blood SXT＋aspirin treated group were significantly decreased.There was a significant difference between the combined group and SXT group.The maximum concentration of plateletsin aspirin treated rats was significantly decreased,however,MPAR was reversed in SXT＋aspirin treated group.Conclusion：SXT combined with aspirin can effectively inhibit platelet activation,regulate the maximum concentration of platelets,and improve coagulation function and fibrinolysis system.展开更多
ABSTRACT It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention （PCI） early after acu...ABSTRACT It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention （PCI） early after acute ST- segment elevation myocardial infarction （STEMI）.展开更多
Tumor vascular infarction has been regarded as a promising therapy in tumor treatment.However,due to the limited activity of designed coagulation agents,resulting from the challenges of inducing sustained and complete...Tumor vascular infarction has been regarded as a promising therapy in tumor treatment.However,due to the limited activity of designed coagulation agents,resulting from the challenges of inducing sustained and complete thrombosis and associated selectivity issues,the traditional vascular infarction strategy consequently results in treatment failure.Here,we report a photo-initiated coagulation activation and fibrinolysis inhibition approach to achieve synergetic tumor vascular infarction via gold nanorods(AuNRs)-based nanosystem for the co-delivery of coagulation initiator thrombin and fibrinolysis inhibitor tranexamic acid.With a photo-initiated cascade reaction,thrombin and tranexamic acid could be released from the nanosystem to activate coagulation and inhibit the fibrinolysis within tumor vessels.By integrating these two physiological reactions,fortified clots were formed,and tumor vessels were occluded steadily,affecting the metabolism of the tumor cells,thereby inhibiting tumor growth.This strategy might open an alternative path for the advancement of the current tumor vascular infarction strategy.展开更多
BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommende...BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.展开更多
C-reactive protein(CRP) is a biomarker of inflammation.Increased plasma levels of CRP are associated with an increased risk of myocardial infarction.However,the correlation between plasma CRP concentration and atheros...C-reactive protein(CRP) is a biomarker of inflammation.Increased plasma levels of CRP are associated with an increased risk of myocardial infarction.However,the correlation between plasma CRP concentration and atherosclerotic plaque burden is poor.Based on these observations,it has been hypothesized that CRP increases the risk of myocardial infarction by promoting thrombosis.This article reviews available data that link enhanced CRP expression to increased risk of thrombosis,with a focus on the effects of CRP on hemostasis,platelet function,and fibrinolysis.Overall,the available data support the hypothesis that CRP is an important mechanistic link between inflammation and throm bosis.展开更多
Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a c...Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.展开更多
Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders.This study aimed to characterize the clinical laboratory findings of hemocoagul...Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders.This study aimed to characterize the clinical laboratory findings of hemocoagulase-induced hypofibrinogenemia as the associated adverse reaction of hemocoagulase injection.Methods Wie retrospectively enrolled 27 in-patients who were treated with hemocoagulase injection for hemoptysis and developed hypofibrinogenemia during the period of January 1,2015 to March 31,2018.Clinical data were collected and investigated,including clinical manifestations,hemostatic and fibrinolytic parameters,dosage of hemocoagulase,the medication time,and the cryoprecipitate blood product infusion.Differences in fibrinogen,D-dimer,and fibrin/fibrinogen degradation products(FDP)before,during,and after the application of hemocoagulase injection were analyzed statistically.Results Plasma fibrinogen level during medication of hemocoagulase injection decreased significantly compared to that before the treatment(F=1.80,P<0.001),with the average decrease of 2.28 g/L(0.63-3.9 g/L).After withdrawal,fibrinogen level increased significantly compared to that during the medication(F=l.20,P<0.001),but was still lower than that before the medication(F=0.59,P=0.03).The D-dimer level and the FDP level after withdrawal decreased significantly compared to the levels during the medication(F=0.83,P=0.002;Wilcoxon-test,Z=-4.54,P<0.001).Spearman's correlation analyses did not find either fibrinogen change during-before the administration or FDP change after-during the administration was associated with the dosage of hemo coagulase(r=-0.17,P=0.40;r=-0.28,P=0.15;respectively)and the time of recovery from hypofibrinogenemia(r=-0.45,P=0.05;r=0.13,P=0.61;respectively).Conclusion Monitoring both clotting and fibrinolysis parameters is essential in the management of hemoptysis patients treated with hemocoagulase injection.Clinicians should be aware of hypofibrinogenemia and consider discontinuation of the administration of hemocoagulase whenever necessary.展开更多
AIM： To investigate the major steps of thrombogenesis and to identify the differences in these steps between idiopathic patient group and control group. METHODS： Fibrinogenesis was studied by measuring the activated...AIM： To investigate the major steps of thrombogenesis and to identify the differences in these steps between idiopathic patient group and control group. METHODS： Fibrinogenesis was studied by measuring the activated factor Ⅶ, total and free levels of tissue factor pathway inhibitor （TFPI）. The fibrinolysis step was investigated by determining the global fibrinolytic capacity. The endothelial function was assessed by measuring the levels of soluble adhesion molecules, namely soluble intercellular adhesion molecule 1 （sICAM-1）, soluble vascular cell adhesion molecule 1 （sVCAM-1） and soluble E-selectin molecule. The exclusion criteria from ＂idiopat- hic＂ patient group were abdominal surgery, pregnancy, use of oral contraceptives, anti-phospholipid syndrome, Behet＇s disease, cancer, myeloproliferative diseases. The congenital factors like mutations of factor-Ⅴ Leiden and prothrombin, deficiencies of proteins C and S, antithrombin, hyperhomocysteinemia and hyperfibrinogenemia were ruled out. The total number of patients was reduced from 96 to 9 （7 with portal vein thrombosis, 2 Budd Chiari syndrome） by exclusion criteria. RESULTS： The levels of adhesion molecules sICAM-1, sVCAM-1, free TFPI levels and global fibrinolytic capacity were significantly different （P〈 0.05） in the patient group indicating an endothelial dysfunction and a lower fibrinolytic activity. CONCLUSION： These results show that this patient group should be tested by means of endothelial dysfunction and managed differently.展开更多
AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic sear...AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.展开更多
基金a grant from the Key Program of Clinical Sciences of Ministry of Health of China (No. WGCF468)
文摘To clarify the role of TAFI in hypertensive disorders in pregnancy, 22 subjects, including 10 with pre-eclampsia （PE） and 12 with gestational hypertension were examined for the levels of TAFI and thrombin-antithrombin （TAT） complex. Thirty normal pregnant women served as controls. ELISA was employed for the detection. The results showed that the TAFI antigen levels in normal pregnancy group, gestational hypertension group and PE group were （85.35±24.69）%, （99.65±18.27）%, （110.12±23.36）%; （97.06±21.40）%, （114.08±27.76）%, （125.49±24.70）%; （106.6±19.21）%, （129.2±25.07）%, （139.1±30.12）%, in the 1st, 2nd and 3rd trimester respectively. No significant differences were found between the normal pregnancy group and gestational hypertension group but significant difference existed between normal pregnancy group and PE group in each trimester （P〈0.05）. TAT complexes were significantly higher in patients with PE than that in controls （P〈0.05）, but no correlation was found between TAT and TAFI. It is concluded that TAFI may contributed to the impairment of fibrinolysis in the patients with PE and may serves as a sensitive indicator for PE, but it may not help in the diagnosis of the gestational hypertension.
基金Supported by Ningbo Medical Technology Foundation (200612)
文摘Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.
基金Supported by a grantfrom Shaanxi Provincial Scientific & Tech-nological Foundation (1995K11-G12 ).
文摘Objective To investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent peri-cardial constriction in patients with infectious exudative pericarditis. Methods A total of 94 patients diagnosed as infectious exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous pericarditis, the disease courses of all patients were less than 1 month), 44 males and 50 females, aged from 9 to 66 years (mean 45.4 ± 14.7 years), were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment in study group, or conventional treatment alone (including pericardiocentesis and drainage) in control group. The dosage of urokinase ranged from 200 000 to 600 000 U (mean 320 000 ± 70 000 U). The immediate effects were detected by pericardiography with sterilized air and diatrizoate meglumine as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The duration of following-up ranged from 8 to 120 months (mean 56.8 ± 29.0 months). Results Percutaneous intrapericardial urokinase irrigation promoted complete drainage of pericardial effusion, signifi-cantly reduced the thickness of pericardium (from 3.1 ± 1.6 mm to 1.6 ± 1.0 mm in study group, P < 0.001; from 3.4 ± 1.6 mm to 3.2 ± 1.8 mm in control group, P > 0.05, respectively), and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication was observed. In follow-up, there was no cardiac death, and pericardial constriction events were observed in 9 (19.1%) of study group and 27 (57.4%) of control group. Cox analysis illustrated that urokinase could significantly reduce the occurrence of pericardial constriction (relative hazard coefficient = 0.185, P < 0.0001). Conclusion The early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction in patients with infectious exudative pericarditis.
文摘<strong>Objective</strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:Verdana;"> To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU),</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">and the </span><span style="font-family:Verdana;">fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) </span><span style="font-family:Verdana;">method and </span><a name="OLE_LINK12"></a><span style="font-family:Verdana;">automatic hemagglutination analyzer.</span><b><span style="font-family:Verdana;"> Results</span></b></span><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group,</span><span style="font-family:""> </span><span style="font-family:Verdana;">the difference w</span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> statistically significant (P < 0.01)</span><span style="font-family:Verdana;">,</span><span style="font-family:""> <span style="font-family:Verdana;">while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy</span><span style="font-family:Verdana;"> grou</span></span><span style="font-family:Verdana;">p, </span><span style="font-family:Verdana;">and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.</span>
文摘The intraglomerular distribution of alpha 2-plasmin inhi-bitor (α2-PI), plasminogen (PLG), fibronectin (FN) andfibrinogen related antigen (FRA), were examined in 118 ca-ses of primary or secondary glomerular disease by immuno-fluorescence method. The plasma concentrations of α2-PI,PLGand FRA were also measured simultaneously. The results ofthis study indicated that there was significant correlationbetween the deposition of α2-PI, PLG, FN, FRA and thedegree of histopathological changes in patients with severeglomerulonephritis. There was no significant correlation be-tween the intensity of α2-PI, PLG, FN and FRA depositionin glomeruli and the serum levels of α2-PI, PLG and FRA.
文摘Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogenesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic administration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre-and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 cases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P > 0.05). The rate of normal hearing following treatment in G3 was 70% or 7 / 10, higher than in G1(41.7% or 5 / 12) and G2 (54.5% or 6 / 11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8 / 10 in G2 and G3, respectively, higher than that in G1(50.0% or 6 / 12)(P < 0.05). Conclusions Therapeutic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In addition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.
文摘Platelet adhesion depends on the platelet membrane glycoprotein Ib (GPIb) and plasma von Willebrand Factor (vWF), which can be reflected by ristocetin-induced aggregation. Here we report damage effect of fibrinolysis and preserving effect of aprotinin on platelet function. Addition of 40 U/ml urokinase and 0.3 U/ml plasmin to PRP or washed platelets made the ristocetin-induced aggregation decline to 31.6% and 38.5% of control value respectively. The extent of declining was positively correlated with the concentration of urokinase and plasmin. Meanwhile, the platelet GPIb decreased to 76.4% of control value. The results showed that the fibrinolysis impaired the platelet function and this effect may be associated with the hydrolysis of GPIb. Further research found that by adding the same dose of urokinase or plasmin to aprotinin-pretreated PRP or washed platelets, the aggregation did not change statistically and decrement of GPIb is much less marked. We concluded that the aprotinin could relieve the platelet dsfunction effectively by its inhibitory effect on fibrinolytic activity.
文摘Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with sing estradiol cypionate) and other /orly--five women, as control,received oral contraceptive pill (Ortho--Novum 1/35, containing norethisterone enantate ling and estradiol valerate 35fig) for nine months. Blood samples were taken during the follicular and luteal phases o/preu treatment, and for Cyclofem group, immediately prior to the 3rd and gth injections and 1 and 3 weeks a/ter the 3rd and gth injections, for Ortho Novum group, blood samples were taken on the irst day o[.the 3rd and gth pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle.Coagulation and librinolysis parameter were detected including hemoglobin,platelet count, prothrombin time, APTT, fibrinogen, factor Vll, [actor X,plasminogen, in PAl, AT Ill (functional and immunological assays) and protein C.In the Cyclolem group, hemoglobin, platelet count, fibrinogen and /Octor X were not changed. Factor Vll significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-- PAl and AT 11.1 increased. These changes showed a dynamic balance between coagulatioll and fibrinolysis. In Ortho---Novum 1/35 group, platelet count, jactor X and [ibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagulation system, plasminogen increased as well as protein C, but AT Ill declined. Those changes showed a tendency o[ hyper-coagulabllity state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight 'changes on coagulation and [ibrinolyls is in Cyclofem injectable contraceptive users.
文摘Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.
基金This project was supported by the Beijing Natural Science Foundation, China （No. 7032019）.
文摘Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hours： sham, （1.05±0.05） ng/ml; control, （1.13±0.06） ng/ml; APC, （1.06±0.06） ng/ml; P 〈0.05）. However, APC failed to prevent the decrease in PaO2/FiO2 ratio. APC-treated rabbits showed no significant difference in platelet count and antithrombin but exhibited less D-dimer production than did the controls. Moreover, APC limited the histopathological score of lung injury （2.6±0.8 in control, vs 1.4±0.6 in APC group, P〈0.01）. Conclusion Anti-coagulation and pro-fibrinolysis activity may be two of the possible mechanisms by which activated protein C attenuated endotoxin-induced ALI.
基金supported by Natural Sciences Foundation of China(81303257)
文摘Objective：To explore the influence of the combination of Shuxuetong（SXT）and aspirin on coagulation and fibrinolytic system of rats.Methods：Suture method was applied to establish focal cerebral ischemia-reperfusion injury models in rats.SD rats were randomly divided into sham group,middle cerebral artery occlusion/reperfusion（MCAO/R）group,aspirin group,SXT group,and SXT＋aspirin group（S＆A）.The neurological deficits were assessed according to Longa’s grade 5 scoring method.The cerebral edema was detected by measuring the content of water in brain tissue.The volume of cerebral infarction was observed by 2,3,5-Triphenyltetrazolium chloride（TTC）staining.Blood plasma was collected by abdominal aortic method to test maximum platelet aggregation rate and four blood coagulation.CD61,CD62p,6-keto prostaglandin F1αantithrombinⅢ（AT-Ⅲ）,D-dimer,plasminogen activator inhibitor-1（PAI-1）,tissue factor（TF）,tissue plasminogen activator（t-PA）,platelet thromboxaneand von Willebrand factor（v WF）content in rat plasma were detected by ELISA.Results：SXT combined with aspirin could improve the neurological deficits,alleviate cerebral edema,and decrease the cerebral infarct value.Compared with the sham operation group,fibrinogen（FIB）,6-AT-III,and t-PA in model group were significantly decreased;Compared with the model group,the above-mentioned indexes in SXT and aspirin treatment group were significantly increased.The prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）,D-dimer,PAI-1,TF,TXB2,and v WF of the model group were significantly increased;The above-mentioned indexes in blood SXT＋aspirin treated group were significantly decreased.There was a significant difference between the combined group and SXT group.The maximum concentration of plateletsin aspirin treated rats was significantly decreased,however,MPAR was reversed in SXT＋aspirin treated group.Conclusion：SXT combined with aspirin can effectively inhibit platelet activation,regulate the maximum concentration of platelets,and improve coagulation function and fibrinolysis system.
文摘ABSTRACT It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention （PCI） early after acute ST- segment elevation myocardial infarction （STEMI）.
基金supported by the National Natural Science Foundation of China(grant nos.51988102,51833007,51690152,51533006,and 21721005)the National Key Research and Development Program of China(grant no.2019YFA0905603).
文摘Tumor vascular infarction has been regarded as a promising therapy in tumor treatment.However,due to the limited activity of designed coagulation agents,resulting from the challenges of inducing sustained and complete thrombosis and associated selectivity issues,the traditional vascular infarction strategy consequently results in treatment failure.Here,we report a photo-initiated coagulation activation and fibrinolysis inhibition approach to achieve synergetic tumor vascular infarction via gold nanorods(AuNRs)-based nanosystem for the co-delivery of coagulation initiator thrombin and fibrinolysis inhibitor tranexamic acid.With a photo-initiated cascade reaction,thrombin and tranexamic acid could be released from the nanosystem to activate coagulation and inhibit the fibrinolysis within tumor vessels.By integrating these two physiological reactions,fortified clots were formed,and tumor vessels were occluded steadily,affecting the metabolism of the tumor cells,thereby inhibiting tumor growth.This strategy might open an alternative path for the advancement of the current tumor vascular infarction strategy.
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
基金Supported by Merit Review Award from the Department of Veterans Affairs,research grants from the Missouri Life Sciences Research Board and NIH,No. HL57346
文摘C-reactive protein(CRP) is a biomarker of inflammation.Increased plasma levels of CRP are associated with an increased risk of myocardial infarction.However,the correlation between plasma CRP concentration and atherosclerotic plaque burden is poor.Based on these observations,it has been hypothesized that CRP increases the risk of myocardial infarction by promoting thrombosis.This article reviews available data that link enhanced CRP expression to increased risk of thrombosis,with a focus on the effects of CRP on hemostasis,platelet function,and fibrinolysis.Overall,the available data support the hypothesis that CRP is an important mechanistic link between inflammation and throm bosis.
文摘Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.
文摘Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders.This study aimed to characterize the clinical laboratory findings of hemocoagulase-induced hypofibrinogenemia as the associated adverse reaction of hemocoagulase injection.Methods Wie retrospectively enrolled 27 in-patients who were treated with hemocoagulase injection for hemoptysis and developed hypofibrinogenemia during the period of January 1,2015 to March 31,2018.Clinical data were collected and investigated,including clinical manifestations,hemostatic and fibrinolytic parameters,dosage of hemocoagulase,the medication time,and the cryoprecipitate blood product infusion.Differences in fibrinogen,D-dimer,and fibrin/fibrinogen degradation products(FDP)before,during,and after the application of hemocoagulase injection were analyzed statistically.Results Plasma fibrinogen level during medication of hemocoagulase injection decreased significantly compared to that before the treatment(F=1.80,P<0.001),with the average decrease of 2.28 g/L(0.63-3.9 g/L).After withdrawal,fibrinogen level increased significantly compared to that during the medication(F=l.20,P<0.001),but was still lower than that before the medication(F=0.59,P=0.03).The D-dimer level and the FDP level after withdrawal decreased significantly compared to the levels during the medication(F=0.83,P=0.002;Wilcoxon-test,Z=-4.54,P<0.001).Spearman's correlation analyses did not find either fibrinogen change during-before the administration or FDP change after-during the administration was associated with the dosage of hemo coagulase(r=-0.17,P=0.40;r=-0.28,P=0.15;respectively)and the time of recovery from hypofibrinogenemia(r=-0.45,P=0.05;r=0.13,P=0.61;respectively).Conclusion Monitoring both clotting and fibrinolysis parameters is essential in the management of hemoptysis patients treated with hemocoagulase injection.Clinicians should be aware of hypofibrinogenemia and consider discontinuation of the administration of hemocoagulase whenever necessary.
基金Supported by Hacettepe University Office of Scientific Research Center
文摘AIM： To investigate the major steps of thrombogenesis and to identify the differences in these steps between idiopathic patient group and control group. METHODS： Fibrinogenesis was studied by measuring the activated factor Ⅶ, total and free levels of tissue factor pathway inhibitor （TFPI）. The fibrinolysis step was investigated by determining the global fibrinolytic capacity. The endothelial function was assessed by measuring the levels of soluble adhesion molecules, namely soluble intercellular adhesion molecule 1 （sICAM-1）, soluble vascular cell adhesion molecule 1 （sVCAM-1） and soluble E-selectin molecule. The exclusion criteria from ＂idiopat- hic＂ patient group were abdominal surgery, pregnancy, use of oral contraceptives, anti-phospholipid syndrome, Behet＇s disease, cancer, myeloproliferative diseases. The congenital factors like mutations of factor-Ⅴ Leiden and prothrombin, deficiencies of proteins C and S, antithrombin, hyperhomocysteinemia and hyperfibrinogenemia were ruled out. The total number of patients was reduced from 96 to 9 （7 with portal vein thrombosis, 2 Budd Chiari syndrome） by exclusion criteria. RESULTS： The levels of adhesion molecules sICAM-1, sVCAM-1, free TFPI levels and global fibrinolytic capacity were significantly different （P〈 0.05） in the patient group indicating an endothelial dysfunction and a lower fibrinolytic activity. CONCLUSION： These results show that this patient group should be tested by means of endothelial dysfunction and managed differently.
文摘AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.
