1.Technique of external ventricular drainage with intraventricular administration of recombinant tissue plasminogen activator for patients with secondary intraventricular hemorrhage - Case series in a single institution.
Kevin Paul B. Ferraris ; Alain James R. Salloman ; Kenny S. Seng ; Joseph Erroll V. Navarro
Philippine Journal of Surgical Specialties 2019;74(2):33-43
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
2.Coagulation-Fibrinolysis system in acute progressive and non-progressive stroke: Preliminary study.
Key Chung PARK ; Dae Il CHANG ; Kyung Cheon CHUNG
Journal of the Korean Neurological Association 1997;15(3):475-480
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*
3.The Effects of Measurement Time and Blood Temperature on Thromboelastographic Parameters.
Dae Hyun KIM ; Seong Hoon KO ; Dong Chan KIM ; Sang Kyi LEE ; He Sun SONG
Korean Journal of Anesthesiology 2002;42(3):306-311
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
4.A Case of Spontaneous Remission of Acute Pulmonary Embolism.
Jae Joon LEE ; Min Ji LEE ; Hyo PARK ; Seok Jae ZEON ; Young Min LIM ; Sang Hee SONG ; Dong Jib NA ; Eun Jin KIM
Tuberculosis and Respiratory Diseases 2012;72(2):232-235
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
5.Clinical Marker of Platelet Hyperreactivity in Diabetes Mellitus.
Jin Hwa KIM ; Hak Yeon BAE ; Sang Yong KIM
Diabetes & Metabolism Journal 2013;37(6):423-428
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
6.Changes in Thromboelastographic Findings after Bleeding-Induced Hemodilution in Patients Undergoing Radical Hysterectomy.
Jaemin LEE ; Chul Soo PARK ; Yong Suk KIM
Korean Journal of Anesthesiology 2005;49(1):11-17
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*
7.Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques.
Journal of the Korean Association of Oral and Maxillofacial Surgeons 2018;44(2):52-58
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
8.Quantification of Tranexamic Acid Reversal of Fibrinolysis Using Thromboelastography and Low Dose Tranexamic Acid Effect in Open Heart Surgery.
Sung Hong LEE ; Kyung Tae KIM ; Hwan Duck KIM ; Sung Ju KIM ; Cheol Hwoy HUR ; Moon Chul KIM ; Sung WOO ; Kang Hee CHO
Korean Journal of Anesthesiology 1998;34(6):1193-1201
BACKGROUND: Prophylactic administration of tranexamic acid (TA) reduces bleeding and transfusion requirement after open heart operations. This study was performed to determine the relationship between inhibition of fibrinolysis and TA blood concentration. METHOD: In phase I, recombinant tissue plasminogen activator[r-tPA (0, 50, 100, 150 ng/ml)] was added to the blood of volunteer and induced fibrinolysis. In phase II, 4 thromboelastography (TEG) models of severe fibrinolysis in which TA was added to achieve blood levels (0, 0.72, 1.44, 2.88 mg/ml) were compared to determine the lowest effective dose. In phase III, the lowest dose (0.72 mg/ml) was mixed with the blood and evaluated on TEG in open heart operation. In phase IV, a placebo group and study group receiving TA in an loading dose of 5 mg/kg before bypass following infusion of 2 mg/kg/hour. Used analysis is Mann Whitney U test and Wilcoxon rank signed test. RESULT: In phase I, fibrinolytic inhibition at A30/MA (r=0.752) and A60/MA (r=0.735) were linearly correlated with the blood r-tPA concentration. In phase II, severe fibrinolysis (r-tPA 100 ng/ml) was reversed completely at all doses of TA. In phase III, the fibrinolysis index at 10 min. after starting bypass, aorta declamping, and 1 hour after operation were improved when the patient's blood was treated with TA (0.72 mg/ml). In phase IV, blood treated with TA showed less fibrinolysis and better TEG results than the placebo group. CONCLUSION: A small dose of TA (5 mg/kg), which was determined by an in vitro model of fibrinolysis on TEG, was effective in preventing changes in fibrinolytic index during cardiopulmonary bypass in open heart surgery.
Aorta
;
Cardiopulmonary Bypass
;
Fibrinolysis*
;
Heart*
;
Hemorrhage
;
Plasminogen
;
Thoracic Surgery*
;
Thrombelastography*
;
Tranexamic Acid*
;
Volunteers
9.Tranexamic Acid Versus a Placebo in Decreasing Blood Loss in Patients Undergoing Spine Surgery.
Myoung Oak KIM ; Sang Wook BAE
Korean Journal of Anesthesiology 2000;39(5):645-650
BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.
Anesthesia, General
;
Blood Transfusion
;
Fibrinolysis
;
Hematocrit
;
Humans
;
Platelet Count
;
Prospective Studies
;
Spinal Stenosis
;
Spine*
;
Tranexamic Acid*
10.An Evaluation of the ACL TOP Automated Coagulometer for Determination of D-Dimer.
Yu Seok HWANG ; Jeong Yeal AHN ; Yiel Hea SEO ; Pil Whan PARK
Journal of Laboratory Medicine and Quality Assurance 2007;29(1):175-180
BACKGROUND: D-dimer is a specific marker of secondary fibrinolysis. D-dimer assay is widely used in the diagnosis of disseminated intravascular coagulation, deep vein thrombosis, pulmonary embolism, and arterial thromboembolism. Enzyme linked immunosorbent assays have been validated as the reference method for plasma D-dimer measurement, but it took long time. We evaluated the analytical performance of new automated coagulation system, ACL TOP, for quantification of D-dimer. METHODS: The total plasma D-dimer concentrations were measured by Nycocard and ACL TOP. To test the linearity, a serial dilution samples were prepared and measured. Between run precision of the ACL TOP D-dimer assay was evaluated with HemosIL D-Dimer controls for 20days. The correlation was evaluated using 75 plasma samples from patients. ACL TOP was evaluated according to CLSI guidelines. RESULTS: ACL TOP showed good linearity (r=0.9996) and between run coefficient of variation was within 4.0%. Coefficient of correlation between Nycocard and ACL TOP was 0.798. Positive concordance rate of ACL TOP was 67%, and negative concordance rate of ACL TOP was 80%. CONCLUSIONS: Since the ACL TOP showed a satisfactory precision, linearity, and comparative high correlation with Nycocard, and is more convenient and automatic than the Nycocard, it should be potentially beneficial in the clinical laboratories.
Diagnosis
;
Disseminated Intravascular Coagulation
;
Fibrinolysis
;
Humans
;
Plasma
;
Pulmonary Embolism
;
Thromboembolism
;
Venous Thrombosis