14,932 research outputs found

    Congenital Antithrombin Deficiency in a Pregnant Woman with Right Atrium Thrombosis

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    BACKGROUND: One of the rare causes of venous thromboembolism in pregnancy is antithrombin III deficiency. Antithrombin III deficiency is estimated to carry a 30% risk of venous thrombotic  complication during each pregnancy and postpartum.CASE DETAILS: We present thea case of a A 21-year-old pregnant woman (Para 1+) with a history of  large atrial septal defect repair at our hospital (Imam Ali Hospital, 2 May 2014). The patient, with  unknown history of antithrombin III deficiency, was admitted at our emergency center with dyspnea and chest pain for the rule out of tamponade. She presented with a right atrial thrombosis in the second  trimester of pregnancy despite the use of therapeutic doses of heparin and warfarin in the postoperative  period as thromboembolic prophylaxis. The risk of warfarin emberyopaty led to termination of pregnancy, and successful redo-cardiac surgery outcome was achieved with the combined use of therapeutic  anticoagulation and regular plasma-derived antithrombin concentrate infusions to normalize her  antithrombin levels.CONCLUSSION: She recovered from the operation uneventfully, and wad discharged in the 12th postoperative day. In the 6th month of follow-up, antithrombin III increased to 70% in more stable level  and transethoracic echocardiography showed no recurrence of right atrial thrombus formation. This case  leads to further debate regarding whether full anticoagulation should be a worthy preventive measure for  venous thromboembolic prophylaxis after an open heart surgery complicated by pregnancy in a women  with inherited antithrombin III deficiency. This point may become more relevant as further experience is  gained with the use of recombinant human antithrombin in known cases during open cardiac surgery.KEYWORDS: pregnancy, antithrombin ш deficiency, cardiac surger

    Effect of CMF-chemotherapy on blood coagulation in patients with breast cancer

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    BACKGROUND: Influences of CMF (cyclophosphamide, methotrexate,5-fluorouracil) chemotherapy on blood coagulation were investigated in 30 patients receiving adjuvant chemotherapy and in 30 patients receiving chemotherapy for metastatic breast cancer. METHODS: In plasma samples of 60 patients (median age 49.5), we evaluated the following parameters 1)Markers of in vivo clotting activation thrombin-antithrombin complex (ELISA) and D-dimer (ELISA), 2) Natural anticoagulants (protein C [PC] and antithrombin III [AT III] by chromogenic methods). The coagulation studies were performed at the beginning and at the end of the first cycle of CMF protocol. RESULTS: Before CMF therapy, significant difference was observed between patients with early stage and patients with metastatic breast cancer in the PC (p<0.01), AT III (p<0.01) and TAT (p<0.01) levels. After CMF therapy, patients with stage II (adjuvant) disease manifested a significant decrease in the level of PC and AT III activity (p<0.01) and an increase in TAT level (p<0.01). In patients with disseminated breast cancer CMF therapy provoked an increased level of TAT and D-dimer with a decreased activity of protein C and antithrombin III. There was significant difference in value of TAT, D- dimer, protein C and antithrombin III between the patients with adjuvant and metastatic breast cancer patients after CMF chemotherapy CONCLUSION: Our results suggest that the application of cytotoxic therapy provokes hypercoagulable condition in breast cancer patients. This effect should be considered when chemotherapy is employed in advanced cancer patients at high risk for thrombosis, or in patients with other risk factors

    Patterns of coagulation profiles observed in different trimesters of pregnancy

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    Background: The risk of venous thromboembolic events (VTE) is high during pregnancy due to both physiologic changes in pregnancy and the impact of inherited and acquired thrombophilia. Protein S (PS), Protein C (PC) and Antithrombin III (ATIII) deficiencies have been found in some pregnant women with recurrent miscarriages and sudden maternal death. This study aimed to determine the changes in the level of plasma protein C, protein S and antithrombin III levels, its correlation with normal pregnancy. Methods: The study was a comparative cross-sectional study conducted among seventy-five normal pregnant women who were selected using a simple random sampling technique with seventy-five age-matched healthy nonpregnant women. Blood samples were collected for analysis of protein C, protein S and antithrombin III using the enzyme-linked immunosorbent assay method. A semi-structured questionnaire was used as the survey instrument and Statistical analysis of data was done using SPSS version 24. Results: The mean ages of the respondents were 32.6±4.6 and 34.5±6.9 years for the subjects and controls respectively. Natural coagulation inhibitors (NCI) show a gradual decrease across the trimesters of pregnancy. There was a statistical significance in the level of antithrombin III and protein S in the first trimester, p<0.05. When compared with the control of protein S of 4.78±0.65 ng/ml and antithrombin III of 554.16±54.65 ng/mL respectively. Conclusions: It was demonstrated that there was an accompanying reduction of NCI across the trimester compared with the controls. Antithrombin III and protein S have a significant relationship with the gestation periods. Antithrombin III decreased as pregnancy advanced while protein S decreased significantly from the first trimester to the second trimester and was maintained at that level throughout the pregnancy

    Rapid Diagnostics with Nanoparticles

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    More than 500,000 open-heart surgeries are performed in the United States every year. The anticoagulant Heparin is used to decrease the likelihood of thrombosis or hemorrhaging in each surgery by bonding to the enzyme inhibitor antithrombin III (AT-III). However, anesthesiologists currently lack the ability to measure antithrombin levels in a patient quickly, making appropriate Heparin dosages difficult to determine and possibly resulting in thrombosis or hemorrhaging if thrombin levels move outside the allowable range. This could be prevented with a simple bedside test. Current tests use gold, but we believe Iron (III) Oxide (commonly known as rust) can be used at a much lower price. Given a thrombin molecule with a fluorescein and quencher, the process to design and synthesize a test particle from Iron (III) Oxide coated in an aminosilane to detect AT-III levels was investigated.https://scholarscompass.vcu.edu/capstone/1011/thumbnail.jp

    Possible role of extracellularly released phagocytic proteinases in the coagulation disorder during liver transplantation

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    Orthotopic liver transplantation is frequently associated with a complex coagulation disorder, influencing the outcome of the procedure. In this respect, disseminated intravascular coagulation (DIC) had been suggested to be of causative importance for bleeding complications after reperfusion of the liver graft. In 10 consecutive patients undergoing orthotopic liver transplantations, we studied the occurrence of two phagocyte proteinases of different origin in the graft liver perfus-ate and in systemic blood during the operation, as well as their effects on hemostasis. As compared with plasma samples taken at the end of the anhepatic phase, highly significant increases of cathepsin B and thrombin-anti-thrombin III complexes (TAT), as well as highly significant decreases in antithrombin III, protein C, and C1-inhibitor were observed in graft liver perfusate. Von Willebrand factor and fibrinogen were slightly decreased, whereas the elastase-alpha1 proteinase inhibitor complexes (EPI) were elevated. In plasma the activity of cathepsin B remained unchanged during the prereperfusion phases, but immediately after revascularization of the graft this cysteine proteinase increased. The EPI showed a gradual increase in plasma during the preanhepatic and anhepatic phases but a more pronounced increase in the reperfusion phase. In parallel with the rise in these two proteinases TAT increased and the activities of antithrombin III and C1-inhibitor in plasma decreased after reperfusion. At 12 hr after revascularization plasma levels of TAT, antithrombin III, and C1-inhibitor had returned to the prereperfusion ranges, whereas cathepsin B and EPI were significantly above the baseline levels. These observations are consistent with the hypothesis that extracellularly released lysosomal proteinases may play a role in the development of a DIC-like constellation, including thrombin formation after revascularization of the liver graft. For the first time we could prove the occurrence of phagocyte proteinases in graft liver perfusate and evaluate the importance of these proteinases for the understanding of the pathophysiology leading to bleeding complications in patients undergoing orthotopic liver transplantation

    Interaction of antithrombin III with preadsorbed albumin-heparin conjugates

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    The adsorption of antithrombin III (AT III) onto polystyrene surfaces preadsorbed with albumin or albuminheparin conjugates was studied using a two step enzyme immuno assay. When AT III-buffer solutions were used, the highest adsorption values were measured on high affinity albumin-heparin conjugate pretreated surfaces. Less AT III adsorption was found on nonfractionated albumin-heparin conjugate preadsorbed surfaces. AT III adsorption could also be detected on low affinity conjugate and albumin coated surfaces. When AT III was adsorbed from plasma or plasma dilutions with buffer, only AT III on surfaces preadsorbed with high affinity or nonfractionated albumin-heparin conjugate was found. These results demonstrate that the heparin moiety of the conjugate is directed to the solution phase whereas the albumin moiety contacts the polystyrene surfaca

    Changes in hemostasis parameters in nonfatal methicillin-sensitive Staphylococcus aureus bacteremia complicated by endocarditis or thromboembolic events : a prospective gender-age adjusted cohort study

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    The aim of this study was to examine the changes in hemostasis parameters in endocarditis and thromboembolic events in nonfatal methicillin-sensitive Staphylococcus aureus bacteremia (MS-SAB) - a topic not evaluated previously. In total, 155 patients were recruited and were categorized according to the presence of endocarditis or thromboembolic events with gender-age adjusted controls. Patients who deceased within 90 days or patients not chosen as controls were excluded. SAB management was supervised by an infectious disease specialist. Patients with endocarditis (N = 21), compared to controls (N = 21), presented lower antithrombin III at day 4 (p <0.05), elevated antithrombin III at day 90 (p <0.01), prolonged activated partial thromboplastin time at days 4 and 10 (p <0.05), and enhanced thrombin-antithrombin complex at day 4 (p <0.01). Thromboembolic events (N = 8), compared to controls (N = 34), significantly increased thrombin-antithrombin complex at day 4 (p <0.05). In receiver operating characteristic analysis, the changes in these hemostasis parameters at day 4 predicted endocarditis and thromboembolic events (p <0.05). No differences in hemoglobin, thrombocyte, prothrombin fragment, thrombin time, factor VIII, D-dimer or fibrinogen levels were observed between cases and controls. The results suggest that nonfatal MS-SAB patients present marginal hemostasis parameter changes that, however, may have predictability for endocarditis or thromboembolic events. Larger studies are needed to further assess the connection of hemostasis to complications in SAB.Peer reviewe

    Evaluation of thrombinogenesis in vivo in acute myocardial infarction in relation to concentrations of thrombin-antithrombin III complexes and antithrombin III activity

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    Background: Thrombotic processes play an essential role in the progression of the atheromatosis and pathogenesis of acute coronary syndromes. The role of haemostatic factors in the development of circulatory system diseases, ischaemic heart disease in particular, has met with great research interest. The purpose of the present research is to define the role of haemostatic factors in the pathogenesis of atheromatosis and ischaemic heart disease and also to deal with their impact on diagnosis and prognosis. The aim of the present study was to evaluate thrombin generation in vivo and to define the role of the main inhibitor of coagulation in patients with acute myocardial infarction. Methods: The study was performed using a group of 70 patients with acute myocardial infarction with ST segment elevation (STEMI). The control group comprised 25 healthy subjects matched for age and gender. Concentrations of thrombin-antithrombin III complexes (TAT complexes) and antithrombin III (AT III) activity were measured; the sample was taken before essential treatment was administered. Results: In a group of patients with myocardial infarction, significantly higher average concentrations of TAT complexes (p < 0.0001) and AT III activity (p < 0.001) were found. An inverse correlation between AT III activity and kinase phosphocreatine concentration (p < 0.02) was shown as well as a positive correlation between AT III activity and the time elapsing from the onset of infarction symptoms to admission (p < 0.05). The increase in TAT complex concentration and AT III activity did not depend on sex, age and risk factors for ischaemic heart disease, nor did it predict late complications.Conclusions: The results provide evidence of an intensification of thrombinogenesis processes in patients with acute myocardial infarction. The increase of AT III activity may reflect a compensatory mechanism of the haemostatic system with regard to intensified thrombinogenesis

    Сравнительное изучение сорбционных свойств аффинных носителей по отношению к белку антитромбину III

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    This paper reports the chromatographic properties of affinity resins in respect of protein antithrombin III. The capacity of resin Toyopearl AF-Heparin was found to be higher than that of resin of Heparin-Sepharose FF. Sorption was carried out by the batch method at room temperature and constant stirring. The specific activity of antithrombin III was estimated by the amidolytic method with the use of a chromogenic substrate. The obtained results can be used for the development of column chromatographic method of isolation of antithrombin III from human plasma.Статья посвящена изучению сорбционных свойств аффинных носителей по отношению к белку антитромбину III. Установлено, что емкость сорбента Toyopearl AF-Heparin значительно выше, чем емкость Heparin-Sepharose FF. Сорбция проводилась batch-методом при комнатной температуре и постоянном перемешивании, а специфическая активность антитромбина III оценивалась амидолитическим методом с помощью хромогенного субстрата. Полученные данные могут быть использованы для разработки колоночного хроматографического способа выделения антитромбина III из плазмы донорской крови
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