vitamin-k-semiquinone-radical and Disseminated-Intravascular-Coagulation

Topics: 4-Hydroxycoumarins; Administration, Inhalation; Adult; Anticoagulants; Delayed-Action Preparations; Disseminated Intravascular Coagulation; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Risk Assessment; Vitamin K

Prothrombin complex concentrates (PCCs) are purified drug products with hemostatic activity derived from a plasma pool. Today, PCCs contain a given and proportional amount of four non-activated vitamin K-dependent coagulation factors (II, VII, IX, and X), a variable amount of anticoagulant proteins (proteins C and S, and in some antithrombin) and low-dose heparin. In some countries PCC products contained only three clotting factors, II, IX, and X. Dosage recommendations are based on IU of F-IX, so that one IU of F-IX represents the activity of F-IX in 1 mL of plasma. Reversion of the anticoagulant effect of vitamin K antagonists (VKAs) in cases of symptomatic overdose, active bleeding episodes, or need for emergency surgery is the most important indication for PCCs and this effect of PCCs appears to be more complete and rapid than that caused by administration of fresh frozen plasma. They may be considered as safe preparations if they are used for their approved indications at the recommended dosage with adequate precautions for administration, and have been shown to be effective for reversing the effect of VKAs. Their adequate use based on decision algorithms in the perioperative setting allows a rapid normalization of International Normalized Ratio (INR) for performing emergency surgery, minimizing bleeding risk. This review aims to propose two algorithms for the use of PCCs in the perioperative setting, one to calculate the PCCs dose to be administered in a bleeding patient and/or immediately before urgent surgery, based on patient's clinical status, prior INR and INR target and another for reversing the action of oral anticoagulants depending on urgency of surgery.

Topics: Algorithms; Anticoagulants; Antidotes; Blood Coagulation Factors; Blood Coagulation Tests; Blood Loss, Surgical; Disseminated Intravascular Coagulation; Drug Monitoring; Emergencies; Evidence-Based Medicine; Hemorrhage; Hemostatics; Humans; Liver Failure; Perioperative Care; Postoperative Hemorrhage; Randomized Controlled Trials as Topic; Thromboembolism; Vitamin K

Prothrombin complex concentrates (PCCs) are recommended as the treatment of choice in warfarin-related coagulopathy. However, the risk of thromboembolic complications associated with their use is not well defined. We performed a meta-analysis to estimate the rate of thromboembolic complications in patients receiving vitamin K antagonists (VKAs) treated with PCCs for bleeding or before urgent surgery. Medline and Embase databases were searched. Two reviewers performed study selection and extracted data independently. Studies providing data on incidence of thromboembolic complications in VKA-treated patients were eligible for the study. Weighted mean proportion of the rate of thromboembolic complications and the mortality rate were calculated. Twenty-seven studies (1,032 patients) were included. Seven studies used 3-factor, and 20 4-factor PCCs. Twelve patients had a thromboembolic complication (weighted mean 1.4%; 95% CI 0.8-2.1), of which two were fatal. The incidence of thromboembolic events was 1.8% (95% CI 1.0-3.0) in patients treated with 4-factor PCCs, and 0.7% (95% CI 0.0-2.4) in patients treated with 3-factor PCCs. Total mortality rate was 10.6% (95% CI 5.9-16.6). In conclusion, our results suggest there is a low but quantifiable risk of thromboembolism in VKA-treated patients receiving PCCs for anticoagulation reversal. These findings should be confirmed in randomised, controlled trials.

Topics: Anticoagulants; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Hemorrhage; Humans; Incidence; Risk; Survival Analysis; Thromboembolism; United States; Vitamin K; Warfarin

Warfarin is the most commonly used oral anticoagulant. Intracranial hemorrhage is the most serious complication of anticoagulation and the anticoagulant effect of warfarin has to be urgently reversed in this situation. Traditional methods of reversal of the anticoagulant effect of warfarin involving the use of vitamin K and fresh frozen plasma are slow and relatively ineffective and there is a need for alternative treatment approaches.. Agents such as prothrombin complex conjugates and recombinant activated factor VII are being increasingly used to emergently correct warfarin-associated coagulopathy. Over the last decade, several small case series have suggested that these agents may lead to more rapid correction of the INR, however, improved clinical outcome is yet to be proven. A recent small prospective trial has also demonstrated the safety of a prothrombin complex conjugate and its efficacy in rapidly correcting an elevated INR in these patients.. There is a need for well designed randomized clinical trials aimed at evaluating the efficacy of these agents in improving the outcome of patients with anticoagulant associated intracranial hemorrhage.

Topics: Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Disseminated Intravascular Coagulation; Factor VIIa; Humans; Plasma; Vitamin K; Vitamins; Warfarin

Heparin-induced thrombocytopenia (HIT) is an immune-mediated disorder caused by the development of antibodies to platelet factor 4 (PF4) and heparin. The thrombocytopenia is typically moderate, with a median platelet count nadir of approximately 50 to 60 x 10(9) platelets/L. Severe thrombocytopenia has been described in patients with HIT, and in these patients antibody levels are high and severe clinical outcomes have been reported (eg, disseminated intravascular coagulation with microvascular thrombosis). The timing of the thrombocytopenia in relation to the initiation of heparin therapy is critically important, with the platelet count beginning to drop within 5 to 10 days of starting heparin. A more rapid drop in the platelet count can occur in patients who have been recently exposed to heparin (within the preceding 3 months), due to preformed anti-heparin/PF4 antibodies. A delayed form of HIT has also been described that develops within days or weeks after the heparin has been discontinued. In contrast to other drug-induced thrombocytopenias, HIT is characterized by an increased risk for thromboembolic complications, primarily venous thromboembolism. Heparin and all heparin-containing products should be discontinued and an alternative, non-heparin anticoagulant initiated. Alternative agents that have been used effectively in patients with HIT include lepirudin, argatroban, bivalirudin, and danaparoid, although the last agent is not available in North America. Fondaparinux has been used in a small number of patients with HIT and generally appears to be safe. Warfarin therapy should not be initiated until the platelet count has recovered and the patient is systemically anticoagulated, and vitamin K should be administered to patients receiving warfarin at the time of diagnosis of HIT.

Topics: Anticoagulants; Arginine; Autoantibodies; Contraindications; Disseminated Intravascular Coagulation; Fondaparinux; Heparin; Hirudins; Humans; Pipecolic Acids; Platelet Count; Platelet Factor 4; Polysaccharides; Recombinant Proteins; Sulfonamides; Thrombocytopenia; Thrombophilia; Time Factors; Venous Thromboembolism; Vitamin K; Warfarin

Topics: Blood Component Transfusion; Disseminated Intravascular Coagulation; Hemostasis; Humans; Infant, Newborn; Intracranial Hemorrhages; Liver Diseases; Plasma; Vitamin K

Recombinant factor VIIa has been increasingly used to provide hemostasis in nonapproved indications. This trend has resulted in concerns about safety, efficacy and costs.. Recombinant factor VIIa seems to have hemostatic effects in posttrauma and perisurgery excessive bleeding, although further studies are required. Recombinant factor VIIa may be used to reverse the effect of warfarin or other vitamin K-antagonist therapy following vitamin K administration. Some beneficial effects have also been suggested in a limited number of patients with liver disease and hemorrhagic stroke. Recombinant factor VIIa should be used with caution in cases with known hypercoagulability, excessive bleeding in the setting of disseminated intravascular coagulation or other states of generalized activation of the hemostatic system. In most of the nonapproved cases, a 4.8-mg vial administered to an adult patient weighing 50-100 kg to achieve a 50-100 microg/kg dose is recommended.. While consensus recommendations on the use of recombinant factor VIIa in nonapproved settings have been developed, more studies are needed to define dose and timing in these diverse patient populations. For now, decisions about off-label use of recombinant factor VIIa remain at the physician's discretion, assisted by hospital pharmacotherapeutic or transfusion committees.

Topics: Adult; Consensus; Disseminated Intravascular Coagulation; Drug Antagonism; Drug-Related Side Effects and Adverse Reactions; Factor VIIa; Hemostasis; Hospitals; Humans; Pharmacy and Therapeutics Committee; Recombinant Proteins; Stroke; Vitamin K; Warfarin

There is considerable evidence that the hemostatic system is involved in the growth and spread of malignant disease. There is an increased incidence of thromboembolic disease in patients with cancers and hemostatic abnormalities are extremely common in such patients. Antihemostatic agents have been successfully used to treat a variety of experimental tumors, and several clinical trials in humans have been initiated. Although metastasis is undoubtedly multifactorial, intravascular coagulation activation and peritumor fibrin deposition seem to be important. The mechanisms by which hemostatic activation facilitates the malignant process remain to be completely elucidated. Of central importance may be the presence on malignant cells of tissue factor and urokinase receptor. Recent studies have suggested that these proteins, and others, may be involved at several stages of metastasis, including the key event of neovascularization. Tissue factor, the principal initiator of coagulation, may have additional roles, outside of fibrin formation, that are central to the biology of some solid tumors.

Topics: Animals; Anticoagulants; Antineoplastic Agents; Biomarkers; Blood Coagulation Tests; Cell Adhesion; Cysteine Endopeptidases; Disseminated Intravascular Coagulation; Factor Xa; Fibrin; Fibrinolysis; Hemostasis; Heparin; Humans; Monocytes; Neoplasm Metastasis; Neoplasm Proteins; Neoplasms; Neoplasms, Experimental; Neoplastic Cells, Circulating; Neovascularization, Pathologic; Platelet Activation; Platelet Aggregation Inhibitors; Receptors, Thrombin; Thrombophilia; Thrombophlebitis; Thromboplastin; Vitamin K

Topics: Bleeding Time; Blood Coagulation; Blood Coagulation Disorders; Clinical Laboratory Techniques; Disseminated Intravascular Coagulation; Fibrinolysis; Humans; Mass Screening; Partial Thromboplastin Time; Risk Factors; Thromboplastin; Transfusion Reaction; Vitamin K

Topics: Blood Coagulation; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Factor VIII; Fibrinogen; Hemostasis; Humans; Liver; Liver Diseases; Prognosis; Risk; Vitamin K

Topics: Animals; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Factor X; Fibrinogen; Humans; In Vitro Techniques; Microsomes, Liver; Prothrombin; Rabbits; Rats; Vitamin K; Warfarin

Topics: Antifibrinolytic Agents; Antithrombin III; Blood Coagulation Tests; Blood Transfusion; Disseminated Intravascular Coagulation; Factor VIII; Fibrinogen; Gabexate; Guanidines; Heparin; Humans; Platelet Transfusion; Vitamin K

The major clinical importance of plasma protein C is attested to by the strong association between inherited protein C deficiencies of half normal levels and recurrent venous thromboembolic disease. Homozygous protein C deficient individuals do not survive beyond infancy without continuous therapeutic intervention. The spectrum of protein C deficiency is becoming broader and includes patients with both abnormal molecules and half normal levels of functionally active molecules. Rarely, a few young adults with thrombosis have been identified with protein C levels below 25%. Studies of protein C activity have been hampered until the very recent developments of functional assays of plasma protein C. Application of these assays to a wide variety of clinical situations involving thrombotic complications is just beginning and may lead to an explosive proliferation of new data that should prove most fascinating and give much further insight into the contributions of protein C in the regulation of thrombosis.

Topics: Anticoagulants; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Glycoproteins; Half-Life; Humans; Infant, Newborn; Liver Diseases; Male; Necrosis; Protein C; Pulmonary Embolism; Purpura; Skin Diseases; Thromboembolism; Thrombophlebitis; Vitamin K

Coagulation disorders in liver disease (cirrhosis or acute hepatic necrosis) may be assessed by the laboratory evaluation of factors V, VII, VIII and IX, and fibrinolysis. Tests of platelet and vascular function do not significantly contribute to this assessment. The response of the factors to vitamin K and to fresh frozen plasma contribute to the assessment of bleeding potential and prognosis.

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Platelets; Cholestasis; Disseminated Intravascular Coagulation; Fibrinolysis; Humans; Liver Cirrhosis; Vitamin K

Hemostatic changes in liver cirrhosis regularly have complex causes. In addition to a quantitative deficiency of hemostatic factors, also qualitative changes in coagulation factors, disturbances in coagulation factor metabolism and possible iatrogenic disturbances in plasmatic and thrombocytic hemostatic mechanism are to be considered. To diagnose a deficit of hemostatic factors is no problem, but to answer the question which of the numerous pathogenetic factors dominates in an individual case at this moment is very difficult and often impossible.

Topics: Antithrombin III; Aprotinin; Blood Coagulation Disorders; Blood Transfusion; Disseminated Intravascular Coagulation; Erythrocyte Transfusion; Factor XIII; Fibrinogen; Heparin; Humans; Liver Cirrhosis; Platelet Transfusion; Prothrombin; Vitamin K

Topics: Blood Coagulation Factors; Cells, Cultured; Disseminated Intravascular Coagulation; Hemophilia A; Humans; Saliva; Thromboplastin; Trypsin; Trypsin Inhibitors; Vitamin K

Topics: Anticoagulants; Aspirin; Blood Platelets; Coumarins; Disseminated Intravascular Coagulation; Female; Hemostasis; Heparin; Humans; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Risk; Thromboembolism; Vitamin K

Topics: Blood Coagulation; Blood Coagulation Tests; Disseminated Intravascular Coagulation; Factor VIII; Humans; Vitamin K

Topics: Disseminated Intravascular Coagulation; Factor IX; Factor VII; Factor VIII; Factor X; Factor X Deficiency; Half-Life; Hemophilia B; Hemostasis; Hepatitis B; Hepatitis, Viral, Human; Humans; Infant, Newborn; Prothrombin; Vitamin K; Vitamin K Deficiency Bleeding

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Platelets; Disseminated Intravascular Coagulation; Fibrinolysis; Hemorrhage; Hemostasis; Humans; Liver Diseases; Thrombosis; Vitamin K

Topics: Adenosine Diphosphate; Anticoagulants; Blood Coagulation; Blood Coagulation Factors; Coumarins; Disseminated Intravascular Coagulation; Heart Valve Prosthesis; Hemostasis; Heparin; Humans; Intracranial Embolism and Thrombosis; Myocardial Infarction; Postoperative Care; Pulmonary Embolism; Rheumatic Heart Disease; Thromboembolism; Vitamin K

Topics: Acute Disease; Anticoagulants; Atrial Fibrillation; Cell Transformation, Neoplastic; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Embolization, Therapeutic; Female; Hemorrhage; Heparin; Humans; Mitral Valve; Postoperative Complications; Pregnancy; Pulmonary Embolism; Thrombocytopenia; Thromboembolism; Thrombophlebitis; Vitamin K; Warfarin

Topics: Age Factors; Anemia; Anticoagulants; Antifibrinolytic Agents; Bacterial Infections; Child; Child, Preschool; Disseminated Intravascular Coagulation; Fibrinolysis; Fibrinolytic Agents; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Diseases; Leukemia; Purpura; Shock; Virus Diseases; Vitamin K; Wounds and Injuries

Topics: Abruptio Placentae; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelet Disorders; Blood Transfusion; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Factor XIII Deficiency; Female; Fetal Death; Fetal Diseases; Fibrin; Fibrinogen; Fibrinolysis; Hemophilia A; Humans; Liver Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Sepsis; Uterine Hemorrhage; Vitamin K

To evaluate the effectiveness and safety of prothrombin complex concentrates (PCCs) in approved and off-label indications.. PCCs are approved for the urgent reversal of vitamin K antagonists (VKAs). Data concerning the efficacy, safety and dosing for off-label indications are limited, but they are included in massive bleeding protocols.. This was a retrospective review of cases treated with four-factor PCCs (4F-PCCs) between January 2009 and 2016. Efficacy end-points include: (i) VKA reversal efficacy assessed by international normalised ratio (INR) normalisation (<1·5) and (ii) clinical efficacy as bleeding cessation and/or decreased number of transfused blood components and 24-h mortality in bleeding coagulopathy. The safety end-point is the incidence of thromboembolic events.. A total of 328 patients were included (51·8% male, median age 78 years old). Indications were as follows: VKA reversal (66·6%), bleeding coagulopathy (30·5%) and direct anticoagulant (DOAC) reversal due to bleeding (2·5%). VKA reversal was effective in 97·1% of patients, and 76·5% demonstrated complete reversal (INR < 1·5); only 34·3% patients needed hemoderivatives. Prior to emergency procedures, PCCs achieved global responses in 83% of patients, with no bleeding complication during intervention. DOAC reversal was effective in 88·9% of patients. Bleeding cessation was associated with the dose administered (P = 0·002). In coagulopathy bleeding, haemorrhage cessation, established by the International Society of Thrombosis and Haemostais (ISTH) definition, occurred in 56·7% of massive bleeding events and in 42·5% of other coagulopathies; 24-h mortality was 30%, mainly related to active bleeding. Ten thrombotic episodes were observed (3·1%).. 4F-PCC was effective as adjuvant treatment with an acceptable safety profile, not only for the emergent reversal of VKAs but also for refractory coagulopathy associated with major bleeding.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Female; Hemorrhage; Humans; Incidence; International Normalized Ratio; Male; Middle Aged; Off-Label Use; Retrospective Studies; Safety; Thromboembolism; Vitamin K

Effects of subcutaneous calcium-heparin and vitamin K administration were studied in 30 cirrhotic patients showing low values of prothrombin time, antithrombin III, fibrinogen, platelet count, plasminogen, alpha 2-antiplasmin, raised levels of fibrin(ogen) degradation products and prolonged activated partial thromboplastin time. A group of 10 patients was first treated with K vitamin for 15 d; after vitamin K therapy interruption, a treatment with 5000 IU (8000 IU in 1 patient) every 12 h of subcutaneous calcium-heparin was started. In another group of 20 patients a treatment with 5000 IU (8000 IU in 2 patients) every 12 h of subcutaneous calcium-heparin was started immediately. The heparin administration in both groups had been performed for at least 2 weeks. No significant changes of blood coagulation picture were observed after vitamin K administration, while calcium-heparin treatment showed an increase in prothrombin time, fibrinogen, platelet count, plasminogen, alpha 2-antiplasmin, a decrease in fibrin(ogen) degradation products and a shortened activated partial thromboplastin time. There was no significant change in antithrombin III values.

Topics: Blood Coagulation Factors; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Fibrinolysis; Heparin; Humans; Liver Cirrhosis; Male; Mononuclear Phagocyte System; Vitamin K

Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium.. A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock.. Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy.. By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound.. At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram.. Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.

Topics: Abdominal Wall; Aged; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Female; Humans; Plasma; Rifampin; Staphylococcal Infections; Vitamin K

Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases. We reported the case of a patient with compensated cirrhosis in whom, isolated severe coagulation failure was found to be due to excessive use of fenugreek milk porridge as part of traditional healing. The coagulation failure was promptly reversed with avoidance of fenugreek and supplementation with vitamin K.

Topics: Antifibrinolytic Agents; Blood Coagulation; Disseminated Intravascular Coagulation; Humans; India; International Normalized Ratio; Liver Cirrhosis; Male; Medicine, Traditional; Middle Aged; Patient Education as Topic; Treatment Outcome; Trigonella; Vitamin K

Disseminated intravascular coagulation (DIC) is a pathological systemic condition resulting from aberrant activation of the coagulation system. It is characterised by the release and activation of procoagulants into the blood, with an associated consumption coagulopathy. Its association with solid and haematological malignancies is well described in literature. This case describes an elderly man, known to have prostate cancer, who following transurethral resection of the prostate developed DIC with haematuria, spontaneous ecchymoses and mucosal bleeding. Subsequent investigations revealed a prostate-specific antigen (PSA) >1000 µg/L, and staging CT showed multiple sclerotic metastatic lesions affecting the thoracic and lumbar vertebra, as well as infiltration into his left femur. Coagulation normalised with blood products and vitamin K within 1 week, and the patient responded to antiandrogen therapy with a reduction in pain and PSA on discharge.

Topics: Aged, 80 and over; Androgen Antagonists; Antifibrinolytic Agents; Biomarkers, Tumor; Diagnosis, Differential; Disseminated Intravascular Coagulation; Hematuria; Humans; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Spinal Neoplasms; Treatment Outcome; Vitamin K

Life threatening bleeding and emergency procedures in patients on vitamin K antagonists are indications for urgent reversal with prothrombin complex concentrate and vitamin K. Rapid reversal in these situations is emphasized in the literature and guidelines, but only very limited information is available on its real life use, especially on the timing of treatment in relation to presentation.. We retrospectively audited emergency warfarin reversal in 131 consecutive patients. We studied the indication, use of vitamin K, time between presentation and administration of vitamin K and PCC, effectiveness in INR reduction and clinical outcome.. The median PCC dose was 26.8 IU/kg. The median INR was reduced from 3.1 to 1.2. Vitamin K (5 mg) was given in 91.6% of evaluable patients. We found significant delays in administration of PCC and vitamin K. The median time between presentation and administration of vitamin K/PCC was 3.6 and 5.2 hours respectively. The times in intracranial haemorrhage were 2.7 and 3.0 hours and in emergency procedures 17.4 and 15.9 hours respectively. Mortality related to bleeding was 7.6% overall but in patients with intracranial haemorrhage 22.8%. The thrombotic rate within 7 days of reversal was 1.5%.. The local protocol for reversal with PCC and vitamin K was adhered to well but the delay in pre-procedural patients, suggests that intravenous vitamin K alone may be sufficient in many cases and PCC administration can be avoided by better planning. Intracranial haemorrhage in warfarinised patients carries a high mortality. Treatment delays should be avoided by making PCC stocks available within emergency departments, simple dosing structures independent of INR and administering PCC without waiting for INR and CT scan results in those with strong suspicion of intracranial haemorrhage and clear trauma. Future reports and studies should always include the time from presentation to PCC treatment.

Topics: Adult; Aged; Aged, 80 and over; Antifibrinolytic Agents; Blood Coagulation Factors; Coagulants; Disseminated Intravascular Coagulation; Female; Humans; International Normalized Ratio; Male; Medical Audit; Middle Aged; Retrospective Studies; Vitamin K; Warfarin

A 28 year-old heretofore healthy woman was transferred to our hospital with a two-month history of recurring episodes of bleeding. Administration of vitamin K and prothrombin complex concentrates in the transferring hospital had only temporarily corrected both the markedly elevated international normalized ratio (INR) and the prolonged activated partial thromboplastin time (aPTT). The patient's medical and family history revealed no reason for these abnormalities. Our laboratory analyses revealed a sustained deficiency of vitamin K-dependent clotting factors. Presence of an acquired inhibitor of clotting factors was excluded. Thus we suspected, intoxication with an anticoagulant rodenticide. Liquid chromatography-mass spectrometry (LC-MS/MS) revealed pharmacologically active concentrations of flocoumafen, a rodenticide belonging to the superwarfarin family, in the patient's serum. While the long elimination half-life of superwarfarins is well described in rodents, information on pharmacokinetics in humans is not yet available. Therefore, patient management was not limited to prolonged administration of vitamin K, but also included repeated measurements of flocoumafen serum levels. During follow-up visits, clotting tests remained normal and flocoumafen levels gradually decreased, reaching the limit of quantification after 48 days. Based on the repeated measurements of flocoumafen serum levels, a half-life of 6.7 days was estimated in our patient, which is in clear contrast to the 220 days reported in rodents. Thus, monitoring flocoumafen serum concentrations in affected patients may provide a rational basis for the duration of vitamin K substitution and adequate follow-up intervals.

Topics: 4-Hydroxycoumarins; Adult; Chromatography, Liquid; Disseminated Intravascular Coagulation; Female; Humans; International Normalized Ratio; Mass Spectrometry; Partial Thromboplastin Time; Rodenticides; Vitamin K; Warfarin

Topics: Amyloid; Amyloidosis; Antifibrinolytic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Agents, Hormonal; Blood Coagulation; Blood Coagulation Factors; Dexamethasone; Disseminated Intravascular Coagulation; Female; Humans; Immunoglobulin kappa-Chains; International Normalized Ratio; Melphalan; Middle Aged; Nephrotic Syndrome; Partial Thromboplastin Time; Vitamin K

Trauma patients are at risk of developing an acute coagulopathy of trauma (ACT) related to tissue injury, shock, and hemodilution. ACT is incompletely understood, but is similar to disseminated intravascular coagulation (DIC) and is associated with poor outcome.. Thrombin generation assays were used to evaluate plasma hemostasis in 42 trauma patients, 25 normal subjects, and 45 patients on warfarin and in laboratory-prepared factor reduced plasma.. Prolonged prothrombin time (PT), more than 18 seconds, or an international normalized ratio of greater than 1.5 was present in 15 trauma patients indicating possible ACT. Native thrombin generation (no activator added, contact activation blocked) showed that Trauma with ACT patients had lag times 68% shorter and peak thrombin generation threefold higher than normal patients indicating the presence of circulating procoagulants capable of initiating coagulation systemically. Trauma patients had lower platelet counts and fibrinogen and Factor (F)II levels putting them at increased risk of bleeding. In laboratory-prepared isolated factor-reduced samples and in patients with vitamin K-dependent factor deficiency due to warfarin, thrombin generation decreased in direct proportion to FII levels. In contrast, in diluted plasma and in trauma patients with reduced factor levels, thrombin generation was increased and associated with slower inhibition of thrombin generation (prolonged termination time) and decreased antithrombin levels (43% of normal in Trauma with ACT).. Thrombin generation studies indicate that Trauma with ACT patients show dysregulated hemostasis characterized by excessive non-wound-related thrombin generation due to a combination of circulating procoagulants capable of activating coagulation systemically and reduced inhibitor levels allowing systemic thrombin generation to continue once started.

Topics: Adult; Anticoagulants; Antithrombins; Disseminated Intravascular Coagulation; Female; Hemostasis; Humans; Male; Middle Aged; Plasma; Prothrombin; Prothrombin Time; Thrombin; Thromboplastin; Vitamin K; Warfarin; Wounds and Injuries

Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted among adults and children. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock, skin manifestation, and multiorgan failure. However, bullous impetigo is invariably considered to be a staphylococcal disease. Staphylococcus aureus produces an epidermolytic toxin, assumed to be the cause of bullous formation in the skin. Here, we present a case of bullous impetigo in an infant with streptococcal toxic shock syndrome. This is a rare presentation of bullous impetigo caused by group A streptococcus.

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Cefotaxime; Clindamycin; Colloids; Combined Modality Therapy; Disseminated Intravascular Coagulation; Female; Humans; Impetigo; Infant; Plasma; Respiration, Artificial; Shock, Septic; Skin Diseases, Vesiculobullous; Streptococcal Infections; Streptococcus pyogenes; Vancomycin; Vitamin K

The purpose of our study was to clarify the frequency of these causes.. Retrospective study using reports of newborns in the neonatal unit in Sousse (Tunisia) from 1991 to 1996, hospitalized for hemorrhagic syndrome defined by bleeding, exteriorized or not, whatever its importance, severity, causes and the associated clinical and biological disorders. Isolated meningeal hemorrhages, limited cutaneo-mucous hemorrhages (conjunctival hemorrhages, bruises), and genital crises of the newborn, were excluded.. One hundred and fifty-five hemorrhagic syndromes were observed from 7,128 newborn infants (2.17% of hospitalization). Sex ratio was 1.42. Prematurity rate was 35.7%. The Apgar score was < 7 at one minute in 40.7% of cases. Disorders associated with hemorrhagic syndromes were observed in 118 newborn infants (76.1%) with a predominance of neonatal infections (35.6%). The etiology of neonatal hemorrhages was specified in 93% of cases: newborn hemorrhagic disease (27.7%), disseminated intravascular coagulation (27.1%), isolated thrombocytopenia (9%), digestive lesions (13.5%), and obstetrical trauma (2.6%).. The frequency of the newborns hemorrhagic syndromes underlines the need for its systematic prevention by vitamin K in the antenatal period to the mother and after birth to the newborn.

Topics: Disseminated Intravascular Coagulation; Humans; Incidence; Infant, Newborn; Retrospective Studies; Thrombocytopenia; Vitamin K; Vitamin K Deficiency Bleeding

Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre-operative vitamin K administration on the incidence of postoperative bleeding.. Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K.. During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6%). Prior to implantation, patients that bled had decreased levels of factor II (52.2 +/- 27.1% vs 69.7 +/- 26.6%; p = 0.048) and prolonged prothrombin times (16.5 +/- 2.4 seconds vs 13.8 +/- 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9%) not treated with vitamin K bled, while only 2 of 39 (5.1%) patients treated with vitamin K required re-exploration for bleeding (p = 0.026).. We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.

Topics: Disseminated Intravascular Coagulation; Factor V; Factor VII; Factor XI; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Fibrinopeptide A; Heart-Assist Devices; Hemostasis; Humans; Incidence; Liver; Liver Failure; Male; Middle Aged; Plasminogen; Postoperative Hemorrhage; Premedication; Prothrombin; Prothrombin Time; Reoperation; Ventricular Dysfunction, Right; Ventricular Function, Left; Vitamin K

Topics: Algorithms; Antithrombin III; Biopsy; Blood Coagulation Disorders; Disseminated Intravascular Coagulation; Gastrointestinal Hemorrhage; Humans; Hypersplenism; Hypertension, Portal; Liver; Liver Diseases; Liver Transplantation; Thrombocytopenia; Vitamin K

Topics: Blood Coagulation Tests; Disseminated Intravascular Coagulation; Female; Humans; Hypertension; Infant, Newborn; Infant, Premature, Diseases; Male; Pre-Eclampsia; Pregnancy; Vitamin K

Gammacarboxyglutamic acid (gla) is a non essential amino acid synthesized in presence of vitamin K, predominantly found in coagulation and bone proteins. In 14 cases of deep vein thrombosis and in 11 cases of disseminated intravascular coagulation, compared to 19 normal subjects and 9 patients hospitalized for leg pain, free plasma gla levels were found significantly elevated (respectively 372 +/- 244 and 559 +/- 361 versus 146 +/- 34 and 120 +/- 40 pmol/mL). In six paired plasma and serum, gla levels were similar. These results suggest an involvement of blood coagulation in gla generation with need of a catabolism of the activated factors. A significant decrease was noticed during vitamin K antagonist therapy and liver disease, both instances in which the synthesis of gla containing coagulation factors is affected. During hepatocellular carcinoma with elevated desgamma carboxyprothrombin, gla was found normal, denying an global impairement of the vitamin K metabolism.

Topics: 1-Carboxyglutamic Acid; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Carcinoma, Hepatocellular; Chronic Disease; Disseminated Intravascular Coagulation; Female; Hemangioma; Humans; Leg; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Pain; Pulmonary Embolism; Skin Neoplasms; Thrombophlebitis; Vitamin K

We have evaluated the contribution of depression of individual procoagulant vitamin K-dependent clotting factors to the ability of warfarin to protect rabbits against tissue factor-induced coagulation. Mean activities of individual procoagulant factors were determined, in assays with rabbit substrates, for a group of rabbits achieving a protective degree of anticoagulation with warfarin. Values were: factor VII, 12%; factor IX, 7%; factor X, 14%, and prothrombin, 13%. The effect upon tissue factor-induced coagulation of selective immunodepletion of each factor to a comparable level was then evaluated. Immunodepletion of plasma factor X or prothrombin, but not of factor VII or factor IX, protected otherwise normal rabbits against tissue factor-induced coagulation. Next, we determined the effect upon the protection in warfarin-treated rabbits of selectively restoring factor X or prothrombin before infusing tissue factor. When either factor was selectively restored, warfarin's protective effect was abolished. Moreover, selective restoration of prothrombin sensitized warfarin-treated rabbits to coagulation more severe than observed in nontreated control rabbits. One may extrapolate from these data that depression of both factor X and prothrombin are required for warfarin's clinical antithrombotic efficacy and that depression of plasma prothrombin is particularly important.

Topics: Animals; Anticoagulants; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Factor IX; Factor VII; Factor X; Female; Infusions, Intravenous; Protein Precursors; Prothrombin; Rabbits; Thromboplastin; Vitamin K; Warfarin

New York State's infant deaths and hospitalizations attributed to hemorrhagic disease of the newborn and other neonatal hemorrhagic conditions were reviewed. In 65% of 34 deaths reviewed, vitamin K was not documented as given or was given only after the onset of hemorrhage. Vitamin K was not included in standing orders in any of 22 hospitals contacted. As a result of this review, vitamin K prophylaxis was made a mandatory newborn care procedure in the State Public Health Code.

Topics: Cerebral Hemorrhage; Disseminated Intravascular Coagulation; Hemorrhage; Humans; Infant Care; Infant, Newborn; New York; Vitamin K; Vitamin K Deficiency Bleeding

Topics: Anticoagulants; Blood Coagulation; Disseminated Intravascular Coagulation; Drug Interactions; Heparin; Humans; Thrombosis; Vitamin K

This solid-phase colorimetric microtiter-plate clotting assay is much more sensitive than standard clotting tests. In enzyme-linked coagulation assay (ELCA), enzyme-labeled fibrinogen and solid-phase fibrinogen are the substrate for thrombin generated in the clotting cascade. We used this assay to measure the factors of the extrinsic pathway by an extrinsic pathway-specific assay (EP-ELCA) and to determine the individual factors of the extrinsic pathway (VII, X, V, II) in plasmas of coumadin-treated and heparin-treated patients, with prothrombin time (PT) values used as a reference. In the ELCA method, samples and controls are incubated on the same plate, eliminating the requirement for pre-standardization of the substrate "plasma" before the factor assay is done. Concentrations of factors are determined by serially diluting sample and control plasmas to yield equivalent activity at given dilutions, a more direct approach for measuring specific factors than determining log concentrations vs log clotting time. Changes in the concentrations of clotting factors are seen before changes are apparent by PT. For coumadin-treated patients, all vitamin K-dependent factors were significantly (P less than or equal to 0.001) less than in normal controls, whereas factor V concentrations were normal, as expected. For patients treated with heparin, concentrations of factors X and VII were less than in normal controls (P less than 0.01) and results for EP-ELCA, II, and V assays were normal. This methodology can readily be automated.

Topics: Adult; Aged; Aged, 80 and over; Blood Coagulation Factors; Blood Coagulation Tests; Disseminated Intravascular Coagulation; Factor V; Factor VII; Factor X; Fibrinogen; Heparin; Humans; Male; Peroxidase; Prothrombin; Prothrombin Time; Thrombosis; Vitamin K; Warfarin

A number of species respond to bacterial endotoxin (lipopolysaccharide [LPS]) wherein cells of the monocyte-macrophage lineage are rapidly induced either directly or via T-cell collaboration to initiate the extrinsic coagulation protease pathway. This results in fibrin formation and deposition as well as consumption of plasma coagulation proteins. It has been claimed that this cellular response, basic to the Shwartzman reaction, is lacking in rats and may account for the more limited severity of the Shwartzman reaction in this species. We examined the in vitro lymphoid procoagulant response in Fischer 344, Brown Norway, and Lewis rats. When peripheral blood mononuclear cells (PBM) were stimulated in vitro with LPS, a procoagulant activity (PCA) response was observed when assayed by acceleration of clotting of recalcified human or rat platelet-poor plasma. The response was rapid, with a maximum achieved at 4 h. PCA was not physically dissociated from viable PBM by 5 mM EDTA, which is consistent with the presence of an intrinsic plasma membrane initiator molecule rather than calcium-bound gamma-carboxylated glutamic acid-containing proteases. The induction of monocyte PCA was prevented by incubation of cells with cycloheximide or actinomycin D, implicating a new biosynthetic requirement. Cultivation of PBM with warfarin did not diminish the function of the effector PCA, nor did vitamin K augment the function of the endotoxin-induced PCA, indicating that the functional activity was not attributable to gamma-carboxylated glutamic acid-containing proteins. No inhibition of the cellular PCA molecule was produced by serine protease inhibitors. The LPS-induced PCA appeared to involve a tissue factor-like molecule since both factors X and VII were required in mediating PCA. Isolation of monocytes and T lymphocytes from LPS-stimulated PBM demonstrated that PCA was present in the monocyte-rich fraction. When isolated rat T lymphocytes and monocytes were separately exposed to LPS, PCA was not induced. In contrast, when the cells were combined, LPS induced PCA, indicating that the PCA response involved cellular collaboration between cells present in T lymphocyte and monocyte populations.

Topics: Animals; Coagulants; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Endotoxins; Female; Humans; Kinetics; Lipopolysaccharides; Lymphocytes; Mice; Monocytes; Protease Inhibitors; Rats; Rats, Inbred F344; Vitamin K; Warfarin

Topics: 4-Hydroxycoumarins; Anticoagulants; Blood Coagulation; Disseminated Intravascular Coagulation; Humans; Indenes; Thrombosis; Vitamin K

In liver parenchymatous disease there is a significant correlation between plasma concentrations of coagulation factors of the prothrombin complex and antithrombin III on the one hand and the severity of the disease on the other hand. These coagulation factors are suitable for following the course of the disease because of their short biological half time. In liver failure hepatic clearance of activated coagulation factors may be delayed which will have influences upon the hemostatic mechanisms. An increased disposition for disseminated intravasal coagulation thus exists in infections, hemorrhagic shock and during monotherapy with concentrated prothrombin complex. Therapy with blood or plasma and its derivatives should always be directed at keeping an equilibrium between activating and inhibiting coagulation factors. Fresh plasma, fractionated blood exchange, or a combined application of equivalent units of antithrombin III and prothrombin complex concentrate with minimal heparin doses are suited for such therapy.

Topics: Antithrombin III; Blood Coagulation Factors; Blood Transfusion; Disseminated Intravascular Coagulation; Hemorrhage; Hemostasis; Heparin; Hepatic Encephalopathy; Humans; Thrombophlebitis; Vitamin K

Topics: Animals; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Dogs; Factor IX; Factor IXa; Factor VIII; Factor X; Humans; Mice; Partial Thromboplastin Time; Prothrombin; Vitamin K

Topics: Antifibrinolytic Agents; Dextrans; Disseminated Intravascular Coagulation; Fibrinolytic Agents; Heparin; Humans; Immunization, Passive; Platelet Aggregation; Vitamin K

Topics: Animals; Antithrombins; Blood Platelets; Busulfan; Disseminated Intravascular Coagulation; Ergot Alkaloids; Fibrinolytic Agents; Humans; Rats; Snakes; Venoms; Vitamin K

This article gives a survey of the physiology of blood coagulation in newborn infants, subdivided into the particularities of the plasmic coagulation system and the fibronolysis. Etiology, diagnosis and therapy of the consumption coagulopathy as well as the coagulopathy of production are dealed with.

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Disseminated Intravascular Coagulation; Female; Fibrinolysis; Hemorrhagic Disorders; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Liver Diseases; Microcirculation; Plasma Substitutes; Prednisolone; Pregnancy; Streptokinase; Vitamin K; Vitamin K Deficiency

Topics: Asphyxia Neonatorum; Autoantibodies; Blood Coagulation Tests; Blood Platelets; Blood Transfusion; Capillary Fragility; Capillary Permeability; Cerebral Hemorrhage; Disseminated Intravascular Coagulation; Exchange Transfusion, Whole Blood; Female; Hemophilia A; Hemorrhage; Hemorrhagic Disorders; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung; Maternal-Fetal Exchange; Pregnancy; Thrombocytopenia; Vitamin K; Vitamin K Deficiency; von Willebrand Diseases

Topics: Angina Pectoris; Anticoagulants; Arterial Occlusive Diseases; Arteriosclerosis; Coumarins; Disseminated Intravascular Coagulation; Fibrinolytic Agents; Heparin; Humans; Myocardial Infarction; Pulmonary Embolism; Streptokinase; Thromboembolism; Thrombophlebitis; Thrombosis; Urokinase-Type Plasminogen Activator; Vitamin K

Topics: Aminocaproates; Blood Coagulation Disorders; Blood Coagulation Factors; Cholestasis; Disseminated Intravascular Coagulation; Fibrin Fibrinogen Degradation Products; Heparin; Hepatitis; Humans; Liver Circulation; Vitamin K

Topics: Bacterial Infections; Blood Coagulation Tests; Diarrhea, Infantile; Disseminated Intravascular Coagulation; Female; Humans; Hypoprothrombinemias; Hypoxia; Infant; Male; Shock; Virus Diseases; Vitamin K

After reviewing the available methods for the clinical study of the extrinsec way of the coagulative process (Quick's time, Owren's Thrombotest and Normotest), the AA. explain what is the significance that the most of hte researchers ascribe to time-value discrepancies between Thrombotest and Normotest. The AA. remember that while the former is sensitive to the presence of certain inhibitors called PIVKA (Protein Induced by Vitamin K Absence or Antagonists), just as Quick's original time; the latter is on the contrary insensitive to them. Then it provides more significant data about the real rate of factors II, VII, and X. Such inhibitors have been found also in subjects that did not undergo any anti-vitamin K therapy and peculiarly in cases in which a Intravascular Coagulation occurred. Therefore the AA. thought to verify the hypothesis that the detection of a discrepancy between TT and NT could be useful in the clinical diagnosis of I.C. which is a serious and often hardly detectable disorder of haemostasis. The AA. have therefore tested 72 patients, 65 of which showed the evidence of I.C. and 7 with I.C. probabilities. The discrepancy values that were obtained are showed in Table I. The first group (65 cases) was furtherly divided into four subgroups, according to the positivities obtained from SDPS test, as shown in Table II. The AA. can therefore come to the following conclusions: a) In human Intravascular Coagulation, the discrepancy between NT/TT may occur with a frequency of 57 per cent but it is not a constant event. b) The discrepancy rate is generally of low degree, being of high degree only in twelve cases (18.5 per cent. c) Analyzing the discrepancy presence and rate in relation to the number of SDPS test positivities, we can notice that the values are remarkably scattered and it is not possible, only on the basis of these data to make a statistical evaluation of their significativity because the groups are not comparable among them, being in exc3ss the cases in which paracoagulation occurs in a low degree. We can only state that the absence of discrepancy predominates in the cases in which a low number of positivities of SDPS test occurs, and on the contrary the discrepancy is a constant event in the cases in which SDPS test shows a large number of positivities. In consitive test to detect Intravascular Coagulation, but we think the positivity of this test may be a support in doubtful cases.

Topics: Blood Coagulation Tests; Blood Proteins; Disseminated Intravascular Coagulation; Humans; Prothrombin Time; Vitamin K; Vitamin K Deficiency

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Disseminated Intravascular Coagulation; Escherichia coli Infections; Factor IX; Factor VII; Factor X; Female; Gastroenteritis; Heparin; Humans; Infant; Infant, Newborn; Liver Diseases; Male; Prothrombin; Sepsis; Vitamin K; Vitamin K Deficiency

Topics: Anti-Bacterial Agents; Blood Coagulation Tests; Diagnosis, Differential; Disseminated Intravascular Coagulation; Factor V; Factor VIII; Fibrinogen; Heparin; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Parenteral Nutrition; Prothrombin Time; Thromboplastin; Vitamin K; Vitamin K Deficiency; Vitamin K Deficiency Bleeding

Topics: Adenocarcinoma; Aged; Atrial Fibrillation; Blood Transfusion; Cephalothin; Digoxin; Disseminated Intravascular Coagulation; Gangrene; Gastrointestinal Hemorrhage; Gentamicins; Heparin; Humans; Hydronephrosis; Hypothermia; Lymphatic Metastasis; Male; Prostatic Neoplasms; Pyelonephritis; Stomach Neoplasms; Vitamin K

Topics: Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Factor V Deficiency; Factor VIII; Fibrinogen; Heparin; Humans; Liver Diseases; Prothrombin Time; Thromboplastin; Vitamin K; Vitamin K Deficiency

Topics: Age Factors; Blood Coagulation Factors; Capillaries; Central Nervous System Diseases; Disseminated Intravascular Coagulation; Factor V; Factor VII; Factor X; Fibrinogen; Gestational Age; Hematocrit; Hemorrhage; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Microchemistry; Respiratory Distress Syndrome, Newborn; Vitamin K

Topics: Abortion, Spontaneous; Adult; Dicumarol; Disseminated Intravascular Coagulation; Female; Hemorrhage; Humans; Personality Disorders; Pregnancy; Prothrombin Time; Spectrophotometry; Substance-Related Disorders; Vitamin K

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Child; Child, Preschool; Diagnosis, Differential; Disseminated Intravascular Coagulation; Hemolytic-Uremic Syndrome; Hemostasis; Heparin; Humans; Kidney Diseases; Liver Diseases; Protease Inhibitors; Vitamin K; Vitamin K Deficiency; Vitamin K Deficiency Bleeding