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ANTITHROMBIN AND HEPARIN ANTITHROMBIN PATTERNS IN PRE-THROMBOSIS AND THROMBOSIS

AMERICAN JOURNAL OF CLINICAL PATHOLOGY 1976年第3期65卷 384-389页

作者： INNERFIELD, I STONE, ML MERSHEIMER, W CLAUSS, RD GREENBERG, J NEW YORK MED COLL FLOWER & 5TH AVE HOSPDEPT MED5TH AVE 106TH STNEW YORKNY 10029 NEW YORK MED COLL THROMBOSIS RES LABNEW YORKNY 10029 NEW YORK MED COLL DEPT OBSTET & GYNECOLNEW YORKNY 10029 NEW YORK MED COLL DEPT SURGNEW YORKNY 10029 NEW YORK MED COLL DEPT PERIPHERAL VASC SURGNEW YORKNY 10029

An antithrombin assay (AA) and an antithrombin assay modified by the addition of heparin (H-AA) were performed using sera from healthy subjects, patients predisposed to thrombosis, and patients with thromboembolic disease. Characteristic AA, and H-AA patterns were found in each group. Normal controls and four of 39 "pill" patients (10%) had normal AA and H-AA findings (Pattern A). Normal AA, with "decreasing" H-AA (Pattern B) was found in sera of 31 of 39 "pill" patients (80%) and three patients who had non-embolic arterial occlusive disease. Low AA and "decreasing" H-AA (Pattern C) occurred in sera of four "pill"-takers (10%) and one patient who had an arterial embolus. Low AA and low H-AA (Pattern D) developed in sera of eight patients with thrombophlebitis and seven patients with pulmonary embolus. It is concluded that the AA and H-AA assays help to identify thrombosis-prone (Pattern C) and thrombotic (Pattern D) individuals for whom antiplatelet (aspirin; dipyridamole) or anticoagulant therapy might be beneficial.

关键词：抗凝血酶类/血液避孕药口服/药理学血栓栓塞/血液血栓性静脉炎/血液血栓形成/血液女(雌)性人类妊娠

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Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: Benefit of oral anticoagulants

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第5期33卷 1317-1322页

作者： Ferrari, E Vidal, R Chevallier, T Baudouy, M Pasteur Hosp Dept Cardiol Nice France

OBJECTIVES Our aim was to confirm the poor prognosis related to thoracic aortic plaques, in particular aortic debris, diagnosed by transesophageal echocardiography (TEE) and to evaluate patients' prognosis as a function of the antithrombotic treatment. BACKGROUND Aortic atheroma (AA) has been widely studied. However, it is still not known which antithrombotic treatment should be adopted in this disease. METHODS Patients referred for TEE and diagnosed with AA were followed. All thromboembolic events and deaths were recorded during a follow-up of 22 +/- 10 months. The antithrombotic treatment to be adopted was left to the discretion of the practitioner in charge of the patient. RESULTS Aortic atheroma was found in 12% of all TEE performed and in 27.5% of TEE performed for stroke. This prevalence was higher when no other etiology existed to explain the stroke (p < 0.001). During follow-up, an end point occurred in 22.5% of patients. The more severe the AA the greater the incidence of events (p = 0.007). A higher mortality rate is shown in patients with aortic debris (p = 0.049). Compared with those treated with oral anticoagulants, patients with aortic plaques >4 mm thick treated with antiplatelets had more embolic events and combined events (p = 0.01 and p = 0.007, relative risk [RR] = 5.9, 95% confidence interval [CI] = 1.4 to 15, respectively);patients with aortic debris had more combined events and a higher mortality rate (p = 0.001, RR = 7.1, 95% CI = 1.2 to 19 and p = 0.019, RR = 9.1, 95% CI = 1.2 to 25, respectively). CONCLUSIONS We confirm the high incidence of vascular events and deaths in patients with AA. We have demonstrated, for the first time in this condition, a better outcome among patients treated with oral anticoagulants Versus antiplatelets. (C) 1999 by the American College of Cardiology.

关键词：投药口服抗凝药/投药和剂量主动脉胸/诊断显像主动脉疾病/并发症主动脉疾病/诊断显像主动脉疾病/药物疗法主动脉疾病/流行病学动脉硬化/并发症动脉硬化/诊断显像动脉硬化/药物疗法动脉硬化/流行病学超声心动描记术经食管随访研究发病率患病率预后回顾性研究疾病严重程度指数存活率血栓栓塞/血液血栓栓塞/流行病学血栓栓塞/病因学老年人女(雌)性人类男(雄)性

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Simulation of particle-hemodynamics in a partially occluded artery segment with implications to the initiation of microemboli and secondary stenoses

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JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME 1998年第4期120卷 446-454页

作者： Buchanan, JR Kleinstreuer, C N Carolina State Univ Dept Mech & Aerosp Engn Raleigh NC 27695 USA

Computational results of laminar incompressible blood-particle flow analyses in an axisymmetric artery segment with a smooth local area constriction of 75 percent have been presented. The flow input waveform was sinusoidal with a nonzero average. The non-Newtonian behavior of blood was simulated with a modified Quemada model, platelet concentrations were calculated with a drift-flux model, and monocyte trajectories were described and compared for both Newtonian and Quemada rheologies. Indicators of ''disturbed flow'' included the time-averaged wall shear stress (WSS), the oscillatory shear index (OSI), and the wall shear stress gradient (WSSG). Implications of the vortical flow patterns behind the primary stenosis to the formation of microemboli and downstream stenoses are as follows. Elevated platelet concentrations due to accumulation in recirculation zones mixed with thrombin and ADP complexes assumed to be released upstream in high wall shear stress regions, could form microemboli, which are convected downstream. Distinct near-wall vortices causing a local increase in the WSSG and OSI as well as blood-particle entrainment with possible wall deposition, indicate sites susceptible to the onset of an additional stenosis proximal to the initial geometric disturbance.

关键词：算法动脉闭塞性疾病/血液动脉闭塞性疾病/并发症动脉闭塞性疾病/病理生理学模型心血管单核细胞/生理学数值分析计算机辅助示波测量法血小板计数结果可重复性流变学应力物理凝血酶/生理学血栓栓塞/血液血栓栓塞/病因学血栓栓塞/病理生理学人类

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Role of the 807 C T polymorphism of the α₂ gene in platelet GP Ia collagen receptor expression and function -: Effect in thromboembolic diseases

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THROMBOSIS AND HAEMOSTASIS 1999年第6期81卷 951-956页

作者： Corral, J González-Conejero, R Rivera, J Ortuño, F Aparicio, P Vicente, V Hosp Gen Univ Sch Med Unit Oncohematol & Hemotherapy Murcia Spain Hosp Gen Univ Sch Med Dept Biochem Murcia Spain

The variability of the platelet GP Ia/IIa density has been associated with the 807 C/T polymorphism (Phe 224) of,the GP Ia gene in American Caucasian population. We have investigated the genotype and allelic frequencies of this polymorphism in Spanish Caucasians. The T allele was found in 35% of the 284 blood donors analyzed. We confirmed in 159 healthy subjects a significant association between the 807 C/T polymorphism and the platelet GP Ia density. The T allele correlated with high number of GP Ia molecules on platelet surface. In addition, we observed a similar association of this polymorphism with the expression of this protein in other brood cell types. The platelet responsiveness to collagen was determined by "in vitro" analysis of the platelet activation and aggregation response. We found no significant differences in these functional platelet parameters according to the 807 CIT genotype. Finally, results from 3 case/control studies involving 302 consecutive patients (101 with coronary heart disease, 104 with cerebrovascular disease and 97 with deep venous thrombosis) determined that the 807 CIT polymorphism of the GP Ia gene does not represent a risk factor for arterial or venous thrombosis.

关键词：抗原 CD/血液抗原 CD/遗传学冠心病/血液冠心病/遗传学欧洲大陆世系人群整合素α2 整合素类/遗传学突变血小板活化/遗传学多态现象遗传受体胶原危险因素血栓栓塞/血液血栓栓塞/遗传学老年人女(雌)性人类男(雄)性中年人

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Thromboembolism and resistance to activated protein C in patients with inflammatory bowel disease

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第3期94卷 685-690页

作者： Novacek, G Miehsler, W Kapiotis, S Katzenschlager, R Speiser, W Vogelsang, H Univ Vienna Dept Internal Med 4 Div Gastroenterol & Hepatol A-1090 Vienna Austria Univ Vienna Clin Inst Med & Chem Lab Diagnost A-1090 Vienna Austria Univ Vienna Dept Internal Med 2 Div Angiol A-1090 Vienna Austria

OBJECTIVE: Thromboembolic events are serious complications in patients with inflammatory bowel disease (IBD). Resistance of factor V to degradation by activated protein C (APC) is a major cause for venous thrombosis and is found in approximately 30% of patients with thromboembolism. The aim of the present study was to assess the prevalence of APC resistance and clinical risk factors in patients with IBD. METHODS: One-hundred-two patients with IBD (64 women and 38 men;median age, 35 yr;range, 17-77 yr;77 with Crohn's disease, 25 with ulcerative colitis) and 102 gender- and age-matched healthy control subjects were investigated prospectively for the presence of APC resistance. None of the healthy controls but 16 patients with IBD had a history of thromboembolism. RESULTS: Patients with IBD and thromboembolism were young, with a median age of 37 yr (range, 17-61 yr). Five (31.3%) of them had APC resistance, which was more common than in patients with IBD without thromboembolism (7%) and in controls (5.9%) (p < 0.01). Three patients had two thromboembolic events, the other 13 each had one. Deep vein thrombosis of the leg and pulmonary emboli were the most common thromboembolic complications (84.2%). Active disease, fistula, or bowel stenosis were found in 10 (52.6%) of 19 thromboembolic events;in three (15.8%) cases thromboembolism happened postoperatively. CONCLUSIONS: APC resistance is not associated with IBD but, when present, increases the risk of thromboembolism. Patients with IBD and thromboembolism are mostly young and clinical risk factors can be found in one-half of cases. (Am J Gastroenterol 1999;94:685-690. (C) 1999 by Am. Cell. of Gastroenterology).

关键词：活化蛋白C抵抗/并发症抗凝血酶Ⅲ/分析 C反应蛋白质/分析纤维蛋白原/分析炎性肠疾病/血液炎性肠疾病/并发症危险因素血栓栓塞/血液血栓栓塞/病因学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Homocysteine in inflammatory bowel disease: A risk factor for thromboembolic complications?

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第10期95卷 2825-2830页

作者： Oldenburg, B Fijnheer, R van der Griend, R vanBerge-Henegouwen, GP Koningsberger, JC Univ Med Ctr Utrecht Dept Gastroenterol NL-3584 CX Utrecht Netherlands Univ Med Ctr Utrecht Dept Hematol NL-3584 CX Utrecht Netherlands

OBJECTIVE: Patients with inflammatory bowel disease (IBD) are at increased risk for thromboembolic events. Hyperhomocysteinemia, which is an established risk factor for arterial as well as venous thrombosis, may be more prevalent in IBD because of vitamin deficiencies. METHODS: In this retrospective study, we studied the concentrations of total homocysteine (tHcy), cobalamin, folate, and pyridoxine in 231 consecutive patients with IBD, of whom 16 patients had a history of venous thrombosis, and nine a history of arterial thrombosis. Age- and gender-matched healthy volunteers served as controls (n = 102). RESULTS: Homocysteine concentrations in patients were higher (12.3 mu mol/L [range 4.6-51.3] vs 11.1 mu mol/L [range 3.9-27.6], p = 0.001) and hyperhomocysteinemia tended to be more prevalent in patients than in the controls (11.1% vs 5%, p = 0.07). Folate, cobalamin, creatinine, and pyridoxine concentrations were correlated with tHcy. Folate deficiency was infrequently encountered in IBD patients (4.3%). The tHcy concentration in patients with a history of venous or arterial thrombosis was not higher than in patients without a history of thrombosis (12.7 mu mol/L [range 4.6-40.1] and 15.2 mu mol/L (range 10.5-26.8) vs 12.3 mu mol/L [range 10.5-26.8], not significant). Hyperhomocysteinemia was found in 18.8% of the patients with venous thrombosis, 11.1% of the patients with arterial thrombosis, and 10.5% of the patients without thrombosis (not significant). CONCLUSIONS: Hyperhomocysteinemia is a common phenomenon in IBD and correlates with serum folate, cobalamin, creatinine, and pyridoxine concentrations. No correlation between tHcy and a history of venous or arterial thromboembolic complications is found. Hyperhomocysteinemia does not seem to be a major contributory factor in the development of venous or arterial thrombosis in IBD patients. (Am J Gastroenterol 2000;95:2825-2830. (C) 2000 by Am. Coll. of Gastroenterology).

关键词：结肠炎溃疡性/血液结肠炎溃疡性/并发症 Crohn病/血液 Crohn病/并发症高半胱氨酸/血液参考值回顾性研究危险因素血栓栓塞/血液血栓栓塞/病因学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Use of Enoxaparin for the chronically anticoagulated patient before and after procedures

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期84卷 478-+页

作者： Spandorfer, JM Lynch, S Weitz, HH Fertel, S Merli, GJ Thomas Jefferson Univ Coll Med Div Internal Med Philadelphia PA 19107 USA Thomas Jefferson Univ Coll Med Div Cardiol Philadelphia PA 19107 USA

Warfarin is used to either treat or prevent thromboembolism;currently >1 million people are taking this anticoagulant.(1) Patients maintained on warfarin may occasionally need to stop their anticoagulation during invasive procedures. All techniques to manage anticoagulation during procedures may be problematic.(2-4) After stopping warfarin, unfractionated heparin, either high-dose subcutaneous or intravenous, may be started once the international normalized ratio (INR) becomes subtherapeutic. Either form of heparin requires monitoring and often several adjustments before becoming therapeutic. Moreover, most physicians prefer intravenous heparin to be given in the inpatient setting, thus increasing costs. Another approach is to lower the dose of warfarin by approximately one third and perform the invasive procedure when the INR is approximately 1.5. The INR can also be lowered by adding a small dose of vitamin K. This method, however, may carry an increased risk for bleeding, even for less vascular procedures. Also, the use of vitamin K may lead to temporary warfarin resistance. A last option is to hold warfarin 4 to 5 days before the procedure and not to use any anticoagulant until the postoperative period. However, this method may carry a risk for thrombotic complications. The use of enoxaparin may avoid these limitations. It can be given subcutaneously and therefore does not require hospitalization perioperatively. Reports show that low molecular weight heparin, such as enoxaparin, is at least as effective and safe as unfractionated heparin in the prevention and treatment of thrombosis.(5,6) This report details our experience to date using enoxaparin for chronically anticoagulated patients.

关键词：抗凝药/治疗应用依诺肝素/治疗应用前瞻性研究问卷调查危险因素血栓栓塞/血液血栓栓塞/病因学血栓栓塞/预防和控制治疗结果华法林/治疗应用成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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AMOUNT AND DISTRIBUTION PATTERN OF SOLUBLE FIBRIN MONOMER COMPLEXES DURING EARLY PUERPERIUM

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1976年第1期124卷 21-24页

作者： GRAEFF, H WIEDEMANN, A HUGO, RV HAFTER, R UNIV MUNICH FRAUEN KLIN 1MAI STR 11D-8 MUNICHFED REP GER

Soluble fibrin monomer complexes (SFMC) were determined in 12 patients following delivery, 2, 4, 6 days and 3 months post partum. Quantitative gel filtration (4 per cent agarose) of the β-alanine-precipitated plasma samples yielded the relative (per cent of the total fibrinogen content) and absolute (milligrams per 100 ml. of plasma) amount of SFMC. During the early puerperium the amount of SFMC remained essentially constant, with average postpartum values of 6.3 ± 1.2 per cent and 27.6 ± 9.1 mg. per 100 ml. (mean and standard deviation). Three months after delivery the level of SFMC was significantly (p < 0.001) decreased (3.3 ± 1.3 per cent and 8.4 ± 3.4 mg. per 100 ml.). The quantitative estimation of SFMC in the early puerperium as presented in this study indicates that a state of hypercoagulability can be evaluated by measuring the thrombin-mediated catabolic products of fibrinogen.

关键词：纤维蛋白/分析纤维蛋白原/分析产后期产褥期疾病/血液血栓栓塞/血液成年人女(雌)性人类妊娠

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RECURRENT THROMBOEMBOLISM WITH SPONTANEOUS PLATELET-AGGREGATION

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THROMBOSIS AND HAEMOSTASIS 1976年第3期36卷 645-646页

作者： SCROBOHACI, ML CUNESCU, V ORHA, I CTR CARDIOL BUCHAREST ROMANIA

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HYPERAGGREGABILITY OF PLATELETS IN THROMBOEMBOLIC DISORDERS

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THROMBOSIS AND HAEMOSTASIS 1976年第2期36卷 479-482页

作者： ZAHAVI, J ICHILOV MUNICIPAL GOVT HOSP MED DEPT BTEL AVIVISRAEL TEL AVIV UNIV SCH MEDTEL AVIVISRAEL

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