Background:Shaoyao decoction(SYD)has been found widespread clinical use in treating ulcerative colitis(UC).However,the mechanism underlying SYD impact on UC remains elusive.Materials and methods:We preliminarily evalu...Background:Shaoyao decoction(SYD)has been found widespread clinical use in treating ulcerative colitis(UC).However,the mechanism underlying SYD impact on UC remains elusive.Materials and methods:We preliminarily evaluated the therapeutic effect of SYD intervention in a dextran sulfate sodium-induced UC mouse model by analyzing the body weight change,disease activity index score,colon length,and HE staining results of colon tissue in each group of mice.Subsequently,we determined pro-inflammatory cytokines level and blood coagulation markers in the colon tissues of mice in each group to evaluate the effect of SYD intervention on colonic inflammatory response and coagulation function in UC mice.Results:Our findings emphasize the significant therapeutic effect of SYD on UC,including slowed down body weight loss,reduced disease activity index score,increased colon length,and reduced inflammatory infiltration in colon tissue.Moreover,SYD intervention significantly downregulated the levels of pro-inflammatory cytokines IL-1β,IL-6,and IL-17A in the colon.Furthermore,SYD intervention reversed the coagulation-related indicators such as prothrombin time,fibrinogen,P-selectin,D-dimer,and platelet glycomembrane protein IIb/IIIa.Conclusion:Our results elucidate the substantial therapeutic impact of SYD on UC mice.Importantly,the therapeutic mechanism of SYD in addressing UC potentially involves the inhibiting of inflammatory response mediated by hypercoagulability.展开更多
Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative...Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2);268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.展开更多
<strong>Introduction:</strong><span style="font-family:Verdana;"> Preeclampsia is one of the major causes of maternal and neonatal</span><span style="font-family:""&...<strong>Introduction:</strong><span style="font-family:Verdana;"> Preeclampsia is one of the major causes of maternal and neonatal</span><span style="font-family:""><span style="font-family:Verdana;"> morbidity and mortality in the world. The complexity of its </span><span style="font-family:Verdana;">etio-pathogenesis</span><span style="font-family:Verdana;"> involves, among other things, hypercoagulability, which alone accounts for about 15% of his deaths. Our objective was to study the parameters of coagulation (prothrombin level, activated cephalin time) in pregnant women with preeclampsia and non-preeclampsia at Laquintinie Hospital in Douala. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> We carried out an analytical cross-sectional case-control study from November 01</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018 to May 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2019, in the gynecology and obstetrics department of Laquintinie Hospital in Douala. We included preeclampsia and non-preeclampsia pregnant women with a gestational age greater than or equal to 20 weeks amenorrhea. The variables of interest were age, pregnancy, parity, gestational age, marital status </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> body mass index, prothrombin level (PL) </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> activated cephalin time (ACT). Hypercoagulability was defined by the presence of at least one of the following abnormalities: PL</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">> 100%, ACT</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">25</span><span style="font-family:""> </span><span style="font-family:Verdana;">seconds. Statistical tests were considered significant for a p-value </span><span style="font-family:Verdana;"><</span><span style="font-family:Verdana;"> 0.05.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We recruited 150 pregnant women including 50 preeclampsia matched</span><span style="font-family:Verdana;"> with 100 non-preeclampsia. The majority age group in both groups was 25</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">30 years (32% versus 37%). We found a high PL in 58% of preeclampsia versus 22% of non-preeclampsia patients (p = <0.001), a low PL in 8% of preeclampsia versus 0% in non-preeclampsia patients (p = 0.004). The ACT was prolonged in 12% of the preeclampsia versus 0% in the non-preeclampsia patients (p = <0.001). Pregnant women with preeclampsia were 4.89 times more likely to develop hypercoagulability than pregnant women without preeclampsia (OR 4.89;CI 2.34</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">10.20;p = <0.001). In linear regression, preeclampsia was significantly associated with PL (correlation coefficient 0.07;p = 0.008). We did not find risk factors associated with hypercoagulability in preeclampsia.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Our study confirms the existence of hypercoagulability associated with preeclampsia, in particular </span><span style="font-family:Verdana;">in relation to</span><span style="font-family:Verdana;"> an increase in the level of prothrombin.</span></span>展开更多
Hypercoagulability observed in patients with inflammatory bowel diseases(IBD)may lead to thromboembolic events(TE),which affect the venous and arterial systems alike and are an important factor in patients’morbidity ...Hypercoagulability observed in patients with inflammatory bowel diseases(IBD)may lead to thromboembolic events(TE),which affect the venous and arterial systems alike and are an important factor in patients’morbidity and mortality.The risk of TE in IBD patients has been demonstrated to be approximately threefold higher as compared to the general population.The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained.The most commonly listed factors include genetic and immune abnormalities,disequilibrium between procoagulant and anticoagulant factors,although recently,the role of endothelial damage as an IBD-triggering factor is underlined.Several studies report that the levels of some coagulation enzymes,including fibrinogen,factorsⅤ,Ⅶ,Ⅷ,active factorⅪ,tissue factor,prothrombin fragment 1+2and the thrombin-antithrombin complex,are altered in IBD patients.It has been demonstrated that there is a significant decrease of tissue plasminogen activator level,a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor,a significantly lower level of antithrombinⅢand tissue factor pathway inhibitor.IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies.Hyperhomocysteinemia,which is a potential risk factor for TE was also observed in some IBD patients.Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.展开更多
Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer...Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.展开更多
BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effect...BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effective way to detect thrombosis.The mother can monitor her own fetal health using ultrasound,which enables her to take preventative action in case of emergency.AIM To investigate ultrasonic blood signal after UAT in the umbilical artery,and evaluate the relationship between hypercoagulability and UAT.METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow,and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital.Patients’information was collected from medical archives,including maternal clinical data,neonatal outcomes,pathological findings and ultrasonic indices of umbilical artery blood flow,such as systolic-diastolic duration ratio(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV).Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R(version 4.2.1)including car(version 3.1-0)and stats(version 4.2.1),and visualized by ggplot2 package(version 3.3.6).RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow(within 2.5th of reference ranges)in a short period of time.Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D,RI,and PI and increase of PSV during the disease process was greater than that of non-UAT.All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery,most of which(16/18)showed umbilical cord abnormalities,with 15 umbilical cord torsion and 1 pseudoknot.Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated.PSV can play important roles in the diagnosis of UAT.Hypercoagulability alone is not sufficient for the occurrence of UAT.展开更多
Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic d...Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic decompensation.Portal flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development.However,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still elusive.In particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet.Moreover,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression.Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still unknown.Nevertheless,their impact on mortality rates should be addressed more extensively.In this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.展开更多
We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type diabetic patients. Subjects consisted of 22 patients with type ...We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type diabetic patients. Subjects consisted of 22 patients with type Ⅱ diabetes mellitus and 25 healthy controls. Compared with the control, activated partial thromboplastin time, prothrombin time were shortened in the patients. The diabetic subjects also displayed higher levels of D-dimer, serum fibrin degradation products,median concentrations of fibrinogen (3.99 vs 2.96 g/L, P【0.01) and yon Willebrand factor (149% vs 87%, P【0.01). Levels of antithrombin Ⅲ activity or antigen were not different from control values. Simple linear regression analysis revealed a negative correlation between antithrombin Ⅲ activity and fast blood glucose. Diabetic patients with vascular complications had significantly higher levels of fibrinogen and D-dimer than those without diabetic angiopathy. Our data demonstrated that patients with type Ⅲ diabetes mellitus had a展开更多
BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to occur.Conventional coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to di...BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to occur.Conventional coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated.Thromboelastogram(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide anticoagulation.TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.AIM To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant recipients.METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results.Graft loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were compared.RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on CCT.No graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45.10%in the CCT group(P=0.05,Fisher’s exact test).The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18%in the TEG and 25.50%in the CCT group(P=0.23,Fisher’s exact test).All recipients with partial thrombi detected in computed tomography(CT)scan had an anticoagulation dose escalation.The thrombus resolution rates in subsequent scan were 85.71%and 63.64%in the TEG group vs the CCT group(P=0.59,Fisher’s exact test).The TEG group had reduced blood product usage{10 packed red blood cell(PRBC)and 2 fresh frozen plasma(FFP)}compared to the CCT group(71 PRBC/10 FFP/2 cryoprecipitate and 2 platelets).The proportion of patients requiring transfusion in the TEG group was 17.65%vs 39.25%in the CCT group(P=0.14,Fisher’s exact test).The median length of hospital stay was 18 days in the TEG group vs 31 days in the CCT group(P=0.03,Mann Whitney test).The 1-year pancreas graft survival was 100%in the TEG group vs 82.35%in the CCT group(P=0.07,log rank test)and,the 1-year kidney graft survival was 100%in the TEG group vs 92.15%in the CCT group(P=0.23,log tank test).CONCLUSION TEG is a promising tool in guiding judicious use of anticoagulation with concomitant prevention of graft loss due to thrombosis,and reduces the length of hospital stay.展开更多
BACKGROUND Hypercoagulability plays an important role in predisposing patients to venous thromboembolism(VTE)after total hip arthroplasty(THA).We used thromboelastography(TEG)to examine the coagulation status of patie...BACKGROUND Hypercoagulability plays an important role in predisposing patients to venous thromboembolism(VTE)after total hip arthroplasty(THA).We used thromboelastography(TEG)to examine the coagulation status of patients undergoing THA.AIM To examine coagulation as measured by TEG in patients undergoing THA who received standard VTE chemoprophylaxis with enoxaparin.METHODS After ethical approval,we performed a retrospective analysis of data collected in patients undergoing primary elective THA.We analyzed TEG data on samples performed before skin incision,intraoperatively and for 5 d postoperatively.Conventional coagulation tests were performed preoperatively and on postoperative day 5.RESULTS Twenty patients undergoing general anesthesia and 32 patients undergoing spinal anesthesia(SA)were included.TEG demonstrated a progressively hypercoagulable state postoperatively,characterized by elevated maximum amplitude.TEG also demonstrated transient intraoperative hypercoagulability in patients receiving SA.In contrast,conventional coagulation tests were normal in all patients,pre-and postoperatively,except for an increase in plasma fibrinogen day 5 postoperatively.CONCLUSION Despite VTE prophylaxis,patients following total hip replacement remain in a hypercoagulable state as measured by both TEG and conventional tests.This group may benefit from more optimal anticoagulation and/or additional perioperative hemostatic monitoring,via TEG or otherwise.展开更多
Live liver donor transplantation to adult recipients is becoming a common practice,increasing the organ pool and providing an alternative to whole cadaveric liver transplantation.These patients are healthy adults with...Live liver donor transplantation to adult recipients is becoming a common practice,increasing the organ pool and providing an alternative to whole cadaveric liver transplantation.These patients are healthy adults without serious medical conditions and typically have normal coagulation profiles preoperatively.Right hepatic lobectomy is usually performed for adult recipients,while left hepatic lobectomy is performed for pediatric recipients.Removal of the whole right lobe from the donors may expose theses patients to multiple intraoperative and postoperative complications.Hypercoagulability has been identified as a serious complication which leads to thromboembolic phenomena with potential fatal consequences.The primary aim of this review is to look at possible changes in post-operative coagulation dynamics that may increase the risk for development of thromboembolic complications in live liver donors.In this article,we stress the importance of addressing the issue that conventional clotting tests(PT,INR,PTT)are unable to detect a hypercoagulable state,and therefore,we should examining alternative laboratory tests to improve diagnosis and early detection of thrombotic complications.Measurement of natural anticoagulant/procoagulant biomarkers combined with conventional coagulation studies and thromboelastography offers a more accurate assessment of coagulation disorders.This allows earlier diagnosis,permitting appropriate intervention sooner,hence avoiding potential morbidity and mortality.Biomarkers that may be evaluated include,but are not limited to:protein C,soluble P-selectin,antithrombinⅢ,thrombin-antithrombin complex,and thrombin generation complex.展开更多
High platelet reactivity (HPR) and suboptimal response to dual antiplatelet therapy (DAPT) may explain high recurrent rates of ischemic events in Type II diabetes mellitus (DM) patients undergoing percutaneous coronar...High platelet reactivity (HPR) and suboptimal response to dual antiplatelet therapy (DAPT) may explain high recurrent rates of ischemic events in Type II diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to examine the effect of clopidogrel on platelet reactivity, and thrombogenecity between DM and non-DM PCI-treated patients (n = 138). Patients were categorized according to clopidogrel treatment and DM status. Patients received a maintenance-dose clopidogrel of 75 mg/d (C75 group, n = 72) or a 600 mg clopidogrel loading-dose in clopidogrel na?ve patients (C600 group, n = 66). Platelet function was assessed by thrombelastography, flow cytometry, VerifyNowTM aspirin assay and light transmittance aggregometry (LTA). Aspirin response was similar between treatments and DM status. In the C75 group, DM patients had higher 5 and 20 μM ADP-, 2 μg/ml collagen-induced LTA;and p-selectin expression compared to non-DM patients (p ≤ 0.05 for all). DM patients in the C600 group had higher 5 and 20 μM ADP-induced LTA post dosing (p p 12 receptor antagonists.展开更多
BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervent...BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervention. PVT is commonly forgotten as a possible cause of abdominal pain. The clinical picture may vary but abdominal pain and low grade fever are the most characteristic picture. METHODS: A 58-year-old male patient was admitted to our hospital complaining of abdominal pain for three days. CT scan revealed an edematous area around the portal vein. Doppler ultrasonography showed evidence of a portal vein thrombosis. RESULTS: PVT can be diagnosed with CT and Doppler ultrasonography. Fresh thrombus can be undetected by sonography because of the low echogenity but can be recognised by color Doppler ultrasonography. Treatment ranges from observation and bowel rest to surgical resection of bowel. CONCLUSIONS: When we suspect a case of PVT, it should be treated at an early stage to prevent being lost in a diagnostic dilemma. The immediate use of anticoagulant could be important in preventing serious consequences of PVT.展开更多
The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficie...The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.展开更多
AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related ma...AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five(28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/ml(AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.展开更多
Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is littl...Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is little information to provide guidelines for the best curative and preventive treatment.We report 2 cases of ischemic strokes due to internal carotid thrombus in patients during active phase of IBD.Ulceration of early atherosclerotic plaques activated by a hypercoagulation state may cause a thrombus.A combined therapy with heparin and corticosteroids was used for both our patients.Lysis of the thrombus was obtained after several days without surgical treatment and shown by ultrasonography.These cases highlight an aetiology of stroke in patients with IBD and use of a synergic treatment to respond to hypercoagulability in link with IBD. Benefits and safety of this therapy should be confirmed with clinical studies.展开更多
Human immunodeficiency virus(HIV) may result in devastating multi-organ complications, including cirrhosis. Consequently, liver transplantation is often required for these patients. We report a case of a 43-year-old f...Human immunodeficiency virus(HIV) may result in devastating multi-organ complications, including cirrhosis. Consequently, liver transplantation is often required for these patients. We report a case of a 43-year-old female with cryptogenic cirrhosis and HIV on highly active antiretroviral therapy, presenting for non-related living donor liver transplantation. The intraoperative course was complicated by hepatic artery and portal vein thrombosis, requiring thrombectomy. On postoperative day-3, the patient required retransplantation with a cadaveric donor organ due to primary graft failure.展开更多
Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cance...Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and postoperative anticoagulation protocol. In this paper we discuss the anti-coagulation protocol for safely and successfully caring out islet transplantation and associated risks and benefits.展开更多
Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A ...Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.展开更多
文摘Background:Shaoyao decoction(SYD)has been found widespread clinical use in treating ulcerative colitis(UC).However,the mechanism underlying SYD impact on UC remains elusive.Materials and methods:We preliminarily evaluated the therapeutic effect of SYD intervention in a dextran sulfate sodium-induced UC mouse model by analyzing the body weight change,disease activity index score,colon length,and HE staining results of colon tissue in each group of mice.Subsequently,we determined pro-inflammatory cytokines level and blood coagulation markers in the colon tissues of mice in each group to evaluate the effect of SYD intervention on colonic inflammatory response and coagulation function in UC mice.Results:Our findings emphasize the significant therapeutic effect of SYD on UC,including slowed down body weight loss,reduced disease activity index score,increased colon length,and reduced inflammatory infiltration in colon tissue.Moreover,SYD intervention significantly downregulated the levels of pro-inflammatory cytokines IL-1β,IL-6,and IL-17A in the colon.Furthermore,SYD intervention reversed the coagulation-related indicators such as prothrombin time,fibrinogen,P-selectin,D-dimer,and platelet glycomembrane protein IIb/IIIa.Conclusion:Our results elucidate the substantial therapeutic impact of SYD on UC mice.Importantly,the therapeutic mechanism of SYD in addressing UC potentially involves the inhibiting of inflammatory response mediated by hypercoagulability.
文摘Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2);268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.
文摘<strong>Introduction:</strong><span style="font-family:Verdana;"> Preeclampsia is one of the major causes of maternal and neonatal</span><span style="font-family:""><span style="font-family:Verdana;"> morbidity and mortality in the world. The complexity of its </span><span style="font-family:Verdana;">etio-pathogenesis</span><span style="font-family:Verdana;"> involves, among other things, hypercoagulability, which alone accounts for about 15% of his deaths. Our objective was to study the parameters of coagulation (prothrombin level, activated cephalin time) in pregnant women with preeclampsia and non-preeclampsia at Laquintinie Hospital in Douala. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> We carried out an analytical cross-sectional case-control study from November 01</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018 to May 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2019, in the gynecology and obstetrics department of Laquintinie Hospital in Douala. We included preeclampsia and non-preeclampsia pregnant women with a gestational age greater than or equal to 20 weeks amenorrhea. The variables of interest were age, pregnancy, parity, gestational age, marital status </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> body mass index, prothrombin level (PL) </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> activated cephalin time (ACT). Hypercoagulability was defined by the presence of at least one of the following abnormalities: PL</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">> 100%, ACT</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">25</span><span style="font-family:""> </span><span style="font-family:Verdana;">seconds. Statistical tests were considered significant for a p-value </span><span style="font-family:Verdana;"><</span><span style="font-family:Verdana;"> 0.05.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We recruited 150 pregnant women including 50 preeclampsia matched</span><span style="font-family:Verdana;"> with 100 non-preeclampsia. The majority age group in both groups was 25</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">30 years (32% versus 37%). We found a high PL in 58% of preeclampsia versus 22% of non-preeclampsia patients (p = <0.001), a low PL in 8% of preeclampsia versus 0% in non-preeclampsia patients (p = 0.004). The ACT was prolonged in 12% of the preeclampsia versus 0% in the non-preeclampsia patients (p = <0.001). Pregnant women with preeclampsia were 4.89 times more likely to develop hypercoagulability than pregnant women without preeclampsia (OR 4.89;CI 2.34</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">10.20;p = <0.001). In linear regression, preeclampsia was significantly associated with PL (correlation coefficient 0.07;p = 0.008). We did not find risk factors associated with hypercoagulability in preeclampsia.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Our study confirms the existence of hypercoagulability associated with preeclampsia, in particular </span><span style="font-family:Verdana;">in relation to</span><span style="font-family:Verdana;"> an increase in the level of prothrombin.</span></span>
文摘Hypercoagulability observed in patients with inflammatory bowel diseases(IBD)may lead to thromboembolic events(TE),which affect the venous and arterial systems alike and are an important factor in patients’morbidity and mortality.The risk of TE in IBD patients has been demonstrated to be approximately threefold higher as compared to the general population.The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained.The most commonly listed factors include genetic and immune abnormalities,disequilibrium between procoagulant and anticoagulant factors,although recently,the role of endothelial damage as an IBD-triggering factor is underlined.Several studies report that the levels of some coagulation enzymes,including fibrinogen,factorsⅤ,Ⅶ,Ⅷ,active factorⅪ,tissue factor,prothrombin fragment 1+2and the thrombin-antithrombin complex,are altered in IBD patients.It has been demonstrated that there is a significant decrease of tissue plasminogen activator level,a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor,a significantly lower level of antithrombinⅢand tissue factor pathway inhibitor.IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies.Hyperhomocysteinemia,which is a potential risk factor for TE was also observed in some IBD patients.Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.
基金Baoding Science and Technology Project(Project Number:18ZF134)Youth Fund of Affiliated Hospital of Hebei University(Project Number:2017Q018)。
文摘Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.
基金Natural Science Foundation of Xiamen,No.3502Z202373120and National Key R&D Program of China,No.2022YFF0606301.
文摘BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effective way to detect thrombosis.The mother can monitor her own fetal health using ultrasound,which enables her to take preventative action in case of emergency.AIM To investigate ultrasonic blood signal after UAT in the umbilical artery,and evaluate the relationship between hypercoagulability and UAT.METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow,and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital.Patients’information was collected from medical archives,including maternal clinical data,neonatal outcomes,pathological findings and ultrasonic indices of umbilical artery blood flow,such as systolic-diastolic duration ratio(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV).Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R(version 4.2.1)including car(version 3.1-0)and stats(version 4.2.1),and visualized by ggplot2 package(version 3.3.6).RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow(within 2.5th of reference ranges)in a short period of time.Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D,RI,and PI and increase of PSV during the disease process was greater than that of non-UAT.All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery,most of which(16/18)showed umbilical cord abnormalities,with 15 umbilical cord torsion and 1 pseudoknot.Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated.PSV can play important roles in the diagnosis of UAT.Hypercoagulability alone is not sufficient for the occurrence of UAT.
文摘Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic decompensation.Portal flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development.However,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still elusive.In particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet.Moreover,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression.Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still unknown.Nevertheless,their impact on mortality rates should be addressed more extensively.In this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.
文摘We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type diabetic patients. Subjects consisted of 22 patients with type Ⅱ diabetes mellitus and 25 healthy controls. Compared with the control, activated partial thromboplastin time, prothrombin time were shortened in the patients. The diabetic subjects also displayed higher levels of D-dimer, serum fibrin degradation products,median concentrations of fibrinogen (3.99 vs 2.96 g/L, P【0.01) and yon Willebrand factor (149% vs 87%, P【0.01). Levels of antithrombin Ⅲ activity or antigen were not different from control values. Simple linear regression analysis revealed a negative correlation between antithrombin Ⅲ activity and fast blood glucose. Diabetic patients with vascular complications had significantly higher levels of fibrinogen and D-dimer than those without diabetic angiopathy. Our data demonstrated that patients with type Ⅲ diabetes mellitus had a
文摘BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to occur.Conventional coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated.Thromboelastogram(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide anticoagulation.TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.AIM To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant recipients.METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results.Graft loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were compared.RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on CCT.No graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45.10%in the CCT group(P=0.05,Fisher’s exact test).The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18%in the TEG and 25.50%in the CCT group(P=0.23,Fisher’s exact test).All recipients with partial thrombi detected in computed tomography(CT)scan had an anticoagulation dose escalation.The thrombus resolution rates in subsequent scan were 85.71%and 63.64%in the TEG group vs the CCT group(P=0.59,Fisher’s exact test).The TEG group had reduced blood product usage{10 packed red blood cell(PRBC)and 2 fresh frozen plasma(FFP)}compared to the CCT group(71 PRBC/10 FFP/2 cryoprecipitate and 2 platelets).The proportion of patients requiring transfusion in the TEG group was 17.65%vs 39.25%in the CCT group(P=0.14,Fisher’s exact test).The median length of hospital stay was 18 days in the TEG group vs 31 days in the CCT group(P=0.03,Mann Whitney test).The 1-year pancreas graft survival was 100%in the TEG group vs 82.35%in the CCT group(P=0.07,log rank test)and,the 1-year kidney graft survival was 100%in the TEG group vs 92.15%in the CCT group(P=0.23,log tank test).CONCLUSION TEG is a promising tool in guiding judicious use of anticoagulation with concomitant prevention of graft loss due to thrombosis,and reduces the length of hospital stay.
文摘BACKGROUND Hypercoagulability plays an important role in predisposing patients to venous thromboembolism(VTE)after total hip arthroplasty(THA).We used thromboelastography(TEG)to examine the coagulation status of patients undergoing THA.AIM To examine coagulation as measured by TEG in patients undergoing THA who received standard VTE chemoprophylaxis with enoxaparin.METHODS After ethical approval,we performed a retrospective analysis of data collected in patients undergoing primary elective THA.We analyzed TEG data on samples performed before skin incision,intraoperatively and for 5 d postoperatively.Conventional coagulation tests were performed preoperatively and on postoperative day 5.RESULTS Twenty patients undergoing general anesthesia and 32 patients undergoing spinal anesthesia(SA)were included.TEG demonstrated a progressively hypercoagulable state postoperatively,characterized by elevated maximum amplitude.TEG also demonstrated transient intraoperative hypercoagulability in patients receiving SA.In contrast,conventional coagulation tests were normal in all patients,pre-and postoperatively,except for an increase in plasma fibrinogen day 5 postoperatively.CONCLUSION Despite VTE prophylaxis,patients following total hip replacement remain in a hypercoagulable state as measured by both TEG and conventional tests.This group may benefit from more optimal anticoagulation and/or additional perioperative hemostatic monitoring,via TEG or otherwise.
文摘Live liver donor transplantation to adult recipients is becoming a common practice,increasing the organ pool and providing an alternative to whole cadaveric liver transplantation.These patients are healthy adults without serious medical conditions and typically have normal coagulation profiles preoperatively.Right hepatic lobectomy is usually performed for adult recipients,while left hepatic lobectomy is performed for pediatric recipients.Removal of the whole right lobe from the donors may expose theses patients to multiple intraoperative and postoperative complications.Hypercoagulability has been identified as a serious complication which leads to thromboembolic phenomena with potential fatal consequences.The primary aim of this review is to look at possible changes in post-operative coagulation dynamics that may increase the risk for development of thromboembolic complications in live liver donors.In this article,we stress the importance of addressing the issue that conventional clotting tests(PT,INR,PTT)are unable to detect a hypercoagulable state,and therefore,we should examining alternative laboratory tests to improve diagnosis and early detection of thrombotic complications.Measurement of natural anticoagulant/procoagulant biomarkers combined with conventional coagulation studies and thromboelastography offers a more accurate assessment of coagulation disorders.This allows earlier diagnosis,permitting appropriate intervention sooner,hence avoiding potential morbidity and mortality.Biomarkers that may be evaluated include,but are not limited to:protein C,soluble P-selectin,antithrombinⅢ,thrombin-antithrombin complex,and thrombin generation complex.
文摘High platelet reactivity (HPR) and suboptimal response to dual antiplatelet therapy (DAPT) may explain high recurrent rates of ischemic events in Type II diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to examine the effect of clopidogrel on platelet reactivity, and thrombogenecity between DM and non-DM PCI-treated patients (n = 138). Patients were categorized according to clopidogrel treatment and DM status. Patients received a maintenance-dose clopidogrel of 75 mg/d (C75 group, n = 72) or a 600 mg clopidogrel loading-dose in clopidogrel na?ve patients (C600 group, n = 66). Platelet function was assessed by thrombelastography, flow cytometry, VerifyNowTM aspirin assay and light transmittance aggregometry (LTA). Aspirin response was similar between treatments and DM status. In the C75 group, DM patients had higher 5 and 20 μM ADP-, 2 μg/ml collagen-induced LTA;and p-selectin expression compared to non-DM patients (p ≤ 0.05 for all). DM patients in the C600 group had higher 5 and 20 μM ADP-induced LTA post dosing (p p 12 receptor antagonists.
文摘BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervention. PVT is commonly forgotten as a possible cause of abdominal pain. The clinical picture may vary but abdominal pain and low grade fever are the most characteristic picture. METHODS: A 58-year-old male patient was admitted to our hospital complaining of abdominal pain for three days. CT scan revealed an edematous area around the portal vein. Doppler ultrasonography showed evidence of a portal vein thrombosis. RESULTS: PVT can be diagnosed with CT and Doppler ultrasonography. Fresh thrombus can be undetected by sonography because of the low echogenity but can be recognised by color Doppler ultrasonography. Treatment ranges from observation and bowel rest to surgical resection of bowel. CONCLUSIONS: When we suspect a case of PVT, it should be treated at an early stage to prevent being lost in a diagnostic dilemma. The immediate use of anticoagulant could be important in preventing serious consequences of PVT.
文摘The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.
文摘AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five(28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/ml(AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.
文摘Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is little information to provide guidelines for the best curative and preventive treatment.We report 2 cases of ischemic strokes due to internal carotid thrombus in patients during active phase of IBD.Ulceration of early atherosclerotic plaques activated by a hypercoagulation state may cause a thrombus.A combined therapy with heparin and corticosteroids was used for both our patients.Lysis of the thrombus was obtained after several days without surgical treatment and shown by ultrasonography.These cases highlight an aetiology of stroke in patients with IBD and use of a synergic treatment to respond to hypercoagulability in link with IBD. Benefits and safety of this therapy should be confirmed with clinical studies.
文摘Human immunodeficiency virus(HIV) may result in devastating multi-organ complications, including cirrhosis. Consequently, liver transplantation is often required for these patients. We report a case of a 43-year-old female with cryptogenic cirrhosis and HIV on highly active antiretroviral therapy, presenting for non-related living donor liver transplantation. The intraoperative course was complicated by hepatic artery and portal vein thrombosis, requiring thrombectomy. On postoperative day-3, the patient required retransplantation with a cadaveric donor organ due to primary graft failure.
文摘Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and postoperative anticoagulation protocol. In this paper we discuss the anti-coagulation protocol for safely and successfully caring out islet transplantation and associated risks and benefits.
文摘Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.
