thromboplastin and Postoperative-Complications

Cancer and venous thromboembolism are frequently associated.. Venous thromboembolism is associated with a worse prognosis in patients with cancer. Thrombosis in cancer patients is related to the expression of tissue factor and other procoagulants by tumour cells. Surgery, chemotherapy and antiangiogenic agents are also associated with an increased risk of thrombosis. Venous thromboembolism may be the first manifestation of cancer, the risk being especially increased during the first six months following an unexplained episode of idiopathic thrombosis. Current evidence does not suggest that a systematic screening for cancer after an unexplained thrombosis is associated with a clinical benefit. Risk factors for thrombosis specific to the cancer population have been identified. A recent controlled trial suggests that low-molecular weight heparin may reduce the incidence of venous thromboembolism in patients with cancer. These results need to be confirmed. Treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin administered for three or six months.. Low-molecular weight heparin may increase the survival of patients with cancer through a direct effect on tumour biology. Several clinical trials are underway to confirm this hypothesis.. Thrombosis in cancer patients is a frequent and difficult to treat condition. The role of long-term prophylaxis remains to be defined. The treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin. Large clinical trials are currently assessing the effect of low-molecular weight heparin on the long-term survival of patients with cancer.

Topics: Administration, Oral; Angiogenesis Inhibitors; Antineoplastic Agents; Combined Modality Therapy; Heparin, Low-Molecular-Weight; Humans; Neoplasms; Neoplastic Cells, Circulating; Postoperative Complications; Prognosis; Pulmonary Embolism; Risk Factors; Thromboplastin; Venous Thromboembolism

The role of the haemostatic system in colorectal cancer (CRC) is reviewed. Correlations between the activation of the haemostatic system and overall survival have been suggested. Experimental studies indicate that the haemostatic system plays a key role in growth, invasion and dissemination of tumour cells, and in tumour related angiogenesis. Additional activation by the surgical trauma and postoperative infections are discussed. Finally, anti-cancer modalities directed against regulation of the haemostatic system in CRC are considered.

Topics: Animals; Blood Coagulation; Chemotherapy, Adjuvant; Colorectal Neoplasms; Fibrinolysis; Hemostasis; Humans; Infections; Peptide Hydrolases; Postoperative Complications; Thromboplastin; Venous Thrombosis

Post-surgical deep vein thrombosis (DVT) is often underdiagnosed by clinical assessment alone. Subclinical DVT is a major source of pulmonary embolism, which is an important cause of death, particularly following total hip replacement surgery. Results from pathophysiological studies and recently conducted, prospective double-blind venographic studies in Europe and North America suggest that, in patients undergoing total hip replacement surgery, thromboprophylaxis with a low-molecular-weight heparin should be continued for at least 5 weeks post-operatively to minimize this serious complication.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Double-Blind Method; Europe; Heparin, Low-Molecular-Weight; Humans; Leg; Multicenter Studies as Topic; North America; Outpatients; Phlebography; Postoperative Complications; Postoperative Period; Prevalence; Prospective Studies; Pulmonary Embolism; Randomized Controlled Trials as Topic; Regional Blood Flow; Risk Factors; Thromboembolism; Thromboplastin; Venous Thrombosis; Warfarin

Topics: Animals; Blood Cell Count; Blood Coagulation; Blood Coagulation Factors; Blood Platelets; Complement System Proteins; Disseminated Intravascular Coagulation; Fibrinogen; Fibrinolysis; Humans; Immunoassay; Leukocytes; Plasminogen; Postoperative Complications; Prothrombin Time; Thrombophlebitis; Thromboplastin

To date, no study has tested the effect of different heparin dosages on the hemostatic changes during off-pump coronary artery bypass graft (OPCABG) surgery, and a wide variety of empirical anticoagulation protocols are being applied. We tested the effect of two different heparin dosages on the activation of the hemostatic system in patients undergoing OPCABG procedures.. Forty-two patients eligible for OPCABG procedures were assigned in a randomized fashion to low-dose heparin (150 IU/kg) or high-dose heparin (300 IU/kg). Prothrombin fragment 1+2, plasmin/alpha(2)-plasmin inhibitor complex, D-dimer, soluble tissue factor, tissue factor pathway inhibitor, total thrombin activatable fibrinolysis inhibitor (TAFI), and activated TAFIa were assayed by specific enzyme-linked immunosorbent assays at six different timepoints, before, during, and after surgery. Platelet function was evaluated by means of an in vitro bleeding time test, platelet function analyzer-100.. The OPCABG surgery was accompanied by significant changes of all plasma biomarkers, indicative of systemic activation of coagulation and fibrinolysis. A significant increase in circulating TAFIa was detected perioperatively and postoperatively, and multiple regression analysis indicated that prothrombin F1+2 but not plasmin/alpha(2)-antiplasmin complex was independently associated with TAFIa level. Platelet function analyzer-100 values did not change significantly after OPCABG. All hemostatic changes were similar in the two heparin groups, even perioperatively, when the difference in anticoagulation was maximal.. Both early and late hemostatic changes, including TAFI activation, are similarly affected in the low-dose and high-dose heparin groups, suggesting that the increase in heparin dosage is not accompanied by a better control of clotting activation during OPCABG surgery.

Topics: Aged; alpha-2-Antiplasmin; Anticoagulants; Bleeding Time; Carboxypeptidase B2; Coronary Artery Bypass, Off-Pump; Coronary Disease; Dose-Response Relationship, Drug; Female; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Hemostasis, Surgical; Heparin; Humans; Lipoproteins; Male; Middle Aged; Peptide Fragments; Postoperative Complications; Prospective Studies; Protein Precursors; Prothrombin; Thromboplastin

BACKGROUND. Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. For instance, 20-30% of patients develop this problem after general surgical operations, while 5.5% of patients have this complication when laparoscopic fundoplications are performed without any prophylaxis. The aim of our study was to evaluate the hypocoagulation effect of the following treatments during and after laparoscopic fundoplication: a) intermittent pneumatic compression (IPC) and b) combination of low-molecular-weight heparin (LMWH) and IPC. MATERIAL AND METHODS. The study was performed on 20 consecutive patients who were randomized into two groups. The first group received IPC during operation, the second group received IPC during operation and LMWH before operation. Plasma prothrombin fragment F1+2 (F1+2), thrombin-antithrombin complex (TAT) - markers of thrombogenesis - and plasma free tissue factor pathway inhibitor (fTFPI) - a marker of hypocoagulation effect - were measured 1 h before, during, and after the laparoscopic operation. RESULTS. In the IPC group, plasma F1+2 and TAT levels increased significantly during and after laparoscopic gastrofundoplication. In the IPC+LMWH group, F1+2 and plasma TAT levels did not change during or after the operation. fTFPI levels significantly increased during and after the operation in the IPC+LMWH group; however, fTFPI levels did not change during or after the laparoscopic operation in the IPC group. CONCLUSIONS. A combination of low-molecular-weight heparin and intermittent pneumatic compression during laparoscopic fundoplication caused hypocoagulation effect in the patients, which was not observed in the patients who were treated with intermittent pneumatic compression alone.

Topics: Anticoagulants; Blood Coagulation; Blood Coagulation Factors; Coagulants; Enoxaparin; Female; Fibrinolytic Agents; Fundoplication; Humans; Informed Consent; Intermittent Pneumatic Compression Devices; Intraoperative Care; Laparoscopy; Male; Postoperative Care; Postoperative Complications; Prospective Studies; Statistics, Nonparametric; Thromboplastin; Venous Thrombosis

We investigated the safety and pharmacodynamics of escalating doses of recombinant nematode anticoagulant protein c2 (rNAPc2) in patients undergoing elective coronary angioplasty.. Recombinant NAPc2 is a potent inhibitor of the tissue factor/factor VIIa complex, which has the potential to reduce the risk of thrombotic complications in coronary artery disease.. In a randomized, double-blinded, dose-escalation, multicenter trial, 154 patients received placebo or rNAPc2 at doses of 3.5, 5.0, 7.5, and 10.0 microg/kg body weight as a single subcutaneous administration 2 to 6 h before angioplasty. All patients received aspirin, unfractionated heparin during angioplasty, and clopidogrel in case of stent implantation.. Minor bleeding rates for the doses 3.5 to 7.5 microg/kg were comparable to that with placebo (6.7%), whereas an incidence of 26.9% was observed at the 10.0 microg/kg dose level (p < 0.01). Major bleedings occurred in the 5.0 microg/kg (n = 3) and 7.5 microg/kg (n = 1) dose groups. The three patients in the 5.0 microg/kg dose group also received a glycoprotein IIb/IIIa receptor inhibitor at the moment of major bleeding. Systemic thrombin generation, as measured by prothrombin fragment 1+2 (F(1+2)), was suppressed in all rNAPc2 dose groups to levels below pretreatment values for at least 36 h. In the placebo group, a distinct increase of F(1+2) levels was observed following cessation of heparin.. Inhibition of the tissue factor/factor VIIa complex with rNAPc2, at doses up to 7.5 microg/kg, in combination with aspirin, clopidogrel, and unfractionated heparin appears to be a safe and effective strategy to prevent thrombin generation during coronary angioplasty.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Coronary Stenosis; Coronary Thrombosis; Dose-Response Relationship, Drug; Double-Blind Method; Elective Surgical Procedures; Factor VIIa; Female; Helminth Proteins; Humans; Male; Middle Aged; Postoperative Complications; Thromboplastin

With the best prophylactics now available, venous thromboembolism after total knee replacement remains substantial (25% to 27%). Recombinant nematode anticoagulant protein c2 (rNAPc2) is a potent inhibitor of factor VIIa/tissue factor complex that has the potential to reduce this risk. The present study was performed to determine an efficacious and safe dose of rNAPc2 for prevention of venous thromboembolism after elective, unilateral total knee replacement.. This open-label, sequential dose-ranging study was conducted in 11 centers in Canada, Europe, and the United States. Five regimens were tested. Injections were administered subcutaneously on the day of surgery (day 1) and days 3, 5, and optionally, day 7. Primary efficacy outcome was a composite of overall deep vein thrombosis based on mandatory unilateral venography (day 7+/-2) and confirmed symptomatic venous thromboembolism recorded

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Knee; Canada; Dose-Response Relationship, Drug; Europe; Factor VIIa; Female; Helminth Proteins; Hemorrhage; Humans; Injections, Subcutaneous; Logistic Models; Male; Odds Ratio; Postoperative Complications; Risk Assessment; Survival Rate; Thromboplastin; United States; Venous Thrombosis

Complex coagulopathies follow cardiopulmonary bypass (CPB) in children. However, objective laboratory data that can be acquired rapidly to guide their management are lacking. Because thromboelastography has proven useful in this regard, we evaluated the use of celite or tissue factor (TF) activation and heparinase modification of blood samples to allow rapid determination of thromboelastogram data in children younger than 2 yr undergoing CPB. Celite or TF activation shortened the initiation of clotting and, thus, the time required for the important thromboelastogram alpha and maximum amplitude values to begin evolving. Although thromboelastogram alpha and maximum amplitude values were increased with these activators, correlations persisted between platelet count or fibrinogen level and each of these values. The additional use of heparinase allowed thromboelastograms to be obtained during CPB with values not different from those obtained without heparinase after protamine administration. Therefore, celite- or TF-activated, heparinase-modified thromboelastograms begun during CPB allow objective data to be available by the conclusion of protamine administration to help restore hemostasis after CPB in children. Thromboelastography identified transient fibrinolysis during CPB in some children that resolved by the conclusion of protamine administration. Future investigations of the effectiveness of modified thromboelastography-guided coagulopathy management after CPB in children are needed.. Thromboelastography is useful in assessing the coagulopathies that follow cardiopulmonary bypass in children. Modifying blood samples with celite or tissue factor and heparinase allows thromboelastography begun before the termination of cardiopulmonary bypass to become a rapid point-of-care monitor to provide objective data for guiding blood component therapy to manage these coagulopathies.

Topics: Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Tests; Cardiopulmonary Bypass; Diatomaceous Earth; Female; Hemostatics; Heparin; Heparin Antagonists; Heparin Lyase; Humans; Infant; Infant, Newborn; Male; Postoperative Complications; Protamines; Thrombelastography; Thromboplastin

Twenty patients with coronary heart disease (CHD) and elevated serum lipids were randomized into 2 groups of 10 to receive encapsulated preparations of either a concentrated ethylester form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or corn oil in doses of 6 g per day, given double blindly for approximately two months prior to coronary bypass surgery. Lipopolysaccharide (LPS) induced monocyte thromboplastin synthesis was studied during the preoperative period and one week following surgery. The ability of n-3 fatty acids to modify tissue factor pathway inhibitor (TFPI) and tissue plasminogen activator inhibitor (PAI-1) was also evaluated along with fibrinogen and thrombin-antithrombin III (TAT) complexes. No significant changes were noted preoperatively. Monocyte reactivity, PAI-1, fibrinogen and TAT increased significantly after surgery. These changes were not modified by preoperative loading with n-3 fatty acids.

Topics: Acute-Phase Reaction; Aged; Blood Coagulation; Coronary Artery Bypass; Double-Blind Method; Fatty Acids, Omega-3; Humans; Lipopolysaccharides; Lipoproteins; Middle Aged; Monocytes; Plasminogen Activator Inhibitor 1; Postoperative Complications; Preoperative Care; Thromboplastin

A prospective open study was performed in a series of 547 patients undergoing gynecologic surgery. A dose of 20 mg of enoxaparin was administered to all patients 2 hours before surgery. Then patients at high risk of thrombosis (mostly oncologic surgery) received 40 mg of enoxaparin daily whereas those at moderate risk received 20 mg of enoxaparin daily. The principal aim of this prospective open study was to monitor amidolytic anti Xa activity and to study the inhibition of intrinsic prothrombinase using prothrombin consumption measurement as a simple and global test. A second aim was to investigate efficacy and tolerance of these regimens. Treatment tolerance was satisfactory with both regimens since the total incidence of bleeding was 1.8%. A single patient developed a clinically significant thrombosis during hospital stay. The results confirm and extend previous reports regarding a dose effect relationship between the dose of Enoxaparin and plasma Anti Xa activity 3 hours after s.c. injection. A significant relationship was found between Anti Xa activity and patients body weight. Interestingly a dose dependent inhibition of intrinsic prothrombinase was observed when using a one stage prothrombin consumption assay in whole blood. This test in whole blood can be considered as closer to physiological conditions than assays performed in citrated platelet rich or platelet poor plasma samples. The mechanism of intrinsic prothrombinase inhibition during prophylactic treatment with enoxaparin requires further investigation.

Topics: Adult; Body Weight; Dose-Response Relationship, Drug; Factor Xa Inhibitors; Female; Genital Diseases, Female; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Injections, Subcutaneous; Middle Aged; Partial Thromboplastin Time; Postoperative Complications; Prospective Studies; Prothrombin; Risk Factors; Thromboembolism; Thromboplastin

Low-dose heparin prophylaxis against fatal pulmonary embolism has been studied in a random and prospective trial in 300 patients over the age of 50 who underwent major surgery. A dose of 5,000 IU mucous heparin sodium given two hours preoperatively and for five days post operatively prevented fatal pulmonary embolism in all 156 patients so treated, whereas out of 144 patients in the unheparinized group 6 (4.2%) died of pulmonary embolism. This difference is statistically significant. There was no increase in operative or post-operative bleeding or in the formation of wound haematomas in the heparinized group.

Topics: Aged; Blood Coagulation Tests; Female; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Postoperative Complications; Prothrombin; Pulmonary Embolism; Thrombelastography; Thrombin; Thromboplastin

Topics: Adult; Aged; Blood Coagulation Tests; Blood Transfusion; Clinical Trials as Topic; Female; Femoral Fractures; Femoral Vein; Fibrinogen; Hematocrit; Heparin; Hip; Humans; Injections, Subcutaneous; Iodine Isotopes; Male; Middle Aged; Myocardial Infarction; Phlebography; Popliteal Vein; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Thrombophlebitis; Thromboplastin; Thrombosis

CKD, characterized by retained uremic solutes, is a strong and independent risk factor for thrombosis after vascular procedures . Urem ic solutes such as indoxyl sulfate (IS) and kynurenine (Kyn) mediate prothrombotic effect through tissue factor (TF). IS and Kyn biogenesis depends on multiple enzymes, with therapeutic implications unexplored. We examined the role of indoleamine 2,3-dioxygenase-1 (IDO-1), a rate-limiting enzyme of kynurenine biogenesis, in CKD-associated thrombosis after vascular injury.. IDO-1 expression in mice and human vessels was examined. IDO-1. Both global IDO-1. Leveraging genetic and pharmacologic manipulation in experimental models and data from human studies implicate IS as an inducer of IDO-1 and a perpetuator of the thrombotic milieu and supports IDO-1 as an antithrombotic target in CKD.

Topics: Animals; Aorta; Carotid Artery Injuries; Carotid Artery Thrombosis; Culture Media; Enzyme Induction; Feedback, Physiological; Female; HEK293 Cells; Humans; Indican; Indoleamine-Pyrrole 2,3,-Dioxygenase; Kynurenine; Mice; Mice, Inbred C57BL; Mice, Knockout; Molecular Targeted Therapy; Myocytes, Smooth Muscle; Postoperative Complications; Renal Insufficiency, Chronic; Thromboplastin; Thrombosis; Tryptophan; Uremia; Vascular Surgical Procedures

Tissue factor (TF) is a membrane component of many cells and a strong activator of blood coagulation. Damage to the cells induces an increase in its expression and concentration in blood plasma. The injury and breakdown of the cells is inseparably connected with the harvesting and preservation of the kidney.. The aim of the study was an analysis of TF in the renal vein after of restoration of circulation in the transplanted kidney. An additional goal was to investigate the impact of warm ischemia on TF.. The examined group included 61 kidney recipients. Blood was taken from the renal vein in the first minute during reperfusion. Simultaneously, blood from a peripheral vein was also drawn. Apart from tissue factor (TF), I also examined thrombin/antithrombin complexes and fragments 1+2 of prothrombin.. In blood from renal veins, I noticed higher level of TF, thrombin/antithrombin complexes and fragments 1+2 of prothrombin in comparison with blood from peripheral veins (P < .0048, P < .016, P < .046, respectively). The 29 recipients (47% of the total) with postoperative complications had much higher concentrations of TF than others (P < .019). TF showed a strong positive correlation with the time of warm ischemia (r = 0.53864, P < .05).. The donor kidney appeared to be one of the main sources of TF in the blood of recipients. Warm ischemia significantly increased its concentration in renal vein blood. This concentration of TF may be associated with damage to the kidney. TF significantly increased the risk of postoperative complications.

Topics: Adult; Antithrombin III; Blood Coagulation; Female; Humans; Kidney; Kidney Transplantation; Male; Peptide Hydrolases; Postoperative Complications; Prothrombin; Renal Veins; Risk Factors; Thromboplastin; Transplants; Warm Ischemia

To investigate the effect of perioperative period D-dimer and tissue factor (TF)-1208D/I gene polymorphism on the long-term prognosis of patients with off-pump coronary artery bypass grafting (OPCABG).. Retrospective analysis of the case data of the first OPCABG patients admitted to Tianjin Medical University General Hospital from May 2015 to May 2016 were enrolled. The general data, operation time, bypass number, left ventricular ejection fraction (LVEF), flow rate of 24-hour pleural effusion, intraoperative heparin dosage, combined anticoagulant and antiplatelet time, and the time of postoperative ventilator were measured. The blood biochemical indexes of 1, 4, 7, 14 days and 1, 2, 3 months after operation, perioperative complications, the level of D-dimer in the patients with different TF-1208D/I gene polymorphism, and prognosis of 1-year follow-up were recorded. The risk factors of recurrent angina 1 year after operation was analyzed by Logistic regression analysis.. The level of plasma D-dimer was increased continuously after OPCABG, and reached a peak at 1 month after operation [1.94 (1.07, 2.70) mg/L], then decreased, and decreased to preoperative level 3 months after operation [0.20 (0.10, 0.45) mg/L]. The level of D-dimer in TF-1208II genotype was significantly higher than that in TF-1208DD genotype and TF-1208D/I genotype group at 14 days and 1 month after operation [mg/L: 4.17 (1.54, 5.09) vs. 1.91 (1.07, 2.26), 1.02 (0.91, 1.88) at 14 days; 5.12 (2.41, 6.32) vs. 1.94 (1.18, 2.70), 1.62 (0.22,1.88) at 1 month, all P < 0.05]. The results of 1-year follow-up showed that 25 patients with recurrent angina pectoris without the occurrence of myocardial infarction. The proportion of recurrent angina pectoris in TF-1208II genotype was significantly higher than that in TF-1208DD genotype and TF-1208D/I genotype group (χ. After OPCABG, the body was in a hypercoagulable state and lasted for a long time, and almost recovered 3 months after operation. LVEF < 0.50 and TF-1208 II genotype were independent risk factors of angina pectoris at 1 year after surgery.

Topics: Coronary Artery Bypass; Fibrin Fibrinogen Degradation Products; Humans; Polymorphism, Genetic; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Thromboplastin; Treatment Outcome

As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations. The purpose of this study was to assess whether pre-operative labs significantly predict post-operative cardiac and septic complications in orthopaedic trauma and hip fracture patients.. Between 2006 and 2013, 56,336 (15.6%) orthopaedic trauma patients were identified and 27,441 patients (7.6%) were diagnosed with hip fractures. Pre-operative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. For each of these labs, patients were deemed to have normal or abnormal values. Patients were noted to have developed cardiac or septic complications if they sustained (1) myocardial infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days after surgery. Separate regressions incorporating over 40 patient characteristics including age, gender, pre-operative comorbidities, and labs were performed for orthopaedic trauma patients in order to determine whether pre-operative labs predicted adverse cardiac or septic outcomes.. 749 (1.3%) orthopaedic trauma patients developed cardiac complications and 311 (0.6%) developed septic shock. Multivariate regression demonstrated that abnormal pre-operative platelet values were significantly predictive of post-operative cardiac arrest (OR: 11.107, p=0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p=0.008) of the development of septic shock in trauma patients. In the hip fracture cohort, abnormal partial thromboplastin time was significantly associated with post-operative myocardial infarction (OR: 15.083, p=0.046), and abnormal bilirubin (OR: 58.674, p=0.002) significantly predicted the onset of septic shock.. This is the first study to demonstrate the utility of pre-operative labs in predicting perioperative cardiac and septic adverse events in orthopaedic trauma and hip fracture patients. Particular attention should be paid to haematologic/coagulation labs (platelets, PTT) and bilirubin values.. Prognostic Level II.

Topics: Aged; Bilirubin; Cost-Benefit Analysis; Diagnostic Tests, Routine; Female; Fractures, Bone; Humans; Male; Multiple Trauma; Myocardial Infarction; Orthopedic Procedures; Orthopedics; Platelet Count; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Prognosis; Shock, Septic; Surgical Wound Infection; Thromboplastin; United States; Unnecessary Procedures

Topics: Aged; Biomarkers; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Percutaneous Coronary Intervention; Postoperative Complications; Prognosis; Thromboplastin; Time Factors

It has been demonstrated that formation of compact plasma fibrin clots resistant to plasmin-mediated lysis characterises patients following in-stent thrombosis (IST). The relationship between defective fibrinolysis, reflected as prolonged clot lysis time (CLT) and IST is unclear. We sought to investigate whether patients with acute and subacute IST have impaired fibrinolytic capacity. We studied 41 definite IST patients, including 15 with acute and 26 with subacute IST experienced 2-73 months prior to enrollment, versus 41 controls matched for demographics, cardiovascular risk factors, concomitant treatment and angiographic/stent parameters. CLT, reflecting lysis of a tissue factor-induced plasma clot by exogenous tissue plasminogen activator, together with plasminogen activator inhibitor-1 (PAI-1) antigen and activity, thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and activity, thrombomodulin (TM), plasminogen and α2-antiplasmin (α2AP) were measured. There were no inter-group differences in angiographic parameters, indication to the first PCI, culprit vessel or a type of stent. Patients with IST had 11% longer CLT (p=0.005) and 13% higher PAI-1 antigen (p=0.04) compared to controls. There were positive correlations in both groups between CLT and PAI-1 antigen and TAFI activity (all p<0.001). Multiple regression analysis showed that CLT (odds ratio [OR]=1.04 per 1 minute, 95% CI 1.01-1.08, p=0.02) and platelet count (OR=1.01 per 1,000/μl, 95% CI 1.00-1.02, p=0.034) were independent predictors of IST (R(2)=0.28, p<0.05). Concluding, impaired fibrinolytic potential, that is in part determined by plasma PAI-1 antigen and TAFI activity, characterises patients with a history of acute and subacute IST, which might help identify patients at higher risk of IST.

Topics: Aged; alpha-2-Antiplasmin; Blood Platelets; Blood Vessel Prosthesis Implantation; Carboxypeptidase B2; Clot Retraction; Female; Fibrinolysis; Humans; Male; Medical History Taking; Middle Aged; Plasminogen; Plasminogen Activator Inhibitor 1; Postoperative Complications; Risk; Stents; Thrombomodulin; Thromboplastin; Thrombosis

Hepatocyte transplantation (HcTx) has proven to be a safe procedure, although the functional results have been unsatisfactory, probably due to insufficient engraftment or a loss of transplanted mass or function. In this study, we investigate whether hepatocytes in contact with blood induce an inflammatory reaction leading to, similar to what happens in clinical islet transplantation, an instant blood-mediated inflammatory reaction (IBMIR) resulting in an early loss of transplanted cells.. By using an experimental model that mimics the portal vein blood flow, we could study different parameters reflecting the effects on the innate immunity elicited by hepatocytes in contact with ABO-matched human blood.. We report that all aspects of the IBMIR such as platelet and granulocyte consumption, coagulation, and complement activation were demonstrated. Addition of various specific inhibitors of coagulation allowed us to clearly delineate the various stages of the hepatocyte-triggered IBMIR and show that the reaction was triggered by tissue factor. Analysis of a case of clinical HcTx showed that hepatocyte-induced IBMIR also occurs in vivo. Both the inflammatory and the coagulation aspects were controlled by low-molecular-weight dextran sulfate.. Isolated hepatocytes in contact with blood induce the IBMIR in vitro, and there are indications that these events are also relevant in vivo. According to these findings, HcTx would benefit from controlling a wider range of signals from the innate immune system.

Topics: ABO Blood-Group System; Blood Coagulation; Cells, Cultured; Dextran Sulfate; Hepatocytes; Humans; Immunohistochemistry; Inflammation; Postoperative Complications; Thromboplastin

Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.

Topics: Aged; Atrial Fibrillation; Biomarkers; C-Reactive Protein; Coronary Artery Bypass; Coronary Artery Disease; Female; Humans; Inflammation; Interleukin-6; Male; Matrix Metalloproteinase 9; Middle Aged; Postoperative Complications; Predictive Value of Tests; Prognosis; Reproducibility of Results; Thromboplastin

The authors carried out a comparative analysis of the level of homocysteine and the state of haemostasis in patients with and without type 2 diabetes mellitus in the remote terms after endured reconstructive operations on the aorto-iliac segment. They examined a total of eighty-eight patients who had endured reconstructive operations on the aorto-iliac segment at various terms. Of these, forty-two patients were found to have a severe course of type 2 diabetes mellitus (59.9% with decompensation) and forty-six subjects without diabetes constituted the group of comparison. The average age of the patients amounted to 61.9 +/- 1.25 years, with all being smokers. The following parameters were assessed: patency of the bypasses and major arteries of the lower limbs (LL), homocysteine (Hey), fibrinolytic activity, fibrinogen, activated partial thromboplastin time (aPTT), factor XIII, thrombin time, prothrombin index, activity of antithrombin III (AIII), platelet aggregation with ADP, and glycosylated haemoglobin (Hb Aic).

Topics: Aged; Antithrombin III; Aorta, Abdominal; Blood Vessel Prosthesis Implantation; Data Interpretation, Statistical; Diabetes Mellitus, Type 2; Female; Fibrinogen; Follow-Up Studies; Hemostasis; Homocysteine; Humans; Iliac Artery; Leg; Male; Middle Aged; Plastic Surgery Procedures; Platelet Aggregation; Postoperative Complications; Thromboplastin; Time Factors

Postoperative bleeding and adhesion formation remain the two major problems after endoscopic sinus surgery (ESS). This study investigates the effect on adhesion formation and wound healing in a sheep model of chronic sinusitis of three topical agents: recombinant tissue factor (rTF, Dade Innovin, Marburg, Germany), poly-ethylene glycol (SprayGel, Confluent Surgical, Waltham, MA), and a novel chitosan-dextran derivative gel (CD, Department of Chemistry, University of Otago, Dunedin, New Zealand).. Twenty sheep with chronic sinusitis underwent ESS with standardized mucosal injuries created on the lateral nasal wall and the ethmoid region. Injured areas were divided into four groups, and one of the three agents or control (no treatment) was randomly applied. The presence and severity of adhesions were noted and the healing was evaluated by taking brushings for ciliary beat frequency and biopsies of the injured regions at day 28, 56, 84, and 112 post initial surgery. The biopsy specimens were assessed for re-epithelialisation using light microscopy and scanning electron microscopy for reciliation. The cytobrush specimens assessed cilial function by measuring ciliary beat frequency.. CD significantly decreased lateral nasal wall and ethmoidal adhesions compared to tissue factor at all time points (5% vs. 25%, and 0 vs. 50%, respectively). There was a noticeable trend toward decreased adhesions on the lateral nasal wall and ethmoids in the SprayGel group (10% and 14%) and the CD group (10% and 0%) compared to controls (15% and 40%). The CD group had a significantly greater percentage of re-epithelialisation at day 28 and day 84 compared to the rTF group (70% vs. 33%, P < .001; 84.5% vs. 61%, P < 0.05). At day 28, the CD group was significantly more ciliated than control (62% vs. 31%, P < .01) and than rTF (62% vs. 23%, P < .001). This difference between CD and rTF reciliation remained significant at day 56 (67% vs. 40%, P < .05). In addition, the mean cilial grade for CD at day 112 was significantly better than control (1.9 vs. 2.7, P < .05).. In the sheep model of chronic sinusitis, CD significantly improves microscopic wound healing and reduces adhesion formation after ESS.

Topics: Animals; Biocompatible Materials; Chitosan; Chronic Disease; Dextrans; Disease Models, Animal; Endoscopy; Epithelium; Gels; Mucous Membrane; Polyethylene Glycols; Postoperative Complications; Random Allocation; Recombinant Proteins; Sheep; Sinusitis; Thromboplastin; Tissue Adhesions; Wound Healing

Concentrations of non-cell-bound (NCB; soluble) tissue factor (TF) are elevated in blood collecting in the pericardial cavity of patients during cardiopulmonary bypass (CPB). Previously, we reported microparticles supporting thrombin generation in such blood samples. In this study we investigated the extent of microparticle association of the NCB form of TF in pericardial and systemic blood, and whether this microparticle-associated form is active in thrombin generation compared with non-microparticle-bound, (fluid-phase) TF.. Systemic and pericardial blood samples were collected before and during CPB from six patients undergoing cardiac surgery. Microparticles were isolated by differential centrifugation and their thrombin-generating capacity measured in a chromogenic assay. Microparticle-associated and fluid-phase forms of NCB TF were measured by ELISA. Microparticle-associated TF was visualized by flow cytometry.. In pericardial samples, 45-77% of NCB TF was microparticle-associated, and triggered factor VII (FVII)-mediated thrombin generation in vitro. Microparticles from systemic samples triggered thrombin generation independently of FVII, except at the end of bypass (P = 0.003). The fluid-phase form of TF did not initiate thrombin generation. Both forms of NCB TF were, at least in part, antigenically cryptic.. We demonstrate the occurrence of two forms of NCB TF. One form, which is microparticle-associated, supports thrombin generation via FVII. The other form, which is fluid-phase, does not stimulate thrombin formation. We hypothesize that the microparticle-associated form of NCB TF may be actively involved in postoperative thromboembolic processes when pericardial blood is returned into the patients.

Topics: Blood Circulation; Coronary Artery Bypass; Coronary Circulation; Factor VII; Humans; Octoxynol; Particle Size; Postoperative Complications; Solubility; Thrombin; Thromboembolism; Thrombophilia; Thromboplastin

The 'high and low responder phenomenon' of monocyte tissue factor (MTF) activity has been attributed to effects on monocytes by granulocytes, platelets and lipopolysaccharide (LPS). To study the possible contribution of plasma to the high and low responder phenomenon, we measured the MTF activity in isolated cryopreserved human monocytes from two donors (monocytes A and monocytes B) after incubation in a plasma environment depleted of granulocytes, platelets and LPS. In buffer only, MTF activity was 643 and 679 fM (fM = final concentration of tissue factor), in normal pooled plasma, it was 1478 and 1615 fM (P = 0.001), respectively, in monocytes A and in monocytes B. Incubation with individual plasma samples from healthy controls (n = 43) gave a median MTF of 1355 fM (range 1044-1976 fM) and 1329 fM (range 858-1951 fM) respectively. A plasma consistently induced a higher or lower level of MTF activity in both monocytes: r = 0.82 (P < 0.00001). Coumarin use did not influence the high and low responder phenomenon. In the absence of granulocytes, platelets and LPS, plasma determines the high and low responder phenomenon. This phenomenon is not influenced by coumarin treatment.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Blood Coagulation; Case-Control Studies; Cell Culture Techniques; Cells, Cultured; Coumarins; Cryopreservation; Culture Media, Serum-Free; Female; Hip Fractures; Humans; International Normalized Ratio; Leukocytes, Mononuclear; Male; Middle Aged; Plasma; Postoperative Complications; Statistics, Nonparametric; Thromboplastin

Cardiac allograft vasculopathy is a major cause of morbidity and mortality of cardiac transplant recipients. The underlying cause of this disease remains unclear. Histological studies have implicated accelerated hemostasis and intravascular fibrin deposition in its pathogenesis. In the present study a defined model of this disease in the rat was used to elucidate the implication of tissue factor in the production of the hypercoagulable state observed in cardiac allograft vessels. Tissue factor protein and mRNA expression were studied in rat heart allografts developing allograft vasculopathy resembling human disease. Immunohistochemistry demonstrated tissue-factor-positive cells present in the allograft coronary intima and adventitia. Significant staining for tissue factor was detected in the endothelium lining coronary lesions in cardiac allografts and in interstitial mononuclear cells, respectively. Both transplant coronary endothelial cells and mononuclear cells contained tissue factor mRNA as indicated by oligo-cell reverse transcription polymerase chain reaction after laser-assisted cell picking. In contrast, tissue factor mRNA and protein were not or negligibly detectable within the coronary intima of nontransplanted control hearts. Thus, the present study clearly demonstrates that aberrant tissue factor expression occurs within the coronary intima after cardiac transplantation. Tissue factor, activating downstream coagulation mechanisms, may account for the intravascular clotting abnormalities observed in cardiac allografts and may represent a key factor in transplant atherogenesis.

Topics: Animals; Coronary Disease; Coronary Vessels; Heart Transplantation; Male; Myocardium; Postoperative Complications; Rats; Rats, Inbred Lew; Reference Values; RNA, Messenger; Thromboplastin; Tunica Intima

The increased risk for deep vein thrombosis (DVT) after orthopaedic surgery has been well documented as well as hypercoagulable state during both total hip arthroplasty (THA) and total knee replacement (TKR). To investigate the influence of the surgical procedure [posterolateral (PL) or lateral (L) approach for THA, use of tourniquet (TQ) or not use of TQ for TKR] on the hypercoagulability and the role of extrinsic pathway activation and endothelial stimulation during orthopaedic surgery we have examined 40 patients (20 patients undergoing primary THA--10 with PL approach and 10 with L approach--and 20 patients undergoing TKR--10 with TQ application and 10 without TQ). Thrombin-antithrombin complexes (TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and von Willebrand factor antigen (vWF:Ag) were analyzed before and during the orthopaedic surgery. During THA, TAT plasma levels increased more markedly in patients assigned to the L than PL approach (p <0.05); during TKR an elevation of TAT of higher degree (p <0.05) was observed when TQ was not applicated. Blood clotting activation was significantly (p <0.001) more relevant during THA than TKR. No changes in TF and vWF:Ag plasma levels were observed in all patients undergoing THA and TKR. TFPI plasma levels significantly (p <0.05) decreased 1 h after the end of the THA in group PL and group L, whereas they remained unaffected in the two groups of patients undergoing TKR. Similarly TM plasma levels significantly decreased during THA, but not during TKR. In conclusion, these results show that: 1) the site of surgical procedures and the type of approach affect the degree of hypercoagulability, 2) the blood clotting activation takes place in the early phases of orthopaedic surgery, without signs of extrinsic pathway and endothelial activation.

Topics: Aged; Blood Coagulation; Female; Humans; Male; Middle Aged; Orthopedics; Postoperative Complications; Surgical Procedures, Operative; Thrombophlebitis; Thromboplastin

Gut-derived substances can activate Kupffer cells to provoke hepatic necrosis after partial hepatectomy in rats. A similar situation may occur during orthotopic liver transplantation (OLT), as congestion in the intestinal wall, caused by portal vein occlusion, is inevitable during the operation. The contribution of such substances to liver injury following OLT was investigated in rats. Oral administration of polymyxin B sulfate for 7 days significantly altered intestinal bacterial flora in rats; Enterobacteriaceae diminished and anaerobes such as Bifidobacterium , Lactobacillus, Bacteroides, and Eubacterium increased in number, compared with the control rats. Also, this treatment significantly reduced endotoxin concentration in the portal blood 30 minutes after blood reflow following portal vein occlusion. When OLT was performed in rats using the liver preserved in cold University of Wisconsin solution for 18 hours, tissue factor activity in Kupffer cells (KC) isolated from the transplanted liver 1 hour after the operation was significantly higher than in that of normal rats. This increase was significantly reduced by pretreatment of the recipients with polymyxin B sulfate. In these recipients, serum alanine aminotransferase activity, tumor necrosis factor alpha (TNF alpha) concentration, and histological extent of liver necrosis were significantly attenuated at 24 hours after the operation compared with those of control rats. We conclude that the substances derived from bacilli sensitive to polymyxin B sulfate in the gut may be a contributing factor to liver injury following OLT in rats; we feel that this probably occurs by entering of the substances into the portal blood during the ahepatic phase of the operation to activate KC. Selective bowel decontamination of recipients with polymyxin B sulfate would be a candidate for protection against early graft failure following OLT.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Endotoxins; Intestines; Kupffer Cells; Liver; Liver Diseases; Liver Transplantation; Male; Polymyxin B; Portal System; Postoperative Complications; Preoperative Care; Rats; Rats, Inbred F344; Thromboplastin; Tumor Necrosis Factor-alpha

Accelerated coronary atherosclerosis in cardiac allografts is the major limiting factor for long-term survival after heart transplantation. There is growing evidence that activation of the coagulation mechanism is involved in the development of transplant atherosclerosis. Tissue factor (TF) expression by cells of the monocyte/macrophage system may represent an important mechanism underlying the fibrin deposition in the affected vessels. In the present study, we investigated the effect of cyclosporine A (CsA) on the lipopolysaccharide (LPS)-induced procoagulant activity (PCA) in human monocytes/macrophages. CsA exerted a dose-dependent inhibitory effect on LPS-induced monocyte/macrophage PCA, which was identified as TF activity based on functional and immunologic characterization. As shown by reverse transcriptase-polymerase chain reaction, CsA reduced the transcription of the TF gene in LPS-stimulated monocytes/macrophages. Electrophoretic mobility shift assay showed that CsA inhibited the LPS-induced activation of the nuclear factor kappa B (NF-kappa B). As shown by Western blot analysis, CsA treatment decreased the nuclear translocation of NF-kappa B, thereby suggesting the mechanism for the inhibitory effect of CsA on TF induction. Hence, a nonimmunologic effect of CsA may contribute to its successful use in transplant medicine.

Topics: Biological Transport; Blood Coagulation Factors; Cell Nucleus; Cells, Cultured; Coronary Artery Disease; Cyclosporine; Depression, Chemical; Gene Expression Regulation; Heart Transplantation; Humans; Lipopolysaccharides; Macrophages; Monocytes; NF-kappa B; Postoperative Complications; Protein Binding; Thromboplastin; Transcription, Genetic

A patient undergoing intracranial surgery developed disseminated intravascular coagulation with life threatening peroperative bleeding. Thromboelastography established the diagnosis of hyperfibrinolysis, usually a fatal complication of a neurosurgical operation. With the administration of a high dose regimen of aprotinin (Trasylol) the haemorrhage was controlled and the hyperfibrinolytic state reversed. Evaluation of blood samples from the jugular bulb suggested that there was a pronounced local release of tissue plasminogen activator into the circulation.

Topics: Aged; Aprotinin; Brain; Brain Neoplasms; Craniotomy; Dose-Response Relationship, Drug; Fatal Outcome; Fibrinolysis; Glioblastoma; Hemorrhage; Humans; Injections, Intravenous; Male; Postoperative Complications; Prothrombin; Thrombelastography; Thromboplastin

Tissue injury following trauma and surgery may induce alterations in blood coagulation and fibrinolysis. Hypercoagulable state after surgery can be associated with the risk of postoperative thromboembolic complications. The contact of coagulation factors with TF after injury of vessel wall and organ tissues may contribute to the development of thrombosis after surgery (1). TF, the cell surface receptor and cofactor of factor VII/VIIa is normally not expressed by cells within the vasculature. Only monocytes and endothelial cells can be stimulated to express TF transiently by a variety of inflammatory and immunological reactions (for review see 2,3). Also surgical treatment was reported to induce TF synthesis in monocytes (4,5,6). TF is present in many extravascular tissues as vascular adventitia, organ capsules, epidermis, colonic mucosal epithelium, liver stroma, pancreas stroma and also on tumor cells (7-12). In this study, we investigated, whether we can detect the release of TF from the traumatized tissues and from activated monocytes into the circulation following abdominal surgery. To test the dependence of the extension of tissue injury during surgery we segregated the patients into group A with major abdominal operations and group B consisting of patients with appendectomy and cholecystectomy. No relationship could be established between changes of TF and postoperative thromboembolic complications.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Factor VII; Female; Humans; Male; Middle Aged; Monocytes; Postoperative Complications; Thromboembolism; Thromboplastin

Primary antiphospholipid syndrome (PAPS) is an autoimmune disorder manifested by recurrent thrombosis in the venous and arterial system. We report a group of seven patients with lower limb ischaemia associated with PAPS. Four were male patients and three were females, with a mean age of 37 years. All had a previous deep vein thrombosis and the majority, five out of seven, had a prior cerebrovascular accident (CVA). Prolonged activated thromboplastin time was demonstrated in all our patients and PAPS was established by positive thromboplastin titration index, circulating anticoagulant index and increased anticardiolipin levels. Symptoms included claudication in three, rest pain in four and gangrene in five patients. Angiography demonstrated thrombosis of various segments of the arterial tree including: aorta, iliac, femoral and popliteal arteries. Two patients were treated conservatively and one by percutaneous transluminal angioplasty (PTA) of the distal aorta. A total of eleven vascular surgical procedures were performed in four patients resulting in early postoperative thrombosis (2h-30 days) in 10 cases. Only one graft remained patent, when full heparinisation (1000 units/h) was used perioperatively. We conclude that PAPS patients are at high risk for graft thrombosis and should only be operated upon on full anticoagulation, starting at operation and proceeding indefinitely.

Topics: Adolescent; Adult; Aged; Antiphospholipid Syndrome; Female; Graft Occlusion, Vascular; Humans; Ischemia; Leg; Male; Middle Aged; Partial Thromboplastin Time; Postoperative Complications; Thrombectomy; Thromboembolism; Thromboplastin; Ultrasonography; Whole Blood Coagulation Time

Extrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of antithrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.

Topics: Adult; Aged; Factor VII; Female; Hematocrit; Heparin Cofactor II; Hip; Humans; Lipoproteins; Male; Middle Aged; Postoperative Complications; Protease Inhibitors; Protein C; Serum Albumin; Thromboplastin; Thrombosis

Topics: Animals; Blood Coagulation Disorders; Drug Evaluation; Drug Evaluation, Preclinical; Drug Therapy, Combination; Humans; Intraoperative Complications; Male; Postoperative Care; Postoperative Complications; Premedication; Prostatectomy; Prostatic Hyperplasia; Rats; Thromboplastin; Vitamins

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

Thromboembolic complications are often a common pathological consequence of severe soft tissue trauma. Recent demonstration that monocytes (M0) produce tissue factor (TF) has led to the suggestion that these TF producing M0 might play a role in coagulopathy. We have previously demonstrated that trauma patients with splenectomy develop aberrant monocyte function and this patient group is also known to be at high risk of hypercoagulability episodes. This paper is an initial report on the use of M0 TF as an indicator of and/or correlated to clotting episodes. Monocytes isolated form the Ficoll-Hypaque purified mononuclear cells of 46 normal individuals, 17 trauma patients and 6 surgical controls were assayed at 3 day post-injury intervals for their levels of TF activity. Changes in monocyte TF activity were correlated to increases in the fractional catabolic rate (FCR) of 125 I-fibrinogen. Trauma patients were retrospectively divided into those whose FcR was elevated to a level indicative of coagulopathy and those whose FCR levels were not associated with coagulation abnormalities. All trauma patients who exhibited significantly increased FCR experienced thromboembolic episodes and had monocytes whose TF activity was increased an average of 300% (mean = 47 units vs mean = 12 units) over surgical controls. These increase in monocyte TF activity occurred at 6-13 days post injury and preceded clinical manifestation of coagulopathy by 4-6 days. The increased monocyte TF activity demonstrated in this study was significantly correlated to detection of pathologically increased FCR (R = 0.850) and compared to other indices of hypercoagulability.

Topics: Blood Coagulation; Fibrinogen; Humans; Monocytes; Postoperative Complications; Splenectomy; Thromboembolism; Thromboplastin; Wounds and Injuries

A patient undergoing subtotal pancreatectomy and intraportal islet tissue autotransplantation for chronic pancreatitis developed severe portal hypertension (49 cm of H(2)O) and acute disseminated intravascular coagulation (DIC). In an attempt to identify the cause of these problems, portal pressure and the activities of the coagulation and fibrinolytic systems were studied in dogs undergoing intraportal autotransplantation of islet tissue. Following intraportal injection of the pancreatic tissue in five control dogs, the portal pressure rose to a maximum of 43.2 cm of H(2)O +/- 2.4 and major coagulation abnormalities occurred. The mean hematocrit value fell to 18% +/- 8.6, the mean platelet count to 218,000 +/- 31,000, the mean plasma fibrinogen to 40 mg/dl +/- 18, and the mean euglobulin clot lysis time (ECLT) to 25 min +/- 4. Partial thromboplastin time (PTT) became prolonged (233 secs +/- 30) and significant quantities of fibrinogen-fibrin degradation products (FDP-fdp) (1:128 +/- 32) appeared. These changes indicate the development of DIC probably secondary to significant amounts of tissue thromboplastin detected in the tissue homogenate infused at time of autotransplantation. In a group of seven dogs in whom heparin and Trasylol (aprotinin) were added to the pancreatic tissue at the time of transplantation, portal pressure rose only to a peak of 28.3 cm of H(2)O +/- 3.6 and no significant abnormalities occurred in mean hematocrit value, plasma fibrinogen, platelet count or ECLT. Minor prolongation of PTT occurred secondary to the activity of heparin. FDP-fdp (1:16) were present transiently during tissue injection. Four patients in whom heparin and Trasylol were added to the pancreatic tissue at the time of autotransplantation developed only minor elevations of portal pressure (mean 15.5 cm of H(2)O) without intravascular coagulopathy.

Topics: Animals; Blood Coagulation Tests; Blood Pressure; Chronic Disease; Disseminated Intravascular Coagulation; Dogs; Female; Humans; Hypertension, Portal; Islets of Langerhans Transplantation; Liver; Male; Pancreas; Pancreatectomy; Pancreatitis; Postoperative Complications; Thromboplastin; Transplantation, Autologous

The distribution and variation of thromboplastic and fibrinolytic activity were studied in various layers of polyester grafts in the dog aorta. One, four and 36 months after implantation, these grafts were removed together with segments of normal arteries and veins and dissected into three layers. The thromboplastic and plasminogen activator activities in these layers were then determined. It was found that in the early post-operative period, the thromboplastic activity in the Dacron graft neointima is very high, whereas that of the plasminogen activator is relatively low. With the passage of time the thromboplastic activity decreases and plasminogen activator activity increases. Similarly the thromboplastic activity in the neomedial and neoadventitial layers of the graft falls as time elapses after the implantation and the fibrinolytic activity gradually increases. These changes in thromboplastic and fibrinolytic activity increase the danger of graft thrombosis in the early post-operative period whereas in the later period they are favourable to maintenance of graft patency.

Topics: Animals; Aorta, Abdominal; Aortic Diseases; Blood Vessel Prosthesis; Dogs; Fibrinolysis; Male; Plasminogen Activators; Polyethylene Terephthalates; Postoperative Complications; Thromboplastin; Thrombosis; Time Factors

Coagulation data were collected before and after peritoneovenous shunting for intractable ascites in 19 shunting procedures. After insertion of the shunts, changes consistent with disseminated intravascular coagulation developed in all cases in which good flow of ascitic fluid was obtained. In cases with temporary shunt function, the coagulation variables suggestive of disseminated intravascular coagulation returned toward normal when the flow of ascitic fluid ceased. A fall in the level of fibrinogen degradation products indicated that the shunt had clotted. Bleeding attributable to disseminated intravascular coagulation alone was uncommon. Clotting of the shunts was frequent. The use of heparin improved some of the coagulation variables but did not prevent shunt clotting or clinical bleeding. We conclude that the peritoneovenous shunt induces a moderate disseminated intravascular coagulation and that measurement of fibrinogen degradation products is useful in assessing shunt function.

Topics: Adult; Aged; Ascites; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Peritoneal Cavity; Postoperative Complications; Prothrombin Time; Thromboplastin; Vena Cava, Superior

Activated coagulation time (ACT) for protamine reversal was monitored in 28 consecutive patients (Group 1) and a standard heparin-protamine protocol was used for an earlier series of 28 patients (Group 2). Although Group 1 received a significantly higher total heparin dose than Group 2 (p less than 0.01), the protamine dose for reversal was significantly less for the ACT group than for the controls (p less than 0.0005). The mean ratio of protamine to total heparin was 1 : 1 (range, 0.33 to 1.44) for the ACT group and 2 : 1 (range, 1.42 to 2.59) for the controls. There were no significant differences between the two groups in operative and postoperative blood loss, transfusion requirements, hematocrit, and partial thromboplastin time. This study shows that the ACT test did not reduce postoperative bleeding significantly when compared with our standard protocol. It also indicates that there is wide individual sensitivity to heparin and that significantly less protamine is required for reversal.

Topics: Blood Coagulation Tests; Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Evaluation Studies as Topic; Hematocrit; Hemorrhage; Heparin; Humans; Middle Aged; Monitoring, Physiologic; Postoperative Complications; Protamines; Thromboembolism; Thromboplastin

The fibrinolytic responses in the blood during surgical operation have been studied in two groups of patients during intraoperative intermittent compression of the calf. Fibrinolytic activity did not differ significantly between the groups. The postoperative fibrinolytic shutdown was not prevented by intermittent compression of the calf. It is concluded that, whatever the mechanism by which venous thrombosis is prevented by intermittent compression of the calf, it is not by further stimulation of systemic fibrinolysis.

Topics: Dextrans; Evaluation Studies as Topic; Factor X; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Humans; Leg; Male; Postoperative Complications; Pressure; Prothrombin Time; Serum Globulins; Thrombophlebitis; Thromboplastin; Time Factors

Two hours before surgery and every 12 hours thereafter 5,000 units of heparin sodium was administered subcutaneously to 100 general surgical patients. Hemostasis was evaluated by a template bleeding time and an activated partial thromboplastin time (PTT). The latter was sensitive to 0.05 units/ml of heparin and gave a straight-line response up to 0.2 units/ml. In the great majority of patients, only a modest elevation of the PTT occurred two and four hours after heparin therapy. However, in 10% to 15% the PTT was prolonged two times or more and in a similar number, PTT after surgery was shorter than baseline values despite heparin. No correlation between PTT prolongation and weight, ponderal index, age, or sex was found. Significant bleeding occurrred in three patients, two from the group of hyperresponders to heparin. Recent aspirin ingestion was implicated in one patient and our evidence indicates that low-dose heparin potentiates aspirin-induced prolongation of bleeding time in certain individuals. Local hematoma formation and discomfort from the injections was not a problem.

Topics: Adult; Aged; Aspirin; Blood Coagulation; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Hemostasis, Surgical; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Postoperative Complications; Thromboplastin

Under the effect of acetylsalicyl lysin, a postoperative hypercoagulability was ascertained with regard to shortened antithrombin and partial prothrombin times. The inhibition of aggregation was easily demonstrable with a high concentration of collagen in the test batch and showed a striking relationship to the occurrence of thrombosis. Under heparin prophylaxis, normal coagulability was maintained. Since disorders of hemostasis due to therapy occur sporadically, early postoperative raising of the dose of heparin should only be done under regular laboratory controll, to which activated PTT and antithrombin time is well suited.

Topics: Aged; Antithrombins; Aspirin; Blood Coagulation Tests; Collagen; Female; Heparin; Humans; Lysine; Male; Middle Aged; Platelet Aggregation; Postoperative Care; Postoperative Complications; Preoperative Care; Thrombelastography; Thrombin; Thromboplastin; Thrombosis

The effect of dipyridamole (Persantine) on the thrombocyte count and bleeding tendency in connection with open-heart surgery and perfusion was studied in 22 patients. A control series of 21 patients undergoing open-heart surgery was available. The treatment group received dipyridamole, 0.5 mg. per kilogram of body weight, in the beginning of cardiopulmonary bypass into the heart-lung machine and thereafter 10 mg. intravenously three times daily for 2 days. From the third day dipyridamole was administered by mouth, 75 mg. three times a day, until the patient was discharged from hospital. We found that dipyridamole had the effect of maintaining the thrombocyte count during cardiopulmonary bypass and the first and second postoperative days. Thereafter no significant difference was seen between the dipyridamole and control groups. The use of dipyridamole did not increase the postoperative hemorrhagic tendency. There were no significant differences in per- and postoperative blood loss and in bleeding and activated partial thromboplastin times between the groups.

Topics: Adolescent; Adult; Blood Cell Count; Blood Coagulation; Blood Platelets; Cardiopulmonary Bypass; Dipyridamole; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Heart Valve Diseases; Hemostasis, Surgical; Humans; Male; Middle Aged; Postoperative Complications; Thrombocytopenia; Thromboplastin

Topics: Adult; Animals; Blood Coagulation; Brain; Brain Injuries; Brain Mapping; Cerebral Ventricle Neoplasms; Disseminated Intravascular Coagulation; Dogs; Factor VIII; Female; Humans; Oligodendroglioma; Postoperative Complications; Thromboplastin

Screening coagulation studies were carried out on 69 long-term survivors who had received renal allografts. Fibrinogen levels were significantly raised in this group. Factor VIII activity was increased in 7 of the 11 patients studied. Six long-term survivors of renal allografts demonstrated arterial thrombotic phenomena. The onset of the thrombotic episode occurred at a relatively young age. It is considered that the hypercoagulable state may contribute to the observed increased tendency towards arterial thrombotic phenomena.

Topics: Adolescent; Adult; Aged; Antithrombins; Blood Coagulation Factors; Factor VIII; Fatty Acids, Nonesterified; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Follow-Up Studies; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Thromboplastin; Thrombosis; Transplantation, Homologous

A nonhuman primate model for thrombus generation was developed. Three different types of test devices constructed of polystyrene or polyethylene-Silastic were exposed to flowing blood in arterioarterial or arteriovenous vascular shunts in rhesus monkeys. The test device design included a simple tube, a vortical flow device, and a turbulent flow device. The amount of thrombus deposited within each individual test device after a 15-minute exposure to blood flowing through the shunt was determined gravimetrically. These studies indicate that a test device designed to include an area of vortical flow generated the greatest amount of thrombus. Test devices fabricated from polystyrene consistently generated larger thrombus deposits than did similar test devices fabricated from polyethylene-Silastic. Arteriovenous shunts proved superior to arterioarterial shunts in that flow was predictable in the former and unpredictable in the latter; venovenous shunts thrombosed quickly. Hematologic studies indicated a progressive fall in platelet count during the 4-hour test interval in all animals, whereas in only a few animals were there a shortening of partial thromboplastin time values, a fall in fibrinogen levels, and the appearance of fibrin degradation products. An optimal model for thrombus generation appears to include vortical flow test devices fabricated of polystyrene exposed to flowing blood in an arteriovenous shunt.

Topics: Animals; Arteriovenous Shunt, Surgical; Blood Cells; Fibrin Fibrinogen Degradation Products; Fibrinogen; Haplorhini; Leukocyte Count; Macaca mulatta; Models, Biological; Polystyrenes; Postoperative Complications; Silicone Elastomers; Thromboplastin; Thrombosis; Time Factors

A prospective study was performed on 32 consecutive patients undergoing elective operations on the abdominal aorta. Dacron prosthetic grafts were used to replace resected abdominal aortic aneurysms or to bypass aorta-iliac occlusive disease. Complete coagulation studies were performed preoperatively, immediately postoperatively and 24 hours postoperatively. Twenty to 30 per cent of the patients had significant postoperative alterations in prothrombin time, partial thromboplastin time and platelet count. Fibrin monomer, fibrin split products and plasminogen were abnormal in 40 to 80 per cent of the patients postoperatively. Results of preoperative studies showed no significant abnormalities. One of the 32 patients had mild clinical evidence of disseminated intravascular coagulation postoperatively, which was treated with 5 units of heparin per kilogram per hour. Results of the study indicate that aortic grafting procedures frequently produce intravascular coagulation, either local or disseminated. In most patients, this is offset by activation of the fibrinolytic system. However, clinically significant sequelae may result, requiring prompt recognition and treatment.

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm; Aortic Diseases; Arterial Occlusive Diseases; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Vessel Prosthesis; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prothrombin Time; Thromboplastin

In 15 patients undergoing aortofemoral bypass, partial thromboplastin time (PTT) tests before and following intravenous administration of 75 U. per kilogram of heparin at zero, 30, 60, 90, and 120 minutes were determined for study of control of anticoagulant adequacy. The results demonstrate clearly that this amount provides excellent protection against thrombosis without bleeding complications. For intraoperative assay of heparin level effectiveness, the PTT test is advised. This test showed that a value of 250 percent of control still existed 75 minutes following the administration of heparin.

Topics: Aged; Blood Coagulation Tests; Female; Heparin; Humans; Male; Middle Aged; Postoperative Complications; Thromboplastin; Thrombosis; Vascular Surgical Procedures

A case report of a patient with primary fibrinolysis resulting in hemorrhage after an oral surgical procedure has been presented. A comparison was made between DIC and primary fibrinolysis in patients with carcinoma of the prostate gland; etiology, clinical findings, diagnosis, and treatment were discussed.

Topics: Aged; Alveoloplasty; Aminocaproates; Blood Cell Count; Blood Coagulation Disorders; Blood Platelets; Blood Transfusion; Chlorothiazide; Diethylstilbestrol; Estrogens, Conjugated (USP); Fibrin; Fibrinolysis; Hematocrit; Hemoglobins; Humans; Male; Methyldopa; Oral Hemorrhage; Postoperative Complications; Prothrombin Time; Thromboplastin; Tooth Extraction

The wall of lover-limb arteries affected with severe atherosclerosis contains a Complex of substances with pro- and anticoagulative activities. The arterial wall, traumatized in endarterectomy by separation of the individual coats, releases procoagulative substances into blood circulation. The most conspicuous local manifestations of hypercoagulation and hypofibrinolysis appear on the day of surgery. The artery operated upon releases the thromboplastic factor for nine days; substances shortening the thrombin time (antiheparin substance, thrombin accelerator), for five days; and inhibitors of fibrinolysis, for four days after operation. A correlation was found between the regenerative process in the endarterectomized artery and the dynamics of the release of tissue factors influencing the haemocoagulation.

Topics: Animals; Arteriosclerosis Obliterans; Blood Coagulation; Catheterization; Dogs; Endarterectomy; Fibrin; Fibrinolysis; Humans; Iliac Artery; Perfusion; Postoperative Complications; Thrombin; Thromboplastin; Time Factors

Recovery of intrathoracic and intraperitoneal blood and reinfusion by autotransfusion has been demonstrated to be safe and practical in selected trauma patients. Autotransfusion is ideally applicable to the trauma patient in whom replacement of six or fewer units of blood is required. In addition, autotransfusion provides readily available blood for patients with unusual blood types and for those in whom multiple transfusions may rapidly deplete available stores. The properties of an ideal autotransfusion device include rapid assembly, relatively low cost, ease of operation, in-line filtration, minimized air blood interface, simplified anticoagulation, and safety from air embolism and coagulopathies.

Topics: Bilirubin; Blood Banks; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Transfusion, Autologous; Fibrinogen; Hematocrit; Hemoglobins; Hemolysis; Hemorrhage; Humans; Leukocyte Count; Liver; Liver Function Tests; Postoperative Complications; Prothrombin Time; Thoracic Surgery; Thorax; Thromboplastin; Wounds and Injuries

Topics: Blood Coagulation; Cesarean Section; Female; Humans; Postoperative Complications; Pregnancy; Thromboembolism; Thromboplastin

Topics: Blood Coagulation Tests; Blood Platelets; Humans; Postoperative Complications; Prognosis; Surface Properties; Thrombin; Thrombophlebitis; Thromboplastin; Time Factors

Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Embolism; Female; Humans; Leukemia; Male; Postoperative Complications; Pregnancy; Pregnancy Complications, Hematologic; Shock; Thromboplastin; Thrombosis; Wounds and Injuries

Topics: Antithrombins; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Heparin; Hip; Humans; Injections, Subcutaneous; Leg; Postoperative Complications; Pulmonary Embolism; Thromboembolism; Thromboplastin; Thrombosis

Topics: Blood Coagulation Disorders; Heparin; Humans; Inhalation; Postoperative Complications; Therapeutic Irrigation; Thromboplastin

Topics: Antibodies; Blood Coagulation; Blood Coagulation Factors; Exchange Transfusion, Whole Blood; Hematocrit; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prostatectomy; Thromboplastin

Topics: Adenoma; Antithyroid Agents; Drug Synergism; Fibrinolysis; Goiter; Hematoma; Hemorrhage; Humans; Plasminogen; Postoperative Complications; Preoperative Care; Thromboplastin; Thyroid Gland; Thyroid Neoplasms

Topics: Adolescent; Adult; Blood Cell Count; Blood Coagulation; Blood Platelets; Body Temperature; Cardiac Surgical Procedures; Child; Child, Preschool; Esophagus; Extracorporeal Circulation; Female; Fibrinogen; Hemorrhage; Humans; Male; Platelet Adhesiveness; Postoperative Complications; Prothrombin Time; Thrombelastography; Thromboplastin

Topics: Aged; Aortic Valve; Disseminated Intravascular Coagulation; Endocarditis; Hernia, Inguinal; Humans; Hyaline Membrane Disease; Infant, Newborn; Intestine, Small; Kidney; Lung; Male; Postoperative Complications; Shwartzman Phenomenon; Thromboplastin

Topics: Alanine Transaminase; Animals; Aspartate Aminotransferases; Blood Platelets; Blood Proteins; Blood Urea Nitrogen; Cryosurgery; Disseminated Intravascular Coagulation; Dogs; Fibrinogen; Hemostasis; Liver; Necrosis; Postoperative Complications; Shock, Hemorrhagic; Thromboplastin

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Heparin; Humans; Indicators and Reagents; Methods; Postoperative Care; Postoperative Complications; Preoperative Care; Thromboplastin

Topics: Adenoidectomy; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Factor IX; Factor VIII; Factor XI; Factor XI Deficiency; Female; Fibrinogen; Hemorrhagic Disorders; Humans; Middle Aged; Postoperative Complications; Thromboplastin; Tonsillectomy

Topics: Animals; Anticoagulants; Blood Coagulation Disorders; Blood Vessels; Dogs; Fibrinolysis; Hematologic Diseases; Hemorrhage; Hemostasis; Humans; Postoperative Complications; Rabbits; Rats; Stress, Physiological; Stress, Psychological; Surgical Procedures, Operative; Thromboplastin; Transfusion Reaction

Topics: Aminocaproates; Aprotinin; Blood Platelet Disorders; Blood Platelets; Fibrinolysis; Hemorrhage; Humans; In Vitro Techniques; Male; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Prothrombin Time; Thromboplastin

Topics: Anemia; Anticoagulants; Blood Cell Count; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Platelets; Blood Transfusion; Fibrinogen; Fibrinolysis; Hematologic Diseases; Hemorrhage; Humans; Infant, Newborn; Postoperative Complications; Preoperative Care; Prothrombin; Prothrombin Time; Thromboplastin

Topics: Abruptio Placentae; Adult; Aprotinin; Blood Coagulation; Blood Coagulation Tests; Blood Platelets; Factor V; Factor VIII; Female; Fibrinogen; Glass; Hemorrhage; Hemorrhagic Disorders; Humans; In Vitro Techniques; Middle Aged; Plasminogen; Postoperative Complications; Pregnancy; Prothrombin; Thrombin; Thromboplastin; Time Factors

Topics: Aminocaproates; Blood Coagulation Tests; Blood Platelets; Factor V; Factor VII; Fibrinogen; Fibrinolytic Agents; Hematuria; Humans; Male; Plasminogen; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Thromboplastin

Topics: Afibrinogenemia; Blood Coagulation; Blood Coagulation Factors; Blood Platelets; Blood Vessels; Calcium; Female; Hemorrhagic Disorders; Hemostasis; Humans; Postoperative Complications; Pregnancy; Pregnancy Complications, Hematologic; Serotonin; Thromboplastin

Topics: Anticoagulants; Blood Coagulation Tests; Coumarins; Erythrocytes; Hematuria; Heparin; Humans; Postoperative Care; Postoperative Complications; Thromboembolism; Thromboplastin

Topics: Blood Coagulation Tests; Cataract; Cataract Extraction; Diagnosis, Differential; Hemophilia A; Hemorrhage; Humans; Male; Methods; Middle Aged; Postoperative Complications; Thromboplastin

Topics: Blood Coagulation Tests; Factor XI; Factor XI Deficiency; Hemorrhage; Hemorrhagic Disorders; Humans; Postoperative Complications; Prothrombin Time; Thromboplastin

Topics: Adrenal Cortex Hormones; Anticoagulants; Arteriosclerosis; Blood Platelet Disorders; Coronary Disease; Fats; Female; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Neoplasms; Pharmacology; Postoperative Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thrombophilia; Thromboplastin; Thrombosis

Topics: Blood Transfusion; Hemorrhage; Humans; Postoperative Complications; Thromboplastin; Tooth Extraction

Topics: Aminocaproates; Aminocaproic Acid; Drug Therapy; Embolism; Factor V; Factor VIII; Fibrinogen; Fibrinolysis; Geriatrics; Hemorrhage; Humans; Male; Postoperative Complications; Prostatectomy; Prothrombin; Thromboplastin; Thrombosis; Toxicology

Topics: Blood Coagulation Tests; Hemorrhage; Hemostasis; Humans; Postoperative Complications; Preoperative Care; Thromboplastin

Topics: Anticoagulants; Blood Coagulation Factors; Blood Coagulation Tests; Esophageal Neoplasms; Factor VII; Fibrinogen; Heparin; Humans; Postoperative Complications; Prothrombin; Stomach Neoplasms; Thromboembolism; Thromboplastin