fibrinopeptide-b and Postoperative-Complications

Topics: Animals; Antithrombin III Deficiency; Blood Coagulation; Blood Coagulation Disorders; Diabetes Complications; Estrogens; Female; Fibrinopeptide B; Hemostasis; Humans; Male; Myocardial Infarction; Neoplasms; Partial Thromboplastin Time; Postoperative Complications; Pregnancy; Prospective Studies; Thrombosis

We investigated the molecular basis of hypofibrinogenemia in a man with a normal thrombin clotting time. Protein analysis indicated equal plasma expression of 2 different Bbeta alleles, and DNA sequencing confirmed heterozygosity for a new Bbeta235 P-->L mutation. Protein analysis also revealed a novel gamma(D) chain, present at a ratio of 1:2 relative to the gamma(A) chain. Mass spectrometry indicated a 14 d decrease in the gamma(D)-chain mass, and DNA sequencing showed this was caused by a novel gamma82 A-->G substitution. DNA sequencing established heterozygosity for 2 further mutations: T-->C in intron 4 of the Aalpha gene and A-->C in the 3' noncoding region of the Bbeta gene. Studies on the man's daughter, together with plasma expression levels, discounted both the Aalpha and Bbeta mutations as the cause of the low fibrinogen, suggesting that the gamma82 mutation caused the hypofibrinogenemia. This was supported by analysis of 31 normal controls in whom the Bbeta mutations were found at polymorphic levels, with an allelic frequency of 5% for the Bbeta235 mutation and 42% for the Bbeta 3' untranslated mutation. The gamma82 mutation was, however, unique to the propositus. Residue gamma82 is located in the triple helix that separates the E and D domains, and aberrant packing of the helices may explain the decreased fibrinogen concentration. (Blood. 2000;95:1709-1713)

Topics: 3' Untranslated Regions; Afibrinogenemia; Aged; Alleles; Amino Acid Sequence; Amino Acid Substitution; Chromatography, High Pressure Liquid; DNA Mutational Analysis; Female; Fibrinogen; Fibrinogens, Abnormal; Fibrinopeptide B; Hematoma; Hernia, Inguinal; Heterozygote; Humans; Introns; Male; Molecular Sequence Data; Peptide Mapping; Point Mutation; Postoperative Complications; Protein Conformation

The hemostatic alterations in two adult patients who were supported by left ventricular assist devices (LVADs) because of postcardiotomy heart failure were evaluated. In both patients, fibrinopeptide A and thrombin-antithrombin III complex increased markedly during the first several days, and thereafter decreased moderately but remained above normal over the entire procedure. Furthermore, fibrinopeptide B beta 15-42 and alpha 2 plasmin inhibitor-plasmin complex were also markedly increased over the entire course of LVAD treatment. These data show that the LVAD system strongly activates both the coagulation and the fibrinolytic system, even when thromboembolic or bleeding complications are not clinically evident. Furthermore, the decrease in physiological coagulation inhibitors, especially protein C, indicates that these factors are activated and consumed during LVAD treatment. Because protein C is important in regulating the coagulation cascade during LVAD treatment, exhaustion of this system might result in thromboembolic complications during LVAD treatment.

Topics: Aged; Antithrombin III; Female; Fibrinopeptide A; Fibrinopeptide B; Heart Failure; Heart-Assist Devices; Hemostasis; Humans; Male; Middle Aged; Peptide Hydrolases; Postoperative Complications; Protein C

The euglobulin lysis time (ELT) in antecubital vein and femoral vein was investigated in 35 patients before and after bilateral intermittent sequential leg compression for one hour. After compression, ELT in antecubital vein was shortened, and that in femoral vein was significantly shortened (p less than 0.05). beta-thromboglobulin, fibrinopeptide B beta 15-42 and alpha 2-plasmin inhibitor were also investigated, but no significant change was found after compression. The mean and peak blood velocity of the femoral vein before and during compression was measured using Doppler ultrasound in 20 patients. The mean blood velocity increased about 183% (p less than 0.001), and the peak blood velocity also increased 178% (p less than 0.001). ELT was measured pre- and post-operatively in 31 patients who had intermittent sequential compression during operation and succeeding two days and in 31 controls which had no compression. Both in antecubiltal vein and in femoral vein, ELT in the compression group was significantly shorter than that of control group in the first postoperative day. This study demonstrates that intermittent sequential compression of the legs increased fibrinolytic activity, and this effect may contribute to the prevention of deep venous thrombosis.

Topics: Adult; Aged; alpha-2-Antiplasmin; beta-Thromboglobulin; Blood Coagulation Tests; Blood Flow Velocity; Clothing; Female; Fibrinolysis; Fibrinopeptide B; Humans; Male; Middle Aged; Postoperative Complications; Thrombophlebitis

Topics: Adolescent; Adult; Aged; beta-Thromboglobulin; Female; Fibrinopeptide A; Fibrinopeptide B; Humans; Leg; Lung; Male; Middle Aged; Platelet Factor 4; Postoperative Complications; Radionuclide Imaging; Thrombin; Thromboembolism; Thrombophlebitis; Thromboplastin