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Thrombin Hemostatic

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1121. Dietary soy containing phytoestrogens does not activate the hemostatic system in postmenopausal women. Full Text available with Trip Pro

Dietary soy containing phytoestrogens does not activate the hemostatic system in postmenopausal women. The soybean is rich in isoflavone phytoestrogens, which are ligands for estrogen receptors, but it is unknown whether soy/phytoestrogens have similar procoagulant effects to estrogen. In this randomized double-blind trial, 40 healthy postmenopausal women of age 50-75 yr received soy protein isolate (40 g soy protein, 118 mg isoflavones) (n = 19) or casein placebo (n = 21). Plasma markers (...) of coagulation, fibrinolysis, and endothelial dysfunction were measured at baseline and 3 months. The baseline characteristics of the two groups were similar. Compared with casein placebo, soy decreased triglycerides (P < 0.005) and low-density lipoprotein/high-density lipoprotein ratio (P < 0.001) and increased lipoprotein (a) (P < 0.05). Activity of coagulation factor VII (VIIc) decreased similarly in both groups (P < 0.005). Prothrombin fragments 1 + 2 (a marker of thrombin generation) decreased

2005 The Journal of clinical endocrinology and metabolism Controlled trial quality: uncertain

1122. New Generation Tissue Sealants and Hemostatic Agents: Innovative Urologic Applications Full Text available with Trip Pro

New Generation Tissue Sealants and Hemostatic Agents: Innovative Urologic Applications Control of blood loss during urologic surgery is paramount to the success of patient recovery. Hemostatic agents and tissue sealants are used routinely to prevent excess blood loss and in reconstruction during surgical repair. Some of the available products include thrombin sealant, fibrin glue, bovine serum/albumin/glutaraldehyde, and gelatin matrix. Each of these agents differs in mechanism, cost (...) , and application. Complications can include allergic reactions or thromboembolism and the risk of contracting bovine spongiform encephalitis or hepatitis. Many new hemostatic agents are being developed and approved. The benefits and risks of use of these agents versus conventional treatment need to be considered on a case-by-case basis by the surgeon.

2006 Reviews in urology

1123. Evaluation of FloSeal as a potential intracavitary hemostatic agent. Full Text available with Trip Pro

Evaluation of FloSeal as a potential intracavitary hemostatic agent. Noncompressible hemorrhage is a major cause of death in combat and civilian trauma. When surgery is unavailable, one potential solution to such hemorrhage might be the introduction of an agent into the closed body cavity to provide hemostasis via a combination of coagulative and tamponade effects. FloSeal is an agent containing collagen and thrombin with proven hemostatic efficacy when applied with manual pressure (...) medial lobes ( approximately 1% of body weight) were rapidly excised. FloSeal (5 mL, 800 units Thrombin/mL) or vehicle (5 mL, 0.9% NaCl) was directly and immediately applied to the cut liver surface. The abdominal cavity was closed and resuscitation initiated. After hemorrhage-induced death, or after euthanasia at 90 minutes, fluid loss (blood + resuscitation fluid) was measured.Compared with the control group, direct and immediate application of FloSeal was associated with a reduction in the amounts

2006 Journal of Trauma

1124. Predicting the severity of systemic inflammatory response syndrome (SIRS)-associated coagulopathy with hemostatic molecular markers and vascular endothelial injury markers. (Abstract)

Predicting the severity of systemic inflammatory response syndrome (SIRS)-associated coagulopathy with hemostatic molecular markers and vascular endothelial injury markers. The changes in biomarkers of coagulation or fibrinolysis, anticoagulation, inflammation, and endothelial damage occur in patients with systemic inflammatory response syndrome (SIRS). The purpose of this study is to assess the prognostic value of these markers in patients with SIRS-associated hypercoagulopathy.Sixty-six SIRS (...) patients with a platelet count less than 15.0 x 10(4)/mm3 in three university hospital intensive care units were enrolled in this prospective, comparative study. Blood samples were obtained on day 0 and day 2. Twelve hemostatic, inflammatory, and vascular endothelial indices were measured and the data were compared between the severe group (patients with a total maximum Sequential Organ Failure Assessment score of 10 or more and nonsurvivors; n = 25) and the less-severe group (Sequential Organ Failure

2007 Journal of Trauma

1125. Assessment of hemostatic activation during cardiopulmonary bypass for coronary artery bypass grafting with bivalirudin: results of a pilot study. Full Text available with Trip Pro

Assessment of hemostatic activation during cardiopulmonary bypass for coronary artery bypass grafting with bivalirudin: results of a pilot study. Bivalirudin has been successfully used as a replacement for heparin during on-pump coronary artery bypass grafting. This study was conducted to assess the effects of the currently suggested protocol for bivalirudin on hemostatic activation during cardiopulmonary bypass with and without cardiotomy suction.Ten patients scheduled for coronary artery (...) fragments, thrombin-antithrombin, and factor XIIa were determined.Values for factor XIIa remained almost unchanged in both groups, indicating a minor effect of contact activation. In patients without cardiotomy suction, post-cardiopulmonary bypass values for D-dimers, fibrinopeptide A, prothrombin 1 and 2 fragments, and thrombin-antithrombin were not significantly increased compared with pre-cardiopulmonary bypass values. In patients with cardiotomy suction, values obtained for these parameters had

2005 Journal of Thoracic and Cardiovascular Surgery

1126. Clinical and hemostatic responses to treatment in ventilator-associated pneumonia: role of bacterial pathogens. (Abstract)

Clinical and hemostatic responses to treatment in ventilator-associated pneumonia: role of bacterial pathogens. To determine pathogen-specific kinetic changes in the alveolar procoagulant (PC) activity, tissue factor (TF), and tissue factor pathway inhibitor (TFPI) expression during the course of ventilator-associated pneumonia (VAP) and to assess the relationship between clinical resolution, intra-alveolar bacterial eradication, and restoration of hemostatic balance.Prospective, multiple (...) -center study in a cohort of VAP patients.Two university-affiliated intensive care units.Thirty-five patients with microbiologically documented VAP who received adequate antimicrobial coverage and 13 controls.Nonbronchoscopic bronchoalveolar lavage was performed at the onset of VAP and on days 4 and 8 after initiation of antibiotic therapy. Samples were assayed for PC, TF, TFPI, and thrombin-antithrombin complex (TATc). The corresponding Clinical Pulmonary Infection Score (CPIS) was collected

2007 Critical Care Medicine

1127. Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression. Full Text available with Trip Pro

recruited. Progressing stroke was defined by deterioration in components of the Scandinavian Stroke Scale. Hemostatic markers (coagulation factors VIIc, VIIIc, and IXc, prothrombin fragments 1+2 [F1+2], thrombin-antithrombin complexes [TAT], D-dimer, fibrinogen, von Willebrand factor [vWF] and tissue plasminogen activator) were measured within 24 hours of symptom recognition.Fifty-four (25%) of the 219 patients met criteria for progressing stroke. F1+2 (median 1.28 versus 1.06 nmol/L, P=0.01), TAT (5.28 (...) predictors of progressing stroke.There is evidence of excess thrombin generation and fibrin turnover in patients with progressing ischemic stroke. Measurement of D-dimer levels can identify patients at high risk for stroke progression. Further research is required to determine whether such patients benefit from acute interventions aimed at modifying hemostatic function.

2004 Stroke

1128. Change in Hemostatic Markers After Recombinant Tissue-Type Plasminogen Activator Is Not Associated With the Chance of Recanalization. Full Text available with Trip Pro

Change in Hemostatic Markers After Recombinant Tissue-Type Plasminogen Activator Is Not Associated With the Chance of Recanalization. We evaluated the association between recombinant tissue-type plasminogen activator recanalization and change in hemostatic markers.We studied 40 patients. Recanalization was measured with transcranial Doppler. We evaluated the change in markers of coagulation (fibrinogen) and fibrinolysis (thrombin activatable fibrinolysis inhibitor and alpha(2)-antiplasmin (...) ) in patients with ischemic stroke treated with recombinant tissue-type plasminogen activator. Samples were obtained before and 90 minutes after recombinant tissue-type plasminogen activator infusion.The analyses (2-way analysis of variance) showed that the change in the value of each marker did not depend on the vascular patency status.From a practical point of view, the measurement of these hemostatic markers is probably not useful for predicting recanalization.

2007 Stroke

1129. Hemostatic activation and outcome after recombinant tissue plasminogen activator therapy for acute ischemic stroke. Full Text available with Trip Pro

Hemostatic activation and outcome after recombinant tissue plasminogen activator therapy for acute ischemic stroke. Early thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rtPA) improves clinical outcome in acute ischemic stroke (AIS), but impaired endogenous fibrinolysis, thrombin generation, and vascular injury may hamper the efficacy of thrombolysis. We investigated in an exploratory, post hoc analysis the relationship between hemostatic markers and clinical (...) outcomes among patients included in the National Institute of Neurological Disorders and Stroke (NINDS) rtPA Stroke Study.Tissue plasminogen activator (tPA) antigen, thrombin-antithrombin complex (TAT), soluble thrombomodulin, and fibrinogen levels were measured in patients with AIS included in the NINDS rtPA Stroke Study from plasma samples collected at baseline, at 2 hours after treatment, and after 24 hours.TAT and tPA antigen levels peaked at 2 hours selectively in the rtPA treatment group, whereas

2006 Stroke

1130. Pretreatment hemostatic markers of symptomatic intracerebral hemorrhage in patients treated with tissue plasminogen activator. Full Text available with Trip Pro

Pretreatment hemostatic markers of symptomatic intracerebral hemorrhage in patients treated with tissue plasminogen activator. Symptomatic intracerebral hemorrhage (ICH) is a major complication of thrombolysis in patients with acute ischemic stroke. We analyzed whether baseline hemostatic markers could predict symptomatic ICH (SICH).In a multicenter study of patients treated with intravenous tissue plasminogen activator (t-PA) within 3 hours of stroke onset, we analyzed the following variables (...) , plasminogen activator inhibitor-1 (PAI-1), and thrombin-activatable fibrinolysis inhibitor. ICH was classified according to the European Cooperative Acute Stroke Study (ECASS) II criteria. SICH was defined as a parenchymal hematoma-1 (PH1) or PH2 type, associated with an increase in > or =4 points on the NIHSS score appearing within 36 hours after infusion.We studied 114 patients. Mean age was 68.4+/-12.7 years, and 61% were men. The median baseline NIHSS score was 14. Mean time to treatment was 153+/-33

2006 Stroke

1131. Antithrombin affects hemostatic response to recombinant activated factor VII in factor VIII deficient plasma. (Abstract)

Antithrombin affects hemostatic response to recombinant activated factor VII in factor VIII deficient plasma. Thromboembolic complications can occur with recombinant activated factor VII (rFVIIa) treatment in trauma and surgical patients but they are infrequent in hemophiliacs. Bleeding diathesis in these conditions is often attributed to reduced thrombin generation, which may be improved with rFVIIa. Normally, thrombin that diffuses from local vascular injury sites is quickly inactivated (...) of thrombin generated.Using FVIII-deficient plasma as a model of reduced thrombin generation, we demonstrate that low AT levels enhance in vitro hemostatic responses to rFVIIa. Reduced AT levels in trauma and surgical patients with normal or increased FVIII levels may be considered potentially prothrombotic. Monitoring of AT levels during rFVIIa therapy may thus reduce thrombotic complications in nonhemophiliacs.

2008 Anesthesia and Analgesia

1132. Extended monitoring of hemostatic activation after varicose vein surgery under general anesthesia. (Abstract)

Extended monitoring of hemostatic activation after varicose vein surgery under general anesthesia. Postoperative heparin prophylaxis after stripping of the long saphenous vein is a matter of controversial discussion, and practices vary by surgeon and country.The aim of this study was to assess the extent of hypercoagulability by continued monitoring of activation markers of coagulation and fibrinolysis for a period of 3 weeks after stripping of the long saphenous vein and concomitant (...) phlebectomy.Including 21 patients, the following markers were measured preoperatively and on postoperative day 1, 2, 3, 7, 14, and 21: Activation products of coagulation: thrombin-antithrombin complex (TAT), thrombus precursor protein (TPP), and prothrombin-fragment F1+2 (F1+2), and markers of fibrinolysis: plasmin-alpha(2)-antiplasmin complexes (PAP), D-Dimer, tissue plasminogen activator (t-PA) antigen, and plasminogen activator inhibitor 1 (PAI-1) antigen.TAT levels increased significantly until day 3 (p=.008

2006 Dermatologic Surgery

1133. Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA. (Abstract)

Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA. To determine whether pretreatment markers of coagulation and fibrinolysis are related to recanalization and functional outcome.The authors included patients treated with IV rt-PA with occlusion on baseline transcranial Doppler (Thrombolysis in Brain Ischemia [TIBI] criteria) in whom recanalization within 6 hours was monitored. At baseline, the authors recorded data about demographics, vascular risk factors (...) , the NIH Stroke Scale (NIHSS) score, early CT signs, etiology, blood glucose, and time to rt-PA. The authors also measured plasmatic markers of coagulation (fibrinogen, prothrombin fragments 1 + 2, Factor XIII, Factor VII) and fibrinolysis (alpha2-antiplasmin, Plasminogen Activator Inhibitor, Functional Thrombin Activatable Fibrinolysis Inhibitor [fTAFI]). A favorable outcome was defined as a modified Rankin score < 2 at 3 months.The authors studied 63 patients with a mean age of 67.3 +/- 12.5 years

2005 Neurology

1134. Progesterone and its metabolite allopregnanolone differentially regulate hemostatic proteins after traumatic brain injury. Full Text available with Trip Pro

Progesterone and its metabolite allopregnanolone differentially regulate hemostatic proteins after traumatic brain injury. Our laboratory has shown in numerous experiments that the neurosteroids progesterone (PROG) and allopregnanolone (ALLO) improve molecular and functional outcomes after traumatic brain injury (TBI). As coagulopathy is an important contributor to the secondary destruction of nervous tissue, we hypothesized that PROG and ALLO administration may also have a beneficial effect (...) on coagulation protein expression after TBI. Adult male Sprague-Dawley rats were given bilateral contusions of the medial frontal cortex followed by treatments with PROG (16 mg/kg), ALLO (8 mg/kg), or vehicle (22.5% hydroxypropyl-beta-cyclodextrin). Controls received no injury or injections. Progesterone generally maintained procoagulant (thrombin, fibrinogen, and coagulation factor XIII), whereas ALLO increased anticoagulant protein expression (tissue-type plasminogen activator, tPA). In addition, PROG

2008 Journal of Cerebral Blood Flow and Metabolism

1135. Reducing hemostatic activation during cardiopulmonary bypass: a combined approach. (Abstract)

Reducing hemostatic activation during cardiopulmonary bypass: a combined approach. Interventions such as heparin-coated circuits, epsilon-aminocaproic acid, and reduced shed blood reinfusion have shown mixed results when applied individually for limiting hemostatic activation during cardiopulmonary bypass (CPB). We compared coagulation and fibrinolytic activation during conventional CPB (control) (CTRL) using noncoated circuits, no antifibrinolytics, and open cardiotomy with a combined strategy (...) (HAC) that used heparin-coated circuits, epsilon-aminocaproic acid, and closed cardiotomy. Blood samples were drawn before, during, and after CPB for primary coronary bypass grafting surgery from 9 CTRL patients and 10 HAC patients. Thrombin-antithrombin complex and fibrinopeptide A levels (markers of thrombin and fibrin generation) were reduced in the HAC versus CTRL group after 30 min of CPB (P < 0.05). Average tissue plasminogen activator (tPA) levels were significantly lower in the HAC group

2004 Anesthesia and Analgesia

1136. Effect of combined anticoagulation using heparin and bivalirudin on the hemostatic and inflammatory responses to cardiopulmonary bypass in the rat. (Abstract)

Effect of combined anticoagulation using heparin and bivalirudin on the hemostatic and inflammatory responses to cardiopulmonary bypass in the rat. Despite high-dose heparin anticoagulation, cardiopulmonary bypass (CPB) is still associated with marked hemostatic activation. The purpose of this study was to determine whether a reduced dose of bivalirudin, added as an adjunct to heparin, would reduce thrombin generation and circulating markers of inflammatory system activation during CPB (...) as effectively as full-dose bivalirudin, without adversely affecting postoperative hemostasis.Using a model of normothermic CPB in rats, the authors prospectively compared markers of thrombin generation (thrombin-antithrombin complexes) and inflammatory markers (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, and interleukin 10) in three groups: conventional high-dose heparin (H), full-dose bivalirudin (B), and a combined group (standard high-dose heparin with the addition of reduced dose

2007 Anesthesiology

1137. No Prognostic Importance of Resistance to Activated Protein C in Unstable Coronary Artery Disease Despite Signs of Thrombin Activation. (Abstract)

No Prognostic Importance of Resistance to Activated Protein C in Unstable Coronary Artery Disease Despite Signs of Thrombin Activation. Resistance to activated protein C (APC resistance) is the single most important hemostatic defect associated with venous thromboembolic disease. However, little is. Known about this defect in arterial disease. The aim of this study was thus to investigate the frequency and prognostic importance of APC resistance and its influence on the coagulation system (...) disease. The APC ratio was assayed using a modified activated partial thromboplastin time reaction method to measure the response to activated protein C. APC resistance was defined as an APC ratio thrombin activation were measured by prothrombin fragment 1+2 levels. The 7.2% (23/318) occurrence of APC resistance found in patients did not differ from the 5.8% (4/69) level in the reference population (P = 0.16). A significant elevation of the prothrombin fragment 1+2 median level of 2.5

1998 Journal of thrombosis and thrombolysis Controlled trial quality: uncertain

1138. Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms Full Text available with Trip Pro

Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms 10836833 2000 05 30 2008 11 20 1468-201X 83 5 2000 May Heart (British Cardiac Society) Heart Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms. 582 Ferguson J D JD Banning A P AP eng Comment Letter England Heart 9602087 1355-6037 0 Hemostatics EC 3.4.21.5 Thrombin AIM IM Heart. 1999 Oct;82(4):526-7 10490575 Aneurysm, False drug therapy Hemostatics (...) administration & dosage adverse effects Humans Thrombin adverse effects Ultrasonography, Interventional 2000 6 3 2000 6 3 0 1 2000 6 3 0 0 ppublish 10836833 PMC1760831

2000 Heart

1139. Immunologic Impact and Clinical Outcomes After Surgical Exposure to Bovine Thrombin Full Text available with Trip Pro

Immunologic Impact and Clinical Outcomes After Surgical Exposure to Bovine Thrombin To determine prospectively the immunologic response and adverse clinical events in surgical patients exposed to bovine thrombin during cardiac surgical procedures.Topical bovine thrombin is used extensively as a hemostatic agent during cardiovascular surgery. Antibodies developing after exposure to bovine thrombin have been anecdotally associated with hemorrhagic complications.One hundred fifty-one patients (...) undergoing cardiac surgical procedures were prospectively recruited for this study before surgical exposure with topical bovine thrombin. Immunoassays were used to determine antibody levels against both bovine and human coagulation proteins before and after exposure to bovine thrombin. Alterations in coagulation assay parameters and adverse clinical events were followed in all patients enrolled in the study.Baseline elevated antibody levels to one or more bovine coagulation proteins were observed most

2001 Annals of Surgery

1140. Effects of estrogen replacement therapy on thrombin generation. (Abstract)

Effects of estrogen replacement therapy on thrombin generation. The aim of this study was to investigate the hemostatic system in menopausal women before and after three months of treatment with transdermal estradiol (TTS 50, 50 micrograms/die, n = 13) or coniugated equine estrogen (CEE, 0.625 mg/die, n = 9) by evaluating : beta-thromboglobulin, platelet factor 4, factor VIIag, factor VIIc, fibrinopeptide A-FPA-, thrombin-antithrombin-TAT-complexes, antithrombin-AT-activity, protein C, plasma

1997 Thrombosis research Controlled trial quality: uncertain

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