INTRODUCTION: Intraventricular hemorrhage (IVH) as an extension of spontaneous intracerebral hemorrhage is an independent predictor of mortality. The Clot Lysis: Evaluating Accelerated Resolution of IVH phase 3 (CLEAR III) trial is a randomized, double-blinded, placebocontrolled, multiregional trial recently conducted to determine whether external ventricular drainage (EVD) plus intraventricular recombinant tissue plasminogen activator (rtPA, alteplase) improved outcome, in comparison to EVD plus saline. This study is an application of the rationale and principles of management in CLEAR III trial and related literature. METHODS: There are five patients described in this case series. Report followed the PROCESS guidelines. RESULTS: 30-day mortality in this series is 2 out of 5 while actual allcause mortality is 4 out of 5. Modified Graeb scores and IVH scores of all subjects have decreased after the intervention. However, good functional status defined as modified Rankin scale (mRS) score of 0-3 has not been achieved with the intervention. Efficacy of completely resolving IVH and hydrocephalus has been achieved in 2 out of 5 which translated to a benefit of survival to one of the two. Shunt dependence has been avoided by the subjects except for the one with the caudate intracerebral hemorrhage. Complications related to the intervention have been noted and discussed CONCLUSION In this single-institution study, patients for which rtPA was used for intraventricular fibrinolysis of IVH clot in addition to EVD as surgical treatment for hydrocephalus resulted to a 30-day survival of 3 out of 5 in this series, while actual survival is 1 out of 5. The intervention was efficacious in decreasing the Modified Graeb scores and IVH scores of all study subjects at end of treatment. Functional status of mRS 5 is the highest score achieved among survivors.
Fibrinolysis

BACKGROUND & PURPOSE: Fibrinoeptide-A (FpA) and D-dimer have been well known as hematologic parameters for activation of the coagulation and the endogeneous fibrinolysis system during acute phase of ischemic stroke. We measured the levels of FpA and D-dimer in acute progressive and non-progressive ischemic strokes to assess whether these markers are valuable as a predictor of stroke progression during acute phase. METHODS: FpA (RIA method) and D dimer (ELISA method) were determined in 54 patients, 9 with acute progressive and 45 with non-progressive within acute stage(< 48 hours of onset) of cerebral infarction. RESULTS: Levels of FpA in patients with acute progressive stroke were significantly higher than those in patients with non-progressive stroke, indicating activation of the coagulation system (P = 0.013). And, levels of D-dimer in patients with acute progressive stroke were also higher than those in patients with non-progressive stroke but statistically insignificant(P-0.071). CONCLUSIONS: These findings suggest that the coagulation system is more enhanced in progressive stroke than non-progressive one during acute stage of ischemic stroke. Higher levels of FpA are thought to be useful markers to predict stroke in progression.
Cerebral Infarction ; Fibrinolysis ; Humans ; Stroke*

Acute pulmonary embolism (PE) ranges from asymptomatic to often fatal, incidentally discovered emboli to massive embolism causing immediate death. Acute PE may occur rapidly and unpredictably and may be difficult to diagnose. Mortality and complications can be reduced by prompt diagnosis and therapy. Untreated PE is associated with a mortality rate of approximately 30 percents. Most patients with PE have endogenous fibrinolysis, although it is not effective enough to prevent PE. A case of spontaneous remission of untreated acute PE has not previously been reported. Here we present a case of spontaneously resolved acute PE without any treatment.
Embolism ; Fibrinolysis ; Humans ; Pulmonary Embolism ; Remission, Spontaneous

BACKGROUND: Thromboelastography (TEG) measures the viscoelastic properties of clotting blood, displaying a visual trace of all phases of coagulation and fibrinolysis. When performing a TEG, it is commonly recommended to store whole blood at 37oC with only a 3-6 min delay after sampling. However, it is difficult to actually keep this recommend time and temperature. The purpose of this study is to investigate the effects on TEG by inadvertent technical errors due to inappropriate measurement time and temperature. METHODS: Twenty healthy male volunteers were studied. TEG measurements were performed at: stat, 4 min, and 8 min at room temperature, and 4 min and 8 min at 37 degrees C. Parameters used were: reaction time (R), clot formation time (K), maximal amplitude (MA), clot formation velocity (alpha-angle), clot lysis 60 min (LY60) and TEG index. RESULTS: When compared with the routine recommendation, 4 min lag time at 37 degrees C, R and K were shortened and alpha angle and LY60 were increased at 8 min after the sample. However, temperature differences did not significantly affect TEG parameters. CONCLUSIONS: Inappropriate measurement temperature does not result in significant changes of TEG parameters, but, delayed storage resulted in a false hypercoagulation state and increased fibrinolysis.
Fibrinolysis ; Humans ; Male ; Reaction Time ; Thrombelastography ; Volunteers

BACKGROUND: Recent studies have produced conflicting results on the influence of hemodilution on the coagulation system. Furthermore, only a few clinical studies have been conducted regarding actual blood loss and associated hemodilution. The purpose of this study was to investigate changes in thromboelastograph (TEG) findings after moderate bleeding-induced hemodilution in patients undergoing radical hysterectomy. METHODS: 23 patients scheduled for radical hysterectomy were included. No patient had a preoperative coagulation abnormality or was receiving anticoagulant or antiplatelet medication. TEG findings 15 min after induction of anesthesia and after an estimated blood loss equaling 15% of the estimated blood volume were compared. Only crystalloid solution was administered until the second blood sampling for TEG analysis in order to produce a hemodilution state. RESULTS: After hemodilution R time, K time and coagulation time (r + k) showed significant reductions, and alpha angle and TEG index showed significant increases (P < 0.01), and increased coagulability. MA increased after hemodilution, but this was not statistically significant. A60 and CL60 also increased, showing decreased fibrinolysis (P < 0.05). CONCLUSIONS: Moderate bleeding-induced hemodilution increased coagulability according to TEG compared to pre-hemodilution findings. We recommend that the decision to replace coagulation factors and/or platelets should not be based on empirically derived, arbitrary standards.
Anesthesia ; Blood Coagulation Factors ; Blood Volume ; Fibrinolysis ; Hemodilution* ; Humans ; Hysterectomy*

Atherothrombotic complications are important causes of morbidity and mortality in diabetic patients. Diabetes has been considered to be a prothrombotic status. Several factors contribute to the prothrombotic condition, such as increasing coagulation, impaired fibrinolysis, endothelial dysfunction, and platelet hyperreactivity. Among the factors that contribute to the prothrombotic status in diabetes, altered platelet function plays a crucial role. Although understanding platelet function abnormalities in diabetes still remains as a challenge, more attention should be focused on platelet function for effective management and the prediction of atherothrombotic events in diabetic patients. This review will provide an overview on the current status of knowledge of platelet function abnormalities and clinical marker of platelet hyperreactivity in patients with diabetes.
Biomarkers* ; Blood Platelets* ; Diabetes Mellitus* ; Fibrinolysis ; Humans ; Mortality

Dry socket, also termed fibrinolytic osteitis or alveolar osteitis, is a complication of tooth exodontia. A dry socket lesion is a post-extraction socket that exhibits exposed bone that is not covered by a blood clot or healing epithelium and exists inside or around the perimeter of the socket or alveolus for days after the extraction procedure. This article describes dry socket lesions; reviews the basic clinical techniques of treating different manifestations of dry socket lesions; and shows how microscope level loupe magnification of 6× to 8× or greater, combined with co-axial illumination or a dental operating microscope, facilitate more precise treatment of dry socket lesions. The author examines the scientific validity of the proposed causes of dry socket lesions (such as bacteria, inflammation, fibrinolysis, or traumatic extractions) and the scientific validity of different terminologies used to describe dry socket lesions. This article also presents an alternative model of what causes dry socket lesions, based on evidence from dental literature. Although the clinical techniques for treating dry socket lesions seem empirically correct, more evidence is required to determine the causes of dry socket lesions.
Bacteria ; Diagnosis* ; Dry Socket* ; Epithelium ; Fibrinolysis ; Inflammation ; Lighting ; Osteitis ; Tooth

BACKGROUND: Many studys on Cesarean section patients have reported that a pregnant women's coagulatory function are elevated during the postoperative period than preoperative period. But, changes in coagulatory function between the preoperative and postoperative periods has been demonstrated only in pregnant women. Therefore, we measured the coagulatory function of pregnant and nonpregnant women pre- and post-operatively by thromboelastography (TEG) and compared the results obtained. METHODS: TEG was performed in 31 pregnant women that underwent Cesarean section delivery and 25 nonpregnant women that underwent total abdominal hysterectomy using native whole blood. The TEG variables included; reaction time (R), clot formation time (K), maximum amplitude (MA), alpha angle, TEG coagulation index the percentage reductions in MA at 30 minutes (LY30) and 60 minutes (LY60). Other laboratory tests and routine coagulation tests were measured in all women. RESULTS: R and K were significantly lower in pregnant women than in nonpregnant women (P<0.05) during the preoperative and postoperative periods. MA, alpha angle and TEG index were significantly higher in pregnant women (P<0.05) pre- and post-operatively. Preoperative and postoperative data were significantly different in the two groups (P<0.05). CONCLUSIONS: Term pregnant women showed a hypercoagulable state preoperatively and this was enhanced postoperatively. But the changes in coagulatory function pre- to post-operation were similar in both patient groups.
Cesarean Section* ; Female ; Fibrinolysis ; Humans ; Hysterectomy ; Postoperative Period ; Pregnancy ; Pregnant Women* ; Preoperative Period ; Reaction Time ; Thrombelastography

There is increasing evidence that thrombin is directly involved in the pathogenesis of cerebral edema after intracerebral hemorrhage. Some authors emphasize that early removal of hematoma using plasminogen activator can be an effective intervention that interrupts the cascade of events leading to increasing edema formation and white matter injury. Recently, there are many reports of the edema intensification following plasminogen activator-induced lysis of the intracerebral clot. The author reports a case who showed protracted perihematomal edema after hematoma evacuation and fibrinolysis therapy with urokinase. Considering that the benefit obtained from fibrinolysis therapy may be offset by an accentuation of its toxic edematous effect, further investigation into the use of urokinase for hematoma evacuation should be undertaken.
Brain Edema ; Cerebral Hemorrhage ; Edema* ; Fibrinolysis* ; Hematoma ; Plasminogen ; Plasminogen Activators ; Thrombin ; Urokinase-Type Plasminogen Activator*

The incidence of spontaneous cerebellar hemorrhage is a range of between 0.3% and 0.7% in several large series and accounts for 10% of all intracranial hemorrhages. The course and prognosis of spontaneous intracerebellar hemorrhage, regardless of treatment, is poor. The Cosman-Robert-Wells(CRW) stereotactic instrument is recently developed modification, based on an arc-radius design, of the Brown-Roberts-Wells(BRW) stereotactic frame utilizing the exising fixation and fiducial components of the BRW stereotactic system localize and verify target data. During the year of 1989 through 1991, 25 patients with spontaneous cerebellar hemorrhage operated on using CRW stereotactic instrument and fibrinolysis. The age incidence was most frequent in 7th decade. 19 cases(76%) obtained a favorable outcome after operation and 4 cases(16%) death. 2 cases subsequently developed postoperative rebleeding and a case infection. The short operating time, the relatively low risk involved, and the lack of danger to healthy brain support the use of CT-guided stereotactic removal and fibrinolysis. In our opinion, CT guided sterotactic removal is simple, effective and safe method for spontaneous cerebellar hematoma.
Brain ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Humans ; Incidence ; Intracranial Hemorrhages ; Prognosis ; Tomography, X-Ray Computed