RESUMO
Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.
Assuntos
Tempo de Protrombina/métodos , Mordeduras de Serpentes/diagnóstico , Transtornos da Coagulação Sanguínea/diagnóstico , Fatores de Coagulação Sanguínea/análiseRESUMO
A better understanding of the proteome profile after bipolar disorder (BD) and schizophrenia (SCZ) treatment, besides monitoring disease progression, may assist on the development of novel therapeutic strategies with the ability to reduce or control possible side effects. In this pilot study, proteomics analysis employing nano liquid chromatography coupled to mass spectrometry (nLC-MS) and bioinformatic tools were applied to identify differentially abundant proteins in serum of treated BD and SCZ patients. In total, 10 BD patients, 10 SCZ patients, and 14 healthy controls (HC) were included in this study. 24 serum proteins were significantly altered (p < 0.05) in BD and SCZ treated patients and, considering log2FC > 0.58, 8 proteins presented lower abundance in the BD group, while 7 proteins presented higher abundance and 2 lower abundance in SCZ group when compared against HC. Bioinformatics analysis based on these 24 proteins indicated two main altered pathways previously described in the literature; furthermore, it revealed that opposite abundances of the complement and coagulation cascades were the most significant biological processes involved in these pathologies. Moreover, we describe disease-related proteins and pathways associations suggesting the necessity of clinical follow-up improvement besides treatment, as a precaution or safety measure, along with the disease progression. Further biological validation and investigations are required to define whether there is a correlation between complement and coagulation cascade expression for BD and SCZ and cardiovascular diseases.
Assuntos
Transtorno Bipolar/patologia , Fatores de Coagulação Sanguínea/análise , Proteínas do Sistema Complemento/análise , Esquizofrenia/patologia , Adulto , Biomarcadores Farmacológicos , Transtorno Bipolar/sangue , Transtorno Bipolar/imunologia , Fatores de Coagulação Sanguínea/metabolismo , Proteínas Sanguíneas/análise , Cromatografia Líquida/métodos , Proteínas do Sistema Complemento/metabolismo , Biologia Computacional/métodos , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Masculino , Espectrometria de Massas/métodos , Projetos Piloto , Proteômica/métodos , Esquizofrenia/sangue , Esquizofrenia/imunologiaRESUMO
OBJECTIVE: The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways. METHODS: We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure. RESULTS: Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21). CONCLUSION: Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Coagulação Sanguínea/fisiologia , Fibrinólise/fisiologia , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Biomarcadores/sangue , Fatores de Coagulação Sanguínea/análise , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência , Fatores de Risco , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Abstract Objective: The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways. Methods: We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure. Results: Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21). Conclusion: Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Coagulação Sanguínea/fisiologia , Aneurisma da Aorta Abdominal/cirurgia , Doença Arterial Periférica/cirurgia , Fibrinólise/fisiologia , Período Pós-Operatório , Valores de Referência , Fatores de Coagulação Sanguínea/análise , Ensaio de Imunoadsorção Enzimática , Biomarcadores/sangue , Projetos Piloto , Fatores de Risco , Resultado do Tratamento , Estatísticas não Paramétricas , Período Pré-OperatórioRESUMO
BACKGROUND: To determine the activity of antithrombin (AT), protein C (PC), and protein S (PS), as well as the frequency of deficiencies of these proteins in a population of healthy Mexican mestizo blood donors. METHODS: AT, PC, and PS were determined from 1,502 plasma samples of healthy blood donors by using commercial kits in a coagulometer 4 STA (Diagnostica Stago, Asnières, France). RESULTS: A total of 741 women and 761 men were under study. They were divided into age range groups (18-24, 25-34, 35-44, 45-54, and 55-64 years). Activity of AT, PC, and PS was determined. For AT, activity values were specific for each age group according to gender when it had to do with PS, as well as when PC was determined. Frequencies of AT, PC, PS, and activated PC resistance activity deficiencies were obtained from reference levels (RLs) and average levels of this study. Differences were found between both frequencies for AT, PC, and PS, and the average levels obtained were used in this study. The frequencies of the activity deficiencies obtained through the values gotten in this population were: AT, 0.6%; PC, 1.06% (which is higher than the one obtained using the RLs described by commercial kits 0.33% and 0.66%, respectively); and PS, 1% (which is less than 4.5%). CONCLUSIONS: It is necessary to know the characteristics and biological behavior of the coagulation proteins in the Mexican population because the RLs used have been established for populations that are genetically different.
Assuntos
Transtornos da Coagulação Sanguínea/etnologia , Fatores de Coagulação Sanguínea/análise , Coagulação Sanguínea , Doadores de Sangue , Indígenas Norte-Americanos , Adolescente , Adulto , Deficiência de Antitrombina III/sangue , Deficiência de Antitrombina III/diagnóstico , Deficiência de Antitrombina III/etnologia , Proteínas Antitrombina/análise , Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Testes de Coagulação Sanguínea , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Proteína C/análise , Deficiência de Proteína C/sangue , Deficiência de Proteína C/diagnóstico , Deficiência de Proteína C/etnologia , Proteína S/análise , Deficiência de Proteína S/sangue , Deficiência de Proteína S/diagnóstico , Deficiência de Proteína S/etnologia , Adulto JovemRESUMO
The object of this work was to determine the efficacy of a low range International Normalized Ratio (INR) between 1.5 and 1.9, in preventing recurrent venous thrombosis and the hemorrhagic manifestations that can complicate anticoagulation with warfarin. Thirty nine patients, 10 to 78 years of age were studied between January 2006 and November 2009. All of them had been treated with warfarin, for at least 6 months, due to deep venous thrombosis or pulmonary embolism. The subjects were separated, at random, into two groups. In group A (20 patients), the doses of warfarin were adjusted until the INR was stabilized between 1.5 and 1.9; in group B, the INR was maintained between 2 and 3. The coagulant activities of plasma factors II, VII, IX and X were determined in a week and between the fourth and fifth weeks, after stabilization of the INR. Plasma activities of the coagulation factors assayed were abnormally low in both groups, in the two opportunities they were determined, although significantly lower in group B (p<0.05). No thromboembolic episodes occurred during the study, in any of the patients. One of the patients from group A and four from group B, presented minor hemorrhagic manifestations (p N.S.) The above results suggest that a range on INR lower that 2, could be sufficient to prevent recurrent thrombotic episodes while diminishing the frequency of hemorrhagic complications associated with the use of warfarin. However, it is necessary to continue incorporating more individuals in the study to obtain greater certainty in the analysis of these results.
Assuntos
Anticoagulantes/uso terapêutico , Coeficiente Internacional Normatizado , Embolia Pulmonar/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Varfarina/uso terapêutico , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/análise , Criança , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Recidiva , Trombose Venosa/sangue , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Adulto JovemRESUMO
El objetivo de este trabajo fue determinar la efectividad de un rango de la Razón Normalizada Internacional (INR) entre 1,5 y 1,9 en la prevención de la recurrencia de trombosis venosa y de las complicaciones hemorrágicas asociadas al uso de warfarina. Entre enero del 2006 y noviembre del 2009, se estudiaron 39 pacientes, con edades entre 10 y 78 años y diagnóstico de trombosis venosa profunda y/o embolismo pulmonar que recibieron warfarina al menos durante 6 meses. Los sujetos fueron separados aleatoriamente en dos grupos: a 20 pacientes se le ajustó la dosis para mantener el INR entre 1,5 y 1,9 y a 19 pacientes se les mantuvo el INR entre 2 y 3. A cada individuo se le cuantificó la actividad plasmática de los factores II, VII, IX y X a la primera y entre la cuarta y quinta semanas, luego de estabilizado el INR. En ambos grupos, la actividad de los factores se encontró por debajo del valor normal con diferencia significativa entre los grupos (p<0,05). No se detectó recurrencia de trombosis durante el seguimiento. Solo se presentaron manifestaciones hemorrágicas menores en un sujeto con INR entre 1,5 y 1,9 y en cuatro del otro grupo (p = NS). Los resultados del presente trabajo sugieren que un rango de INR entre 1,5 y 1,9, provee un esquema de anticoagulación eficaz para la prevención de recurrencia de trombosis venosa con menor frecuencia de hemorragias. Sin embargo, es necesario seguir incorporando más individuos en el estudio para obtener mayor certeza en el análisis de estos resultados.
The object of this work was to determine the efficacy of a low range International Normalized Ratio (INR) between 1.5 and 1.9, in preventing recurrent venous thrombosis and the hemorrhagic manifestations that can complicate anticoagulation with warfarin. Thirty nine patients, 10 to 78 years of age were studied between January 2006 and November 2009. All of them had been treated with warfarin, for at least 6 months, due to deep venous thrombosis or pulmonary embolism. The subjects were separated, at random, into two groups. In group A (20 patients), the doses of warfarin were adjusted until the INR was stabilized between 1.5 and 1.9; in group B, the INR was maintained between 2 and 3. The coagulant activities of plasma factors II, VII, IX and X were determined in a week and between the fourth and fifth weeks, after stabilization of the INR. Plasma activities of the coagulation factors assayed were abnormally low in both groups, in the two opportunities they were determined, although significantly lower in group B (p<0.05). No thromboembolic episodes occurred during the study, in any of the patients. One of the patients from group A and four from group B, presented minor hemorrhagic manifestations (p N.S.) The above results suggest that a range on INR lower that 2, could be sufficient to prevent recurrent thrombotic episodes while diminishing the frequency of hemorrhagic complications associated with the use of warfarin. However, it is necessary to continue incorporating more individuals in the study to obtain greater certainty in the analysis of these results.
Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anticoagulantes/uso terapêutico , Coeficiente Internacional Normatizado , Embolia Pulmonar/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Varfarina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/análise , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos , Hemorragia/induzido quimicamente , Embolia Pulmonar/sangue , Recidiva , Trombose Venosa/sangue , Varfarina/administração & dosagem , Varfarina/efeitos adversosRESUMO
El odontólogo debe comprender qué ocurre cuando se lesiona un vaso o tejido durante procedimientos quirúrgicos o traumáticos que le pueden suceder a un paciente normal ycon trastornos de la hemostasia. Con la elaboración de la historia clínica se pueden detectar antecedentes importantes que permitan tomar acciones preventivas o implementar otras, de tal forma que la atención del paciente sea más segura. La hemostasia es un fenómeno fisiológico complejo por el cual se detiene la hemorragia. Es un mecanismo de defensa que con la respuesta inflamatoria y la reparación ayudan a proteger la integridad vasculardespués de la agresión de los tejidos. El propósito de este artículo es revisar los mecanismos normales de hemostasia, los trastornos más frecuentes que predisponen a eventos hemorrágicos y las herramientas que se disponen para su control, así como las recomendaciones para la evaluación, diagnóstico y tratamiento odontológico en cada paciente...
The dentist must understand the events that occur when vessels or tissues are damaged during surgical or traumatic procedures that can happen to a healthy patient or one withhemostatic disorders. The elaboration of the clinical history is important to identify this kind of disorders, so the dentist can plan and implement safer preventive and other type ofprocedures for the patient. Hemostasis is a complex physiological phenomenon that causes the bleeding process to stop. It is a defense mechanism that, along with the inflammatory response and healing, protects vascular integrity after tissue aggression. The purpose of this article is to review the normal hemostatic mechanisms, the most frequent disorders that predispose bleeding events, and the available resources to control them, as well as the recommendations for an effective evaluation, diagnosis and dental treatment for each patient...
Assuntos
Assistência Odontológica , Fatores de Coagulação Sanguínea/análise , Fatores de Coagulação Sanguínea , Hemostasia , Medicina Bucal , OdontopediatriaRESUMO
BACKGROUND: The relationship between inflammatory and prothrombotic activity in chagas cardiomyopathy and in other etiologies is unclear. OBJECTIVE: To study the profile of pro-thrombotic and pro-inflammatory markers in patients with Chagas' heart failure and compare them with patients of non-chagas etiology. METHODS: Cross-sectional cohort. INCLUSION CRITERIA: left ventricle ejection fraction (LVEF) < 45% and onset time to symptoms > one month. The patients were divided into two groups: group 1 (G1) - seropositive for Chagas - and group 2 (G2) - seronegative for Chagas. Pro-inflammatory factor: Ultra-sensitive CRP. Pro-thrombotic factors: thrombin-antithrombin factor, fibrinogen, von Willebrand factor antigen, plasma P-selectin and thromboelastography. Sample calculated for 80% power, assuming a standard deviation difference of 1/3; significant p if it is < 0.05. STATISTICAL ANALYSIS: Fisher's exact test for categorical variables; unpaired Student's t-test for parametric continuous variables and Mann-Whitney test for nonparametric continuous variables. RESULTS: Between January and June 2008, 150 patients were included, 80 in G1 and 70 in G2. Both groups maintained the averages of high sensitivity CRP above baseline values, however, there was no significant difference (p = 0.328). The fibrinogen levels were higher in G2 than in G1 (p = 0.015). Among the thromboelastography variables, the parameters MA (p=0.0013), G (p=0.0012) and TG (p =0.0005) were greater in G2 than in G1. CONCLUSION: There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.
Assuntos
Fatores de Coagulação Sanguínea/análise , Cardiomiopatia Chagásica/sangue , Biomarcadores/sangue , Métodos Epidemiológicos , Feminino , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Fatores de Risco , Tromboelastografia/métodos , Trombose/sangueRESUMO
FUNDAMENTO: A relação entre atividade inflamatória e pró-trombótica na cardiomiopatia chagásica e em outras etiologias é obscura. OBJETIVO: Estudar o perfil de marcadores pró-trombóticos e pró-inflamatórios em pacientes com insuficiência cardíaca chagásica e compará-los com os de etiologia não chagásica. MÉTODOS: Coorte transversal. Critérios de inclusão: fração de ejeção do VE (FEVE) < 45 por cento e tempo de início de sintomas > um mês. Os pacientes foram divididos em dois grupos: grupo 1 (G1) - sorologias positivas para Chagas - e grupo 2 (G2) - sorologias negativas para Chagas. Fator pró-inflamatório: PCR ultrassensível. Fatores pró-trombóticos: fator trombina-antitrombina, fibrinogênio, antígeno do fator de von Willebrand, P-selectina plasmática e tromboelastograma. Amostra calculada para poder de 80 por cento, assumindo-se diferença de 1/3 de desvio-padrão; p significativo se < 0,05. Análise estatística: teste exato de Fischer para variáveis categóricas; teste t de Student não pareado para variáveis contínuas paramétricas e teste de Mann-Whitney para variáveis contínuas não paramétricas. RESULTADOS: Entre janeiro e junho de 2008, foram incluídos 150 pacientes, 80 no G1 e 70 no G2. Ambos os grupos mantinham médias de PCR ultrassensível acima dos valores de referência, porém, sem diferença significativa (p=0,328). Os níveis de fibrinogênio foram maiores no G2 do que no G1 (p=0,015). Entre as variáveis do tromboelastograma, os parâmetros MA (p=0,0013), G (p=0,0012) e TG (p=0,0005) foram maiores no G2 em comparação ao G1. CONCLUSÃO: Não há indícios de maior status pró-trombótico entre chagásicos. A dosagem de fibrinogênio e dos parâmetros MA, G e TG do tromboelastograma apontam para status pró-trombótico entre não chagásicos. Ambos os grupos tinham atividade inflamatória exacerbada.
BACKGROUND: The relationship between inflammatory and prothrombotic activity in chagas cardiomyopathy and in other etiologies is unclear. OBJECTIVE: To study the profile of pro-thrombotic and pro-inflammatory markers in patients with Chagas' heart failure and compare them with patients of non-chagas etiology. METHODS: Cross-sectional cohort. Inclusion criteria: left ventricle ejection fraction (LVEF) < 45 percent and onset time to symptoms > one month. The patients were divided into two groups: group 1 (G1) - seropositive for Chagas - and group 2 (G2) - seronegative for Chagas. Pro-inflammatory factor: Ultra-sensitive CRP. Pro-thrombotic factors: thrombin-antithrombin factor, fibrinogen, von Willebrand factor antigen, plasma P-selectin and thromboelastography. Sample calculated for 80 percent power, assuming a standard deviation difference of 1/3; significant p if it is < 0.05. Statistical analysis: Fisher's exact test for categorical variables; unpaired Student's t-test for parametric continuous variables and Mann-Whitney test for nonparametric continuous variables. RESULTS: Between January and June 2008, 150 patients were included, 80 in G1 and 70 in G2. Both groups maintained the averages of high sensitivity CRP above baseline values, however, there was no significant difference (p = 0.328). The fibrinogen levels were higher in G2 than in G1 (p = 0.015). Among the thromboelastography variables, the parameters MA (p=0.0013), G (p=0.0012) and TG (p =0.0005) were greater in G2 than in G1. CONCLUSION: There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.