Ever since mankind has had blood, efforts to stop bleeding have never ceased and so numerous methods for hemostasis have been developed. In recent decades, minimally invasive surgical techniques have led patients to less-bleeding surgery but, hemostatic agents, devices and techniques still play an important role in medical side. A number of hemostatic agents and devices have been developed and they can be classified by their mechanism of action. That classification of the coagulants includes mechanisms with physical, caustic, bio-physical, biologic actions. Hemostatic devices are divided into categories such as dressings, glue, clips, electrocoagulations and so on. Based on the concept of minimally invasive surgical procedures, variously developed surgical techniques are divided by the number of ports used and auxiliary instruments. However, there are advantages and disadvantages to each of the hemostatic agents and minimally invasive methods, and the belief in the classical method also prevents the application of new hemostatic methods. The knowledge and understanding of the benefits and costs of these newly developed hemostatic methods will make it easier for medical personnel to manage patient's blood.
Adhesives ; Bandages ; Bloodless Medical and Surgical Procedures* ; Classification ; Coagulants ; Cost-Benefit Analysis ; Electrocoagulation ; Hemorrhage ; Hemostasis ; Humans ; Methods ; Minimally Invasive Surgical Procedures

BACKGROUND: Patients undergoing brain surgery have a high risk of developing a number of perioperative coagulation disorders. Anesthesia and surgical stress may affect blood coagulation and fibrinolysis. The aim of this study was to evaluate perioperative changes in hemostatic parameters of patients undergoing clipping of cerebral aneurysms with a thromboelastograph (TEG) in combination with simple laboratory tests. METHODS: Twenty adult patients who had cerebral aneurysms and no history of coagulation disorders were studied. Isoflurane and N2O were used for all anesthetic proceedings. Preanesthetic, intraoperative (after skin incision and after clipping of cerebral aneurysms) and postanesthetic measurements included a TEG and simple laboratory tests. The TEG variables included r time (reaction time for clot formation), k time (clot formation time), alpha angle (rate of clot growth), MA (maximal amplitude of clot strength) and LY30 (fibrinolytic index). RESULTS: In simple laboratory tests, prothrombin time (PT) and partial thromboplastin time (PTT) at intraoperation and postanesthesia were longer than those at preanesthesia (p < 0.05). In the TEG, r and k time at intraoperation and postanesthesia were shorter than those at preanesthesia (p < 0.05). However the alpha angle at intraoperation and postanesthesia was longer than that at preanesthesia (p < 0.05). There was no significant difference in MA and LY30 except an increase in MA after the skin incision (p < 0.05) compared to the MA at preanesthesia. CONCLUSIONS: These results indicate a general hypercoagulability during and after a cerebral aneurysms operation in terms of TEG, although, the level of the PT and PTT can be at the upper limits within normal. Therefore perioperative use of coagulants in cerebral aneurysms may increase the risk of a thromboembolism because of accelerating blood coagulability. By early intraoperative and postoperativeevaluation of the hemostatic abnormality with a TEG, appropriate measures might be initiated to prevent postoperative complications due to hypercoagulability.
Adult ; Anesthesia ; Blood Coagulation* ; Brain ; Coagulants ; Fibrinolysis ; Humans ; Intracranial Aneurysm* ; Isoflurane ; Partial Thromboplastin Time ; Postoperative Complications ; Prothrombin Time ; Skin ; Thromboembolism ; Thrombophilia

Coagulants have been used for a long time to promote the hemostasis during operation. We have carried out the study to see the effect of the thromboplastin preparation. Thrombokinase, on the coagulation mechanism, thrombin time, partial thromboplastin time, Ca++, and operation time and amount of bleeding in the twenty patients undergoing laminectomy or femur fracture operation. The patients were divided into two groups, in the control group(n=10), disllied water 20ml, and in the Thrombokinase group(n=10), 20ml of Thrombokinase(4 amles) was administered intravenously during 5 minutes. The results were as follows: 1) Prothrombin time and partial thromboplastin time were significantly prolonged in the control group compared to the Thrombokinase group(p<0.05). 2) In the Thrombokinase group, the duration of operation was shorter and the amount of blood loss was less than in the control group, but there was no significant statistical difference(p>0.05).3) There was no change in either blood pressure or pulse rate and also no side reaction during or after the Thromobkinase injection.
Blood Coagulation* ; Blood Pressure ; Coagulants ; Factor Xa* ; Femur ; Heart Rate ; Hemorrhage ; Hemostasis ; Humans ; Laminectomy ; Partial Thromboplastin Time ; Prothrombin Time ; Thrombin Time ; Thromboplastin* ; Water

INTRODUCTIONWe report a successful case of immune tolerance to factor VIII (FVIII) inhibitor after a major operation. An attempt was made to induce immune tolerance with inhibitor in a haemophilia A patient, who was required to undergo an above-knee amputation. We opted to give high-dose FVIII infusion with no immunosuppression.

OUTCOMEThe highest preoperative FVIII inhibitor level was 5 BU and the peak postoperative FVIII inhibitor level was 1.5 BU demonstrated on Day 9 post operation. High-dose FVIII support was provided during the perioperative period and continued with a low maintenance dose to achieve a FVIII level of 30% to 40%. The requirement of high-dose FVIII lasted from day 6 to 23 post operation and this was tailed down to a maintenance dose over the next 37 days. There were only 2 episodes of mild oozing from the wound at around Day 9, which coincided with the peak postoperative FVIII inhibitor level. Both bleeding episodes were arrested adequately by administering a single dose of FEIBA during each episode. Immune tolerance was demonstrated after around 3 months and a follow-up period of 233 days showed no recurrence of FVIII inhibitor with the normalisation of FVIII half-life study.

CONCLUSIONAfter immune tolerance, the patient suffered fewer episodes of joint haemorrhage and required a lower amount of FVIII infusion as well. The cost may be high initially but the longterm cost-effectiveness has to be carefully evaluated.

Adult ; Amputation ; Coagulants ; administration & dosage ; immunology ; Factor VIII ; administration & dosage ; immunology ; Hemophilia A ; complications ; Humans ; Immune Tolerance ; drug effects ; Male ; Perioperative Care ; Postoperative Care

Anticoagulants ; therapeutic use ; Child ; Coagulants ; blood ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Purpura, Schoenlein-Henoch ; blood ; drug therapy ; Signal Transduction ; Thromboplastin

OBJECTIVETo study diterpenoid alkaloids from the roots of Aconitum recemulosum, and their inhibitory effects on PAF-induced platelet aggregation.

METHODThe root of A. recemulosum was extracted with 95% EtOH. The total alkaloids extracted were isolated and purified by several kinds of column chromatography over silica gel, RP-18, and Sephadex LH-20, and identified based on spectral analysis. And the inhibitory effects of isolated compounds on PAF-induced platelet aggregation were detected.

RESULTFive alkaloids were isolated and identified as sachaconitine (1), 14-acetylsachaconitine (2), hemsleyanine C (3), circinasine A (4), and talatisamine (5). The results showed compounds 1 and 2 have moderate inhibition effect on PAF.

CONCLUSIONCompounds 1-5 were firstly isolated from this plant. Furthermore, compounds 1 and 2 possessed moderate inhibitory effects on PAF-induced platelet aggregation.

Aconitum ; chemistry ; Alkaloids ; chemistry ; isolation & purification ; pharmacology ; Coagulants ; pharmacology ; Diterpenes ; chemistry ; isolation & purification ; pharmacology ; Humans ; Plant Extracts ; chemistry ; isolation & purification ; pharmacology ; Plant Roots ; chemistry ; Platelet Aggregation ; drug effects

BACKGROUNDAlthough low-molecular-weight heparin has replaced unfractionated heparin to become the primary anticoagulation drug for treatment of acute coronary syndrome, there is no convenient bedside monitoring method. We explored the best laboratory monitoring method of low-molecular-weight heparins (enoxaparin, dalteparin, and nadroparin) by use of the Sonoclot coagulation analyzer to monitor the activated clotting time.

METHODSA total of 20 healthy volunteers were selected and 15 ml of fasting venous blood samples were collected and incubated. Four coagulants, kaolin, diatomite, glass bead, and magnetic stick, were used to determine the activated clotting time of the low-molecular-weight heparins at different in vitro anti-Xa factor concentrations. A correlation analysis was made to obtain the regression equation. The activated clotting time of the different low-molecular-weight heparins with the same anti-Xa factor concentration was monitored when the coagulant glass beads were applied.

RESULTSThe activated clotting time measured using the glass beads, diatomite, kaolin, and magnetic stick showed a linear correlation with the concentration of nadroparin (r = 0.964, 0.966, 0.970, and 0.947, respectively). The regression equation showed that the linear slopes of different coagulants were significantly different (glass beads 230.03 s/IU, diatomite 89.91 s/IU, kaolin 50.87 s/IU, magnetic stick could not be calculated). When the concentration of the anti-Xa factor was the same for different low-molecular-weight heparins, the measured activated clotting time was different after the application of the glass bead coagulant.

CONCLUSIONSThe glass bead coagulant is most feasible for monitoring the in vitro anticoagulation activity of nadroparin. The different effects of different low-molecular-weight heparins on the activated clotting time may be related to the different anti-IIa activities.

Adult ; Anticoagulants ; pharmacology ; Blood Coagulation ; drug effects ; Blood Coagulation Tests ; Coagulants ; pharmacology ; Female ; Glass ; Heparin, Low-Molecular-Weight ; pharmacology ; Humans ; Kaolin ; pharmacology ; Male ; Middle Aged ; Nadroparin ; pharmacology

OBJECTIVETo describe the early experiences with rFVIIa in the management of bleeding after cardiovascular surgery.

METHODSFrom May 2006 through December 2007, 16 patients received rFVIIa during or after surgery despite conventional medical therapy and transfusion of blood products. There were 15 male patients and 1 female patients, aged from 36 to 77 years old with a mean of 52 years old. The surgical procedures include aortic procedures for 8 cases, valve replacement for 6 cases, pulmonary thromboendarterectomy for 1 case and atrial septal defect repair for 1 case. The data of these patients were reviewed and the safety and efficacy of rFVIIa after cardiovascular surgery were evaluated.

RESULTSrFVIIa was administered as a first dose of 27.6 to 54.5 microg/kg with a mean of 40.2 microg/kg. Six patients achieved hemostasis after the first dose. Nine patients received a second administration within 30 min, with a cumulative dose of 59.3 to 90.9 microg/kg, a mean of 80.3 microg/kg. Eight patients achieved hemostasis and 1 patient went to exploration. One patient received four doses of rFVIIa with a cumulative dose of 203.4 microg/kg and the bleeding stopped. Mean amount of chest drain loss and the amount of red blood cell, fresh frozen plasma, cryoprecipitate, and platelet transfusions decreased significantly after rFVIIa administration. The total amount of chest drain losses, transfusions of red blood cell and cryoprecipitate within 12 h postoperatively was positively correlated with the time from the end of bypass to administration of rFVIIa. No thromboembolic complications and other adverse reactions were noted.

CONCLUSIONSThe use of rFVIIa is associated with reduced blood loss, rapid improvement of coagulation variables, and decreased need for blood products. rFVIIa is safe and efficacious in the management of refractory postcardiotomy bleeding.

Adult ; Aged ; Cardiovascular Surgical Procedures ; Coagulants ; administration & dosage ; therapeutic use ; Factor VIIa ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; drug therapy ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Retrospective Studies

Procoagulant or impaired fibrinolytic states as well as inflammatory reactions mediated by cytokines are likely involved in the pathogenesis of acute ischemic stroke. We examined the potential relationship between interleukin 6 (IL-6) and hemostatic markers. The procoagulant and fibrinolytic states were assessed in 46 patients with acute stroke by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT), and plasminogen-antiplasmin complex (PAP). Circulating IL-6 levels were measured using ELISA (Quantikine, R and D systems, MN, USA). Circulating IL-6 (mean, 26.5 pg/mL) and PAI-1 (mean, 19.9 ng/mL) levels were higher in patients with acute stroke than in healthy subjects (mean, 3.0 pg/mL, 10.4 ng/mL, respectively). TAT levels were statistically different according to the etiologic subtypes of stroke (atherogenic, 2.5 ng/mL; lacunar 3.2 ng/mL; cardiogenic 9.9 ng/mL, p = 0.021). Neither procoagulant levels nor fibrinolytic markers significantly correlated with circulating IL-6 levels. Our findings suggest that elevated proinflammatory cytokines during the initial hours of ischemic stroke may be an independent pathogenic factor or a consequence of the thrombotic event with no relationship to the procoagulant or fibrinolytic states.
Thrombosis ; Thrombolytic Therapy ; Thrombin/chemistry ; Plasminogen Activator Inhibitor 1/blood ; Phospholipids/chemistry ; Models, Statistical ; Middle Aged ; Male ; Ischemia/*blood/*pathology ; Interleukin-6/*blood/metabolism ; Humans ; Hemostasis ; *Fibrinolysis ; Female ; Enzyme-Linked Immunosorbent Assay ; Cytokines/metabolism ; Coagulants/*metabolism ; Cerebrovascular Accident/*blood/*pathology ; Blood Coagulation Factors/metabolism ; Antithrombins/chemistry ; Aged ; Acute Disease

OBJECTIVE: To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software. RESULTS: A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [MD=-88.60, 95%CI(-260.30, 83.10), P=0.31], blood transfusion rate [OR=1.48, 95%CI(0.96, 2.27), P=0.08], thrombotic complications [OR=0.80, 95%CI(0.07, 8.83), P=0.85], per capita hemoglobin input [MD=0.04, 95%CI(-0.02, 0.10), P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [MD=-147.13, 95%CI(-216.52, -77.74), P<0.0001], the difference was statistically significant. The blood transfusion rate [OR=1.30, 95%CI(0.74, 2.28), P=0.37], thrombotic complications [OR=0.95, 95%CI(0.38, 2.36), P=0.92], per capita hemoglobin input [MD=-0.00, 95%CI(-0.05, 0.06), P=0.48], tourniquet time [MD=1.54, 95%CI(-2.07, 5.14), P=0.40] were similar between two groups, the difference was not statistically significant. CONCLUSION In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.
Aminocaproic Acid/therapeutic use* ; Antifibrinolytic Agents/therapeutic use* ; Arthroplasty, Replacement, Hip/methods* ; Arthroplasty, Replacement, Knee/methods* ; Blood Loss, Surgical/prevention & control* ; Hemoglobins ; Hemostatics ; Humans ; Tranexamic Acid/therapeutic use*