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Stephen A Kunz, Lachlan F Miles, Damian J Ianno, Kelly L Mirowska-Allen, George Matalanis, Rinaldo Bellomo, Siven Seevanayagam
INTRODUCTION: Accurate dosing of protamine reversal following on-pump cardiac surgical procedures is challenging, with both excessive and inadequate administration recognised to increase bleeding risk. We aimed to examine the relationship between three ratios for heparin reversal and markers of haemostasis. METHODS: A retrospective analysis of a prospectively collected database was undertaken at a single tertiary cardiac unit, reviewing all cases of on-pump coronary artery bypass grafts and single valve replacements from 01/01/2011 to 31/12/2015...
March 1, 2018: Perfusion
Dilek Uysal, Hakan Cokmez, Cetin Aydin, Tolga Ciftpinar
Postpartum haemorrhage is the most important cause of maternal morbidity and mortality, especially when all conservative measures, including syntometrine oxytocin and Bakri balloons have failed to accomplish haemostasis and expeditious surgical procedures, such as uterine artery ligation and emergency peripartum hysterectomy (EPH) are required. This retrospective study analysed 31 cases of EPH performed between January 2007 and January 2016 in the Department of Gynecology and Obstetrics of Izmir Ataturk Teaching and Research Hospital...
March 2018: JPMA. the Journal of the Pakistan Medical Association
Rahat A Abdoellakhan, Nakisa Khorsand, Reinier M Van Hest, Nic Veeger, Ewoud Ter Avest, Paula F Ypma, Laura M Faber, Karina Meijer
INTRODUCTION: There is currently little evidence for the optimal dosing strategy of four-factor prothrombin complex concentrates (PCC) in vitamin K antagonist (VKA)-related bleeds. The generally accepted dosing strategy is the use of a variable dose calculated using patient-specific characteristics as per manufacturer's instruction. However, evidence exists that the use of a fixed low dose of 1000 international units of factor IX (IU fIX) might also suffice. Recent studies indicate that in terms of haemostatic effectiveness, the fixed dosing strategy might be even superior to the variable dosing strategy...
March 14, 2018: BMJ Open
Chantal C Clark, Mirjam M Mebius, Steven de Maat, Aloysius G M Tielens, Philip G de Groot, Rolf T Urbanus, Rob Fijnheer, Bouke P C Hazenberg, Jaap J van Hellemond, Coen Maas
ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) cleaves von Willebrand Factor (VWF) multimers to control their thrombogenicity. The fibrinolytic enzyme plasmin can cleave VWF in a similar manner. However, plasmin can also cleave ADAMTS13, which ultimately inactivates it. This leaves the overall role of plasmin in primary haemostasis uncertain.We investigated the combined molecular effects of plasmin on VWF and ADAMTS13. We first identified that plasmin destroys FRETS-VWF73 substrate by cleaving the ADAMTS13 binding region in a buffered system...
March 2018: Thrombosis and Haemostasis
Cecilia Augustsson, Anders Svensson, Birgitte Kjaer, Tzu-Yuan Chao, Xia Wenjuan, Berit Olsen Krogh, Jens Breinholt, Jes Thorn Clausen, Ida Hilden, Helle Heibroch Petersen, Lars Christian Petersen
BACKGROUND: Initiation of coagulation is induced by binding of activated factor VII (FVIIa) to tissue factor (TF) and activation of factor X (FX) in a process regulated by tissue factor pathway inhibitor (TFPI). TFPI contains three Kunitz-type protease inhibitor domains (K1-K3) of which K1 and K2 block the active sites of FVIIa and FXa respectively. OBJECTIVE: To produce a monoclonal antibody (mAb) directed towards K1, to characterize the binding epitope, and to study its effect on TFPI inhibition...
March 12, 2018: Journal of Thrombosis and Haemostasis: JTH
S Støy, V C Patel, J P Sturgeon, G K Manakkat Vijay, T Lisman, W Bernal, D L Shawcross
BACKGROUND: Thrombocytopenia and circulating dysfunctional immune cells are commonly observed in patients with cirrhosis. Platelets may form complexes with neutrophils, monocytes and T cells modulating their function. We recently reported increased frequencies of platelet-complexed neutrophils in cirrhosis with evidence of neutrophil activation upon contact with healthy platelets in vitro. Whether this occurs in vivo following platelet transfusion and contributes to systemic inflammation and endothelial activation is unknown...
March 12, 2018: Alimentary Pharmacology & Therapeutics
R Heitmar, P Nicholl, B Lee, Y C Lau, Gyh Lip
Background Hypercoagulability is a leading factor in diabetes and cardiovascular disease. Retinal vessel responses to flickering light are an important tool for assessing ocular function. We hypothesised a significant relationship between systemic markers of haemostasis and retinal vessel function. Methods Intra-ocular pressure and retinal microcirculation function were measured in 116 patients with diabetes and/or cardiovascular disease using unstimulated and stimulated arterial and venous retinal vessel responses to flickering light...
March 9, 2018: British Journal of Biomedical Science
Roberta Rossini, Giuseppe Tarantini, Giuseppe Musumeci, Giulia Masiero, Emanuele Barbato, Paolo Calabrò, Davide Capodanno, Sergio Leonardi, Maddalena Lettino, Ugo Limbruno, Alberto Menozzi, U O Alfredo Marchese, Francesco Saia, Marco Valgimigli, Walter Ageno, Anna Falanga, Antonio Corcione, Alessandro Locatelli, Marco Montorsi, Diego Piazza, Andrea Stella, Antonio Bozzani, Alessandro Parolari, Roberto Carone, Dominick J Angiolillo
Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided...
March 12, 2018: JACC. Cardiovascular Interventions
Jessica Mandrioli, Laura Ferri, Antonio Fasano, Elisabetta Zucchi, Nicola Fini, Cristina Moglia, Christian Lunetta, Kalliopi Marinou, Nicola Ticozzi, Gianluca Drago Ferrante, Carlo Scialo, Gianni Sorarù, Francesca Trojsi, Amelia Conte, Yuri M Falzone, Rosanna Tortelli, Massimo Russo, Valeria Ada Sansone, Gabriele Mora, Vincenzo Silani, Paolo Volanti, Claudia Caponnetto, Giorgia Querin, Maria Rosaria Monsurrò, Mario Sabatelli, Adriano Chiò, Nilo Riva, Giancarlo Logroscino, Sonia Messina, Andrea Calvo
BACKGROUND: Only a few studies considered the role of comorbidities on ALS prognosis and provided conflicting results. METHODS: our multicenter, retrospective study included patients diagnosed from 1/1/2009 to 31/12/2013 in 13 Referral Centers for ALS located in 10 Italian Regions. Caring neurologists collected a detailed phenotypic profile and follow-up data until death into an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role on ALS prognosis...
March 7, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
P Sasikumar, K S AlOuda, W J Kaiser, L M Holbrook, N Kriek, J A Unsworth, A P Bye, T Sage, R Ushioda, K Nagata, R W Farndale, J M Gibbins
OBJECTIVE: Heat shock protein 47 (HSP47) is an intracellular chaperone protein that is vital for collagen biosynthesis in collagen secreting cells. This protein has also been shown to be present on the surface of platelets. Given the importance of collagen and its interactions with platelets in triggering haemostasis and thrombosis, in this study we sought to characterise the role of HSP47 on these cells. APPROACH AND RESULTS: The deletion of HSP47 in mouse platelets or its inhibition in human platelets reduced their function in response to collagen and the GPVI agonist (CRP-XL), but responses to thrombin were unaltered...
March 7, 2018: Journal of Thrombosis and Haemostasis: JTH
Marilena Crescente, Laura Menke, Melissa V Chan, Paul C Armstrong, Timothy D Warner
Platelets are important players in thrombosis and haemostasis with their function being modulated by mediators in the blood and the vascular wall. Among these, eicosanoids can both stimulate or inhibit platelet reactivity. Platelet cyclooxygenase (COX)-1 generated thromboxane (TX) A2 is the primary prostanoid that stimulates platelet aggregation; its action is counter-balanced by prostaglandin (PG)I2 (prostacyclin), a product of vascular COX. PGD2 , PGE2 , 12- hydroxyeicosatraenoic acid (HETE) or 15-HETE, are other prostanoid modulators of platelet activity, but some also play a role in carcinogenesis...
March 7, 2018: British Journal of Pharmacology
Hellen McKinnon Edwards
This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions...
March 2018: Danish Medical Journal
Francesco Marongiu, Doris Barcellona
Direct oral anticoagulants (DOACs) represent an innovation because they avoid periodic laboratory monitoring, and also reduce cerebral bleeding. An examination of the performance of DOACs versus warfarin in randomized clinical trials dedicated to atrial fibrillation would reveal the poor performance of warfarin because the percentage of major bleeding is always above 3%; however, the percentage of major bleeding is less than half of that when the management is done in anticoagulation clinics (ACs). Several years ago, a common opinion was that ACs would disappear as soon as DOACs enter the market...
March 2, 2018: Internal and Emergency Medicine
Mathilde Fénelon, Sabine Castet, Jean-Christophe Fricain, Sylvain Catros
Introduction: Von Willebrand Disease is the most common inherited bleeding disorder. In the general population, 1/8000 patients are affected. Primary hemostasis (platelet adhesion) and coagulation (protection of Factor VIII) are altered. Among several bleeding symptoms, these patients suffer from excessive bleeding of oral mucosa and dental management requires a close collaboration between haematologists and oral surgeons. Materials & Methods: Guided implant surgery can be used to increase the accuracy of implant placement and to reduce the overall morbidity of this surgical procedure by using a flapless surgery technique...
2018: Open Dentistry Journal
G W Kershaw, K Dissanayake, V M Chen, T-L Khoo
INTRODUCTION: Chromogenic substrate assays (CSA) to measure Factor IX (FIX) have recently become commercially available. However, information on their performance characteristics and use in diagnostic haemostasis laboratories remains limited. AIM: To evaluate the Hyphen Biomed (Hyphen) and Rossix FIX CSAs on fully automated coagulation analysers and compare them to the FIX one-stage assay (OSA). This study was conducted in a tertiary referral haemostasis laboratory associated with a haemophilia treatment centre...
February 28, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
Antoine Brangier, Sébastien Celle, Frédéric Roche, Olivier Beauchet, Guylaine Ferland, Cédric Annweiler
BACKGROUND: Vitamin K antagonists (VKAs) are commonly used for their role in haemostasis by interfering with the vitamin K cycle. Since vitamin K also participates in brain physiology, this voxel-based morphometric study aimed to determine whether the duration of exposure to VKAs correlated with focal brain volume reduction in older adults. METHODS: In this exposed/unexposed (1: 2) study nested within the GAIT (Gait and Alzheimer Interactions Tracking) cohort, 18 participants exposed to VKA (mean age 75 ± 5 years; 33...
February 27, 2018: Dementia and Geriatric Cognitive Disorders
S J X Murphy, S T Lim, J A Kinsella, D Murphy, H M Enright, Dominick J H McCabe
BACKGROUND: The pathophysiological mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis patients are not fully understood. The functionally important reticulated platelet fraction and reticulocytes could play a role. OBJECTIVES: We performed a prospective, multi-centre, observational analytical study comparing full blood count parameters and platelet production/turnover/activation markers in patients with asymptomatic versus recently symptomatic moderate (≥ 50-69%) or severe (≥ 70-99%) carotid stenosis...
February 23, 2018: Journal of Neurology
Harvey G Roweth, Ruoling Yan, Nader H Bedwani, Alisha Chauhan, Nicole Fowler, Alice H Watson, Jean-Daniel Malcor, Stewart O Sage, Gavin E Jarvis
Citalopram prevents serotonin (5-HT) uptake into platelets by blocking the serotonin reuptake transporter (SERT). Although some clinical data suggest that selective serotonin reuptake inhibitors (SSRIs) may affect haemostasis and thrombosis, these poorly-characterised effects are not well understood mechanistically and useful in vitro data is limited. We sought to determine whether the inhibitory effects of citalopram on platelets are mediated via its pharmacological inhibition of 5-HT transport. We quantified the inhibitory potency of (RS)-, (R)- and (S)-citalopram on platelet function...
February 22, 2018: Scientific Reports
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