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*

Thromboelastography(TEG) is a useful monitor for assessing coagulation function in patients undergoing open heart surgery. However, whole blood clotting patterns on TEG are not able to obtain during the cardiopulmonary bypass(CPB) with heparin anticoagulation. When pretreating TEG sample with heparin antidote, heparinase or protamine (heparinase-modified TEG or protamine modified TEG) can make possible assessing the changes of clotting on TEG during the CPB. In this study, data from heparinase(N=50) and protamine(N=26) modified TEG were obtained before, during and after CPB in 76 open cardiac patients, which are presented to describe their usefulness concerning about prediction for coagulation after weaning of CPB. Heparin neutralized TEG revealed that all of depressed values initially after starting bypass were returning back to the values of before starting bypass on weaning CPB. These results suggested that function of the fibrinogen and platelet were relatively well maintained during the bypass. The fibrinolysis during the bypass were commonly developed in 51.2% without affecting by time course of CPB. Even though initial dose of protamine reversal after bypass, there were obviously residual heparin effects on heparinase-modified TEG as simultaneously comparing with native TEG. Regarding correlation of TEG findings in cases excluding fibrinolysis between before and after bypass, R time and MA before bypass were significantly correlate with R time and MA on heparinase-modified TEG after bypass but not on native TEG. (R time: R 0.46, MA: R=0.54). The data gathered in this study suggested heparin independent TEG assay can be useful to assess the coagulation function during the bypass and to predict the values of TEG after bypass, but residual heparin effect must be initially excluded to avoid underestimating the coagulation status after protamine reversal.
Blood Coagulation ; Blood Platelets ; Fibrinogen ; Fibrinolysis ; Heart* ; Heparin Lyase ; Heparin* ; Humans ; Thoracic Surgery* ; Weaning

BACKGROUND: Various plasma substitutes are used for the correction of hypovolemia caused by blood loss. It is known that plasma substitutes themselves have some adverse effects on blood coagulation. We performed this study to show the actual effect of plasma substitutes on blood coagulation in clinical hypovolemic situation caused by blood loss. METHODS: 60 patients scheduled for radical hysterectomy were grouped by the plasma substitutes infused; group C, S, V and P correspondingly infused with Hartman's solution, Salinhes(R), Voluven(R) and Pentaspan(R). Thromboelastograms (TEG) at 15 minutes after induction of anesthesia (T(0)), after 15% blood loss of the estimated blood volume (T(1)) and just after infusion of the plasma substitutes (T(2)) were compared among the groups and changes with the time course within each group were investigated. RESULTS: Compared to group C, MA, A60, coagulation index, CL60 (parameters of TEG) were decreased and LY60 increased in group S and P while group V presented no significant changes. Hypercoagulability and reduced fibrinolysis were observed for T(1); for T(2), group C showed decrease in k-time, LY60 and increase in alpha angle, CL60. Group S presented decrease in MA, A60 compared to T0 and decrease in CL60 and increase in LY60. CONCLUSIONS: Surgery and blood loss accelerated coagulation and reduced fibrinolysis. These were aggravated after crystalloid infusion. In contrast, coagulability was reduced and fibrinolysis augmented after infusion of HES except HES 130/0.4/6.
Anesthesia ; Blood Coagulation ; Blood Volume ; Fibrinolysis ; Humans ; Hypovolemia ; Hysterectomy* ; Plasma Substitutes* ; Plasma* ; Thrombophilia

No abstract available.
Blood Coagulation*

OBJECTIVETo study single wall carbon nanotubes (SWCNT) and its role in inducing inflammatory cytokines in the cruor-fibrinolysis system of rat.

METHODSTwenty one Wistar rats were divided into four groups: 1) control; 2) low-dose SWCNT (0.15 mg/kg BW); 3) medium-dose SWCNT (0.75 mg/kg BW); 4) high-dose SWCNT (1.5 mg/kg BW). Intratracheal instillation of SWCNT suspensions was administered to rats once per day for 21 days. In order to assess the exposure effect of SWCNT to the rats, activity of Inflammatory cytokine was measured and markers of cruor-fibrinolysis system were studied via ELSIA. Also, change in clotting time was recorded and histopathology was studied.

RESULTSIL-6 and IL-8 concentrations of rats exposed to SWCNT were significantly higher than those in controls (P<0.05). The activity of inflammatory cytokines and histopathological change indicated that oxidative damage occurred. Change in clotting time in rats exposed to SWCNT decreased compared with controls. Meanwhile, t-PA (tissue-tupe plassminogen activator) and AT-III (antithrombin-III) levels in rats exposed to particulates increased or decreased significantly compared with controls (P<0.05). A similar trend was observed for D-dimer (D2D) levels, indicating that SWCNT can impact the cruor-fibrinolysis system of rat.

CONCLUSIONThe results from our study suggest that an increased procoagulant activity and reduced fibrinolytic activity in rats exposed to SWCNT can cause pulmonary oxidative stress and inflammation, due to the release of pro-thrombotic and inflammatory cytokines into the blood circulation of rat.

Animals ; Blood Coagulation ; Body Weight ; Cytokines ; metabolism ; Fibrinolysis ; Inflammation ; etiology ; metabolism ; Nanotubes, Carbon ; Rats ; Rats, Wistar

Adult ; Blood Coagulation ; Female ; Fibrinolysis ; Hepatitis B, Chronic ; blood ; Humans ; Pregnancy ; Pregnancy Complications, Infectious ; blood ; Pregnancy Trimester, Third ; Young Adult

BACKGROUND: There is a high incidence of thromboembolism after major orthopedic surgery. However, more perioperative thromboembolic complications are expected after orthopedic surgery in geriatric patients due to the more offensive therapeutic measures and the increasing number of such patients with multimorbidity. Therefore it is important to investigate the perioperative blood coagulation status in detail. METHODS: Forty-five patients who were over 65 years old and scheduled for major orthopedic surgery were enrolled in this study. Patients with preoperative coagulation abnormalities, or receiving anticoagulants or antiplatelet medications were excluded. Preoperative thromboelastography (TEG), intraoperative TEG after blood loss equaling approximately 10% of the estimated blood volume, and postoperative TEG at the recovery room were measured and compared. RESULTS: During the operation, the R time and coagulation time (r + k) showed significant decreases, whereas the alpha angle, maximum amplitude (MA) and TEG index increased significantly (P < 0.05), indicating increased coagulability. The A60, CL30 and CL60 also increased, indicating decreased fibrinolysis (P < 0.05). These hypercoagulable findings were relieved after surgery to levels similar to those observed preoperatively. CONCLUSIONS: The intraoperative coagulability increased compared with the preoperative and postoperative period according to the TEG. This means that the intraoperative period is the period of most susceptibility to thromboembolic complications.
Aged* ; Anticoagulants ; Blood Coagulation ; Blood Volume ; Fibrinolysis ; Humans ; Incidence ; Intraoperative Period ; Orthopedics* ; Postoperative Period ; Recovery Room ; Thrombelastography ; Thromboembolism

OBJECTIVETo investigate the effects of chronic mercury poisoning on blood coagulation and fibrinolysis systems, and the possible mechanism.

METHODSTwenty-seven patients with chronic mercury poisoning were studied with 30 healthy people as control. Thrombomodulin (TM), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), interleukin-13 (IL-13), interleukin-18 (IL-18), soluble intercellular adhesion molecule-1 (SICAM-1) were examined with ELISA methods, and superoxide dismutase (SOD) and lipid peroxidation (LPO) was examined with chemical catalysis methods. Two to three weeks after treatment with reduced glutathione, tiopronin and daidzein, blood was used for determin the above items again.

RESULTS(1) The concentration of TM in patients [(2.36 +/- 0.16) ng/ml] was significantly lower than in the control [(4.36 +/- 0.24) ng/ml] (P < 0.01), while TM tended to be higher after treatment [(4.82 +/- 0.34) ng/ml] (P < 0.05). (2) The concentration of t-PA in patients [(3.44 +/- 0.34) ng/ml] was significantly lower than in the control [(4.52 +/- 0.16) ng/ml] (P < 0.05), and was higher significantly [(5.63 +/- 0.58) ng/ml] after treatment (P < 0.05); The concentration of PAI in patients [(48.23 +/- 3.59) ng/ml] was significantly higher than in the control [(31.59 +/- 2.13) ng/ml] (P < 0.05), but after treatment no significant change [(50.71 +/- 4.29) ng/ml] was found (P > 0.05). (3) The activity of SOD in patients [(953.85 +/- 9.56) U/g Hb] was significantly lower than in the control [(1,308.75 +/- 10.21) U/g Hb] (P < 0.01), and was higher significantly [(1,217.95 +/- 6.29) U/g Hb] after treatment (P < 0.05); and the concentration of LPO in patients [(9.53 +/- 0.26) nmol/ml] was significantly higher than in the control (P < 0.05), and significantly lower [(7.29 +/- 0.35) nmol/ml] after treatment (P < 0.05). (4) The concentrations of IL-13 [(35.93 +/- 5.28) pg/ml], IL-18 [(28.79 +/- 2.53) pg/ml], SICAM-1 [(603.16 +/- 29.12) ng/ml] were significantly higher than those in the controls (P < 0.05, P < 0.01), but no significant difference was found after treatment.

CONCLUSIONDysfunction of the TM/protein C system and t-PA/PAI system (i.e. the decrease of anti-coagulation activity and the inhibition of the function for the fibrolysis system) may play a key role in the secondary hypercoagulable state induced by chronic mercury poisoning.

Adult ; Blood Coagulation ; physiology ; Case-Control Studies ; Chronic Disease ; Female ; Fibrinolysis ; physiology ; Humans ; Male ; Mercury Poisoning ; blood ; physiopathology ; Plasminogen Inactivators ; blood ; Thrombomodulin ; blood ; Tissue Plasminogen Activator ; blood

BACKGROUND: Coagulation and fibrinolysis biomarkers can effectively reflect the dysfunction of coagulation and anticoagulation system, and the changes of their levels were closely related to the hypercoagulable status. The aim of this study is to study the variation tendency of these coagulation and fibrinolysis markers and explore the diagnosis power and clinical value of these biomarker for thrombosis in postoperative lung cancer patients with deep vein catheterization. METHODS: We selected 118 postoperative lung cancer patients with deep vein catheterization including 29 patients with thromboembolism and 89 patients in control group. Coagulation and fibrinolysis parameters [thrombomodulin (TM)/thrombin-antithrombin complex (TAT)/α2-plasmin inhibitor-plasmin complexes (PIC)/tissue plasminogen activator-inhibitor complexes (t-PAIC)] and traditional coagulation time[prothrombintime (PT)/activated partial thrombo plastin time(APTT)/thrombintime (TT)/fibrinogen (FIB)/antithrombin III (ATIII)/fibrinogen degradation products (FDP)/D-Dimer (D-D)] were detected in both groups. We analyzed the variation tendency of these biomarkers and figured out the diagnosis powerfor thrombosis. RESULTS: A statistically significant difference was available on the value of TM, TAT, PIC, t-PAIC, D-D, FDP between thrombosis group and non-thrombosis group (P<0.05). TM, TAT, PIC, t-PAIC, D-D, FDP performed with an AUC of 0.770, 0.771, 0.669, 0.671, 0.819, 0.816, respectively (P<0.05). CONCLUSIONS An enhanced coagulation and fibrinolysis activity existed in lung cancer patients with deep vein catheterization after surgery, and early detection of coagulation and fibrinolytic biomarkers could prevent thrombosis and reduce postoperative thrombosis complications in patients with lung cancer.
Biomarkers ; metabolism ; Blood Coagulation ; Female ; Fibrinolysis ; Humans ; Lung Neoplasms ; complications ; metabolism ; physiopathology ; Male ; Middle Aged ; Thromboembolism ; complications

This study was aimed to investigate the dynamic changes of plasma prethrombotic state molecular marker levels during perioperation of patients and to provide laboratorial evidence for clinical diagnosis of these patients so as to take intervenient measure to high risk patients. 40 patients with gynecological and urological malignant tumors (without metastasis) and 20 patients with benign tumors and 20 healthy individuals were selected for analysis. The levels of plasm prethrombotic state molecular markers including TF, TFPI, TpP, PAI-1, P-S, TAT and D-D were measured by using ELISA method and transmission immunity nephelometry. The results showed that the levels of TF, TpP, D-D, P-S and TAT in plasma of patients with malignant tumors at 6 hours after operation were higher than that before operation, but the levels of TFPI and PAI-1 in these patients after operation were lower than before operation, and there was significant difference as compared with the levels of these markers before operation. At day 3 after operation, the levels of TF, TpP and D-D continuously increased; the level of PAI-1 begins to elevate, there were significant difference in comparison with that before operation; the levels of P-S and TAT decreased, but still were higher than that before operation. At day 7 after operation, the levels of TpP, TAT, P-S, TFPI and PAI-1 returned to levels before operation, but the levels of TF and D-D were still higher than that before operation, and showed significant difference from that before operation. In patients with benign tumors and non-operation patients, the levels of prethrombotic state molecular markers mentioned above at different points of time after operation did not present difference, except levels of TF and D-D that at 6 hours after operation were higher than that before operation. It is concluded that at 6 hours after operation of patients with gynecological and urological malignant tumours, the plasma levels of prethrombotic state molecular markers are in higher state of coagulation and fibrinolysis, at 3 days after operation these levels are mainly in coagulation state. At 7 days after operation, the level of these markers returned to levels before operation. At 6 hours after operation the levels of these markers in patients with benign tumors are in mild coagulation state.
Adult ; Biomarkers ; blood ; Blood Coagulation ; Blood Proteins ; analysis ; Case-Control Studies ; Female ; Fibrinolysis ; Humans ; Male ; Middle Aged ; Perioperative Period ; Plasminogen Activator Inhibitor 1 ; blood ; Venous Thromboembolism ; diagnosis