Heparin induced thrombocytopenia ( HIT ) is a severe side effect of heparin with antibody-mediation.Laboratory assays can be divided into two major categories, about functional assays and HIT antibodiesdetection.Thefunctional assays, such as the serotonin release assay ( SRA ) and heparin-induced platelet activationassay( HIPA) , are sensitive and specific for HIT.They arethe reference standard assays generally, but have thedeficiencies of complicated operation and time-consuming, and cannot be used as a routine examination. TheHIT antibodiesdetections, such as ELISA, immune turbidimetry assay, chemiluminescent assay and lateral flow immunoassay, have high diagnostic sensitivityandareavailable at routine laboratories.They can exclude the diagnosis of HIT or beused to diagnose HIT effectively combined with the pre-test probability score(4Ts score) of HIT.

OBJECTIVETo assess the value of thrombotic biomarkers in estimation of venous thromboembolism (VTE) risk in cancer patients.

METHODSA total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56 ± 17 years. The activities of von Willebrand factor antigen (vWF:Ag), factor VII (F VII:A), factor VIII (F VIII:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer. The level of D-dimer (D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic performance of the parameters. Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.

RESULTSThe levels of vWF:Ag, D-D, and F VIII:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups (P < 0.05). F VIII:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group (P < 0.05). The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups (P < 0.05). The PS: A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05). The AT: A level was significantly lower in all tumor groups than in the control group (P<0.05). When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192% in the cancer group, the area under ROC curve = 0.828 (95% CI: 0.716 to 0.939). When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve = 0.915 (95% confidence interval: 0. 840 to 0.988). When the optimum cut-off point of PC: A for VTE diagnosis was 75.2% in the cancer group, the area under ROC curve = 0.764 (95% confidence interval: 0.630 to 0.898). The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients. The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.

CONCLUSIONSThe plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability. It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.

Aged ; Antithrombins ; blood ; Biomarkers ; blood ; Factor VII ; analysis ; Factor VIII ; analysis ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Male ; Middle Aged ; Neoplasms ; blood ; Prognosis ; Protein C ; analysis ; Protein S ; analysis ; ROC Curve ; Regression Analysis ; Risk Assessment ; Risk Factors ; Venous Thromboembolism ; etiology ; von Willebrand Factor ; analysis

The P2Y12 receptor antagonist is used widely in prevention and treatment of cardiovascular and cerebrovascular disease. Monitoring changes of platelet function after treatment can improve the prognosis of patients. The platelet function test is the important way to evaluate high residual platelet reactivity after antiplatelet treatment, including light transmission aggregometry (LTA), whole blood impedance aggregometry assay (WBIA), vasodilator- stimulated phosphoprotein (VASP), thrombelastogram (TEG), platelet function analyzer- 100 (PFA-100) and VerifyNow system (VerifyNow). It is very different for the reflecting ability with residual reactivity of platelets among these tests after anti-platelet therapy, and also significant difference for assessment effect. Among them, LTA is a classic method for the curative effect evaluation of anti-platelet agents, which is convenient and cheap, but it is susceptible to the operating and environment interference. The clinical application of WBIA is less, and which lacks threshold value for assessment. VASP is sensitive for the changes of platelet function, but the test is complex and expensive. TEG can monitor the inhibition ratio of drugs on anti-platelets, but it needs to verify the safety of treatment. It is not clear for sensitivity and specificity with monitoring anti-platelet agent by PFA-100. VerifyNow is effective and reliable, but the cost is high. The evidence of clinical study shows that LTA, VASP and VerifyNow can reflect the effect of platelet inhibition of P2Y12 receptor antagonists sensitively, and is associated with the risk of major adverse cardiac events (MACE) in patients with cadiovascular diseases.

Objective To investigate the value for the level mensuration of von Willebrand factor antigen (vWF:Ag) in stroke risk assessment in the patients with non-valvular atrial fibrillation (AF).Methods 180 non-valvular AF patients were selected from the Tianjin medical university general hospital from the 2009 to 2011 for retrospective cohort study,112 males and 68 females in the group,age 61-87 years.Using the IL ACL-9000 blood coagulation instrument assay the level of vWF:Ag.Using ROC curve to analyze the diagnosis performance of vWF:Ag,using Cox regression analysis model to evaluate the of vWF:Ag effect on prognosis,using x2 test to analyze the relevance between vWF:Ag and clinical pathological factors.Compared the patients group with CHADS2 score with the patients group with CHA2DS2VASc score date using t test.Results vWF:Ag levels were control group (112 ± 34)％,paroxysmal AF group (119 ±31)％,the persistent AF group (179 ± 47)％,permanent AF group (217 ± 56)％,atrial fibrillation associated with stroke group (235 ± 104)％ respectively.There was no difference between the paroxysmal AF group and control group (q =1.75,P ＞ 0.05) ; vWF:Ag level was higher in persistent atrial fibrillation group than in paroxysmal AF group (q =10.10,P ＜ 0.01); permanent atrial fibrillation group was higher than that of the persistent AF group (q =5.21,P ＜ 0.01).The optimum cut-off point with vWF:Ag for stroke diagnosis was 188.5％,the area under ROC curve =O.843 (95％ confidence interval:0.785-0.901).In Cox regression multianalysis,the vWF:Ag (HR =0.405; 95％ CI =0.268-0.716; P =0.026),the congestive heart failure(HR =2.901 ; 95％ CI =1.837-3.951 ; P =0.001),stroke/transienl ischemic attack (HR =4.665 ; 95 ％ CI =2.837-7.291 ; P =0.000),age (HR =0.474 ; 95 ％ CI =0.211-0.765; P =0.039),the Cox analysis showed that vWF:Ag was the independent prognosis factor for stroke in AF patients.Inx2 analysis,there was the relationship between the level of the vWF:Ag and the congestive heart failure/LVdysfunction (x2 =8.227,P ＜ 0.01),hypertension (x2 =3.305,P ＜ 0.05),age (x2 =7.581,P ＜ 0.01),diabetes mellitus (x2 =6.730,P ＜ 0.01),stroke/ transient ischemic attack/thromboembolism (x2 =4.825,P ＜ 0.05),vascular disease (x2 =4.126,P ＜ 0.05).Compared the subjects with CHADS2 (score =1) with the CHA2DS2VASc(score =1),the level of the vWF:Ag was higher in patients with CHADS2 score =1 (t =4.283,P ＜ 0.01).Conclusion There was relationship between the level of vWF:Ag and main pathologic factors in patients with AF,and changed with the condition,high vWF:Ag level was an independent predictor of stroke risk,and had superior reference value for in assessment of stroke in patients with atrial fibrillation.

ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.

Objective:To assess aspirin efficacy in the early postoperative period following off-pump coronary artery bypass(OPCAB)surgery.Methods:Sixty patients undergoing OPCAB surgery were enrolled in the study.Previous aspirin treatment Was terminated 5-7 days before OPCAB and continued to take at the day with food intake after surgery.The functional and biochemical responses to aspirin were evaluated by arachidonie acid (ARA)-induced platelet aggregation.Samples were collected before and on days 1,4 and 10 after aspirin intake(100 mg/d).Results:There were 17 patients(28.3%),9 patients (15%)and 2 patients(3.3%)with aspirin resistance on day 1,4 and 10 of aspirin intake.The overall levels of platelet aggregation(%)were 63(52,70),13(11,22),12(10,14),and 12(11,14)before the surgery and on day 1,4 and 10 of aspirin intake.The level was stable from the 4th day after aspirin intake.It was found that aspirin resistance was not an independent risk factor for the operation.Conclusion:Aspirin did not sufficiently inhibit platelet aggregation at the early stage after OPCAB.It is important to keep potential anti-coagulation therapy in the early postoperative period.

Objective To investigate the reasonable time limit for stopping the aspirin treatment in preoperative pa-tients with general surgery and the effects on platelet function in postoperative patients with recovering the therapy of aspirin. Methods A total of 121 patients undergoing elective general surgery were divided into stopping aspirin treatment 5 d group (n=59) and stopping aspirin treatment 7 d group (n=62). Fifty healthy volunteers were used as the control group. The arachi-donic acid (AA)-induced platelet aggregation test was used to detect the platelet agglutination rate in all groups. Aspirin was reused 24~48 h after surgery. The level of urinary 11-dehydro-thromboxane B2 (11-DH-TXB2) was assayed by ELISA 7 and 10 d after retreatment. Results The levels of the PAgT (5 min, 8 min and 10 min) were decreased significantly in pa-tients with stopping aspirin treatment 5 d group compared with those of patients with stopping aspirin treatment 7 d group and control group (P<0.05). There was no significant difference in the level of PAgT between patients with stopping aspirin treatment 7 d group and control group. The platelet aggregation showed two different characteristic curves after stopping aspi-rin treatment for 5 d. And the normal curve of platelet aggregation was found after stopping aspirin treatment for 7 d. The lev-els of PAgT and urinary 11-DH-TXB2 were significantly lower in patient recovered the aspirin treatment for 7 d and 10 d than that of control, and which was significantly higher in 7 d group than that of 10 d group (P>0.05). Conclusion The platelet aggregative function returned to normal level in patients with 7-d preoperative stopping aspirin. The laboratory moni-toring of aspirin therapy should be more than 7 d after postoperative reusing aspirin.

Objective To investigate the influence of combined thrombolysis therapy on clinical effects for short -and long -term of patients with acute cerebral infarction caused by sudden occlusion of anterior and posterior circulation.Methods 75 patients with cerebral infarction caused by sudden occlusion of anterior and posterior circulation were chosen and divided into A group (46 patients)with sudden occlusion of anterior circulation and B group (29 patients)with sudden occlusion of posterior circulation by comprehensive therapy for intra -arterial thrombolysis combined with mechanical crushing and dilation.The recanalization rate,the excellent and good rate of ADL -Barthel score,NIHSS score and GCS score before and after treatment,intracranial hemorrhage rate and mortality rate of two groups were compared.Results The recanalization rates of A group and B group were 50.00%(23 /46), 89.66%(26 /29).After treatment,the excellent and good rates of ADL -Barthel score of A group and B group were 58.70%(27 /46),62.07%(18 /29).The recanalization rate of B group was significantly higher than A group(χ2 =7.44,P <0.05).There was no significant difference in the excellent and good rate of ADL -Barthel score after treatment between the two groups(χ2 =1.21,P >0.05).After treatment,the NIHSS scores of A group and B group were (8.66 ±2.48)points,(8.72 ±2.51 )points,the GCS scores of A group and B group were (12.89 ± 3.61)points,(13.10 ±3.72)points.There were no significant differences in NIHSS score and GCS score after treatment between the two groups(t =1.47,1.52,all P >0.05).After treatment,the intracranial hemorrhage rate of B group was significantly lower than A group (χ2 =8.16,P <0.05 ).There was no significant difference in the mortality rate between the two groups(χ2 =0.98,P >0.05).Conclusion Compared with acute cerebral infarction caused by sudden occlusion of anterior circulation,combined thrombolysis therapy in treatment of patients with sudden occlusion of posterior circulation has advantages including higher recanalization rate and lower risk of intracranial hemorrhage.

Objective To study the assessment value of serum protein C activity ( PC∶A) test in the patient′s condition and prognosis in bronchial asthma.Methods 202 bronchial asthma patients were selected from the Tianjin medical university general hospital from 2010 to 2012 for this retrospective cohort study, 77 males and 125 females with a mean age of 41.2 ±11.4 years.the level of PC∶A were analysed by IL ACL TOP 700 coagulation analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnosis performance of PC∶A, χ2 test was used to analyze the relevance between PC∶A and clinical pathological factors , Cox regression analysis model was used to evaluate the effect on prognosis , Kaplan-Meier curve to implement survival analysis.Results The elevels of PC∶A were:control group ( 102.2 ± 13.6)%, intermittent attack group (104.8 ±11.9)%, mild persistent group (136.3 ±15.8)%, moderate persistent group ( 129.0 ±13.5 )% and severe persistent ( 126.8 ±14.7 )% respectively , and there was significantly difference among the all groups ( F =7.15, P <0.01 ).Compared the control group and intermittent attack group with other groups , the PC∶A level was higher in mild persistent group ( q=16.83, q=15.54, P<0.05), moderate persistent group (q=19.94,q=12.15, P<0.05), and severe persistent group(q=11.37,q=10.66, P<0.05).The PC∶A level was lower in moderate and severe persistent group than mild persistent group ( q =3.82, q =4.30, P <0.05 ).After undergoing regular treatment for six months, the PC∶A level was higher in partly controlled group and uncontrolled group than complete controlled group (q=12.45, q=9.91,P<0.05).The optimum cut-off point of PC∶A (after undergoing regular treatment for six months ) for asthma condition with uncontrolled was 118.0%, the area under ROC curve was 0.892 ( 95% confidence interval:0.851-0.936 ).The χ2 test results showed that there was the relevance between the serum PC∶A level and the eosinocyte , total serum IgE , complicated allergic rhinitis and lung function ( FEV1%) ( P<0.01 ).The Cox analysis and survival analysis showed that the serum PC∶A level ( after undergoing regular treatment for six months ) was the independent assessment parameter for asthma acute attack in 7th-12th month, the cumulative probability of acute attack was increased obviously in the patients who with PC∶A level over the cut-off value.Conclusions The serum PC∶A level was increased obviously in asthma patients , and was related to patient′s condition, level of asthma control and severe attacks risk , which could be used as an effective indicator for assessment of disease progression and asthma control in asthma patients.

Objective To study the variation characteristics of plasma von Willebrand factor antigen (vWF Ag) after the off-pump coronary artery bypass graft (OPCAB) and its predictive value on the assessment of cardiovascular ischemia events in the postoperative patients.Methods A total of 338 patients with non-ST-segment elevation myocardial infarction were selected from 2010 to 2012 in this retrospective cohort study,with 249 males and 89 females and a mean age of (69.2 ± 4.5) years.The level of vWF Ag was assayed by the IL ACL-TOP 700 blood coagulation instrument.Receiver-operator curve (ROC) analysis of vWF Ag levels in the prediction of risk of ischemic events was performed.x2 test and Logistic regression were conducted to analyze the relevance between vWF Ag and clinical pathological factors.Cox regression analysis model were used to evaluate the effect on prognosis.Results There was significant difference in vWF Ag level at different time point between the poor recovery group and the stable disease group (x2 =129.53 and 101.48 respectively,both P＜0.01).And the vWF Ag level was higher in the poor recovery group on the 14th,30th,60th,90th day after OPCAB than in the stable disease group at the same time points respectively (all P＜0.05).The optimum cut-off point of vWF Ag (the 30th day after OPCAB) for prediction of ischemic events was 251 ％ within the 31-90th day after OPCAB,the area under ROC curve was 0.839 (95％ confidence interval:0.776-0.902).The Logistic regression analysis showed that the vWF Ag level on 30th day after OPCAB was affected by age,left ventricular ejection fraction,left main artery disease,serum creatinine level,vascular number of bypass grafts,history of myocardial infarction and hypertension (all P＜0.01).The Cox analysis showed that the cut-off value of vWF Ag (on the 30th day after OPCAB) was the independent prognostic assessment parameter for ischemic events in patients with cardiovascular diseases within one year.Conclusions The variation of serum vWF Ag level can reflect the integrated influence of multiple pathological factors on vascular endothelial function after the OPCAB,it can become the effective predictor for disease progression within 90 days and the long-term prognosis after OPCAB.