cardiovascular-agents and Blood-Coagulation-Disorders

This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs has been administered. Cryoprecipitate should be given for documented low fibrinogen or ongoing bleeding after administration of 1 round of all 3 blood components. For patients at risk of massive hemorrhage, early administration of tranexamic acid with an initial loading dose of 15 mg/kg (maximum 1 g) is recommended. Choice of medication for intubation of the patient with Traumatic Brain Injury (TBI) may best be guided by physiology: in the TBI patient with a high mean arterial pressure, premedication with lidocaine, fentanyl and use of etomidate may be most appropriate, whereas in the hemodynamically compromised patient, use of ketamine alone may be considered. If needed, norepinephrine has been recommended as a temporizing agent for vasopressor support in the setting of fluid-refractory shock. Although controversial, in the setting of significant spinal cord injury, the potential benefits of administering 24-48 hours of steroids (initial 30 mg/kg of methylprednisolone within 8 hours of injury) may outweigh the risks especially in previously healthy pediatric patients.

Topics: Blood Coagulation Disorders; Blood Transfusion; Cardiovascular Agents; Child; Fluid Therapy; Hematologic Agents; Humans; Intubation, Intratracheal; Pediatrics; Rehydration Solutions; Resuscitation; Shock, Traumatic; Wounds and Injuries

Topics: Acute Kidney Injury; Blood Coagulation Disorders; Cardiovascular Agents; Humans; Infections; Shock, Septic

Diabetic cardiomyopathy is characterized by a prominent interstitial fibrosis. Postulated etiologies include microangiopathy, autonomic neuropathy, and metabolic factors. A common root of these pathologies is hyperglycemia or hyperinsulinemia, both of which are prominent in type 2 diabetes mellitus, which has the highest incidence of cardiovascular morbidity and mortality. The relative importance of each factor is a matter of debate; it is likely that both of these factors in addition to the concomitant risk factors seen in diabetics (dyslipidemias, hypertension, obesity, coagulation abnormalities) contribute to the spectrum of myocardial disease in diabetes. A discussion of these contributive pathologies and the hyperglycemia and hyperinsulinemia that underlie them is the subject of this review. Treatment methodologies to control the development of such pathology also are discussed.

Topics: Albuminuria; Blood Coagulation Disorders; Cardiovascular Agents; Cause of Death; Coronary Disease; Diabetes Mellitus, Type 2; Female; Global Health; Heart Failure; Humans; Hyperinsulinism; Hyperlipidemias; Hypertension; Hypoglycemic Agents; Incidence; Insulin Resistance; Male; Obesity; Oxidative Stress; Prognosis; Risk Factors; Sex Characteristics; United States

Topics: Acidosis; Adrenal Cortex Hormones; Arteriovenous Anastomosis; Blood Coagulation Disorders; Blood Transfusion; Cardiovascular Agents; Child; Child, Preschool; Hemodynamics; Hormones; Humans; Hypoxia; Infant; Infant, Newborn; Microcirculation; Receptors, Adrenergic; Shock; Shock, Hemorrhagic; Shock, Septic

The objective of the study is to investigate the effects of Shen-Fu injection (SFI) on coagulation-fibrinolysis disorders in a porcine model of cardiac arrest.. Thirty Wuzhishan pigs were randomly assigned into the sham operation group (SO group, n = 6), epinephrine group (EP group, n = 12), and SFI group (n = 12). After 8 minutes of untreated ventricular fibrillation (VF), pigs in the EP group or SFI group were administered with either EP (0.02 mg/kg) or SFI (1.0 mL/kg), respectively. Plasma levels of tissue factor, thrombin-antithrombin complex, tissue factor pathway inhibitor, antithrombin III, protein C, tissue plasminogen activator, plasminogen activator inhibitor 1, soluble thrombomodulin, and soluble endothelial protein C receptor were measured at baseline, 1, 6, 12, and 24 hours after return of spontaneous circulation (ROSC). In addition, arterial lactate levels were measured at baseline, 1, 6, 12, and 24 hours after ROSC, and lactate clearance was calculated at 1, 6, 12, and 24 hours after ROSC.. Compared with the EP group, tissue factor, thrombin-antithrombin complex, tissue factor pathway inhibitor, tissue plasminogen activator, and plasminogen activator inhibitor 1 levels were significantly lower, whereas antithrombin III and protein C levels were significantly higher in the SFI group (all P < .05). In addition, soluble thrombomodulin and soluble endothelial protein C receptor levels in the SFI group were significantly lower in comparison to the EP group (all P < .01). Furthermore, arterial lactate levels were significantly lower, and lactate clearance was higher in the SFI group (all P < .01).. This study demonstrates that SFI can inhibit coagulation-fibrinolysis disorders after cardiac arrest, which may be associated with alleviating endothelial damage and improving systemic metabolism.

Topics: Animals; Blood Coagulation Disorders; Cardiovascular Agents; China; Disease Models, Animal; Drugs, Chinese Herbal; Epinephrine; Fibrinolysis; Heart Arrest; Injections; Phytotherapy; Resuscitation; Swine; Swine, Miniature; Ventricular Fibrillation

The objective of this study was to determine the effects of a TREM (triggering receptor expressed on myeloid cells 1)-like transcript 1-derived peptide (LR12) administration during septic shock in pigs. Two hours after induction of a fecal peritonitis, anesthetized and mechanically ventilated adult male minipigs were randomized to receive LR12 (n = 6) or its vehicle alone (normal saline, n = 5). Two animals were operated and instrumented without the induction of peritonitis and served as controls (sham). Resuscitation was achieved using hydroxyethyl starch (up to 20 mL/kg) and norepinephrine infusion (up to 10 μg/kg per minute). Hemodynamic parameters were continuously recorded. Gas exchange, acid-base status, organ function, and plasma cytokines concentrations were evaluated at regular intervals until 24 h after the onset of peritonitis when animals were killed under anesthesia. Peritonitis induced profound hypotension, myocardial dysfunction, lactic acidosis, coagulation abnormalities, and multiple organ failure. These disorders were largely attenuated by LR12. In particular, cardiovascular failure was dampened as attested by a better mean arterial pressure, cardiac index, cardiac power index, and S(v)O(2), despite lower norepinephrine requirements. LR12, a TREM-like transcript 1-derived peptide, exhibits salutary properties during septic shock in adult minipigs.

Topics: Animals; Blood Coagulation Disorders; Cardiovascular Agents; Cardiovascular Diseases; Hemodynamics; Hydroxyethyl Starch Derivatives; Hypotension; Male; Multiple Organ Failure; Random Allocation; Receptors, Immunologic; Shock, Septic; Swine; Swine, Miniature

To determine whether dogs with ascites secondary to right-sided congestive heart failure (CHF) have bleeding disorders associated with hypofibrinogenemia and discordant plasma fibrin-fibrinogen degradation products (FDPs) and D-dimer assay results (ie, a circulating concentration of FDPs higher than the reference range and a circulating concentration of D-dimer within the reference range).. Retrospective case-control study.. 80 client-owned dogs.. Dogs with ascites secondary to right-sided CHF (group 1; n = 20), unhealthy dogs without cardiac disease (group 2; 40), and dogs with left-sided CHF (group 3; 20) were included in the study. Urine bile acids-to-creatinine concentration ratios were calculated as a marker of liver function. Differences among groups regarding coagulation profile analysis results and prevalence of discordant FDPs and D-dimer assay results were determined.. No significant differences were detected among the 3 groups regarding urine bile acids-to-creatinine concentration ratios. Plasma fibrinogen concentration was significantly lower for group 1 versus groups 2 or 3. Prevalence of discordant FDPs and D-dimer assay results was significantly higher for group 1 versus groups 2 or 3. Eighteen group 1 dogs had discordant FDPs and D-dimer assay results. Ten of these dogs had concurrent hypofibrinogenemia, 2 of which had clinical signs of bleeding. Only 10 dogs in groups 2 or 3 had discordant FDPs and D-dimer assay results; none of these dogs had hypofibrinogenemia or clinical signs of bleeding.. Dogs with right-sided CHF and ascites may be at increased risk for primary hyperfibrinogenolysis (ie, hypofibrinogenemia and discordant FDPs and D-dimer assay results).

Topics: Animals; Ascites; Biomarkers; Blood Coagulation Disorders; Cardiovascular Agents; Case-Control Studies; Dog Diseases; Dogs; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Heart Failure; Male; Partial Thromboplastin Time; Prothrombin Time; Retrospective Studies

To present a case series showing efficacious use of vincristine in treating Kasabach-Merritt syndrome (KMS).. The case notes of four children treated for KMS by the authors with corticosteroids and vincristine were reviewed. Specific attention was paid to the efficacy and adverse effects of each therapeutic agent.. The age of presentation ranged from birth to 11 months. Initial treatment with high dose corticosteroids was uniformly ineffective, and in 2 cases, prolonged use caused significant side-effects. Subsequent or concurrent treatment with vincristine was effective and well-tolerated, with no discernable side effects. The only complications were line-related.. Kasabach-Merritt syndrome is rare, but it is associated with significant morbidity and mortality. No definitive treatment regime has been established, but the authors suggest that vincristine should be considered a first-line agent, and that the use of systemic corticosteroids should not be routine.

Topics: Blood Coagulation Disorders; Cardiovascular Agents; Female; Glucocorticoids; Hemangioma; Humans; Infant; Infant, Newborn; Male; Vincristine