Blood clotting parameters in revision knee replacement patients with aseptic instability and periprosthetic infection

Введение. Представляет интерес оценка адаптационных возможностей системы гемостаза у пациентов, поступающих для ревизионного эндопротезирования коленного сустава, с использованием теста генерации тромбина (ТГТ). Цель исследования: оценить на основании ТГТ дооперационное состояние системы гемокоагуляции у больных, поступивших для ревизионного эндопротезирования коленного сустава по поводу асептической нестабильности протеза или перипротезной инфекции. Материалы и методы. Пациенты с воспалительными осложнениями, поступившие для ревизионного эндопротезирования коленного сустава, были разделены на 2 группы: 28 человек с асептическим воспалением и 24 с инфекционным. По результатам ТГТ в каждой группе были выделены подгруппы: пациенты с адекватной реакцией и пациенты с напряжённой реакцией системы гемостаза (всего 4 подгруппы). О состоянии плазменного гемостаза судили по тестам скрининговой коагулограммы. Активность воспаления оценивали по уровням С-реактивного белка (СРБ) и фибриногена. Результаты. Показано, что в каждой из 4 подгрупп больных адаптационные возможности системы гемокоагуляции различны. Выявлены наиболее угрожаемые по развитию тромбогеморрагических осложнений пациенты — это больные (подгруппы 3 и 4) с парадоксальной реакцией процесса тромбинообразования. Влияние воспалительного процесса на развитие гиперкоагуляционного синдрома у пациентов подгруппы 4 подтверждает наличие корреляционных связей между параметрами ТГТ и СРБ. Заключение. Анализ полученных данных показал различные адаптационные возможности системы гемостаза у пациентов с воспалительными осложнениями, развившимися после эндопротезирования коленного сустава. Background. The assessment of adaptive abilities of blood clotting system using thrombin generation assay (TGA) in revision knee replacement patients is a promising issue for researching. Objectives: to assess pre-surgical condition of blood clotting system using TGA in patients admitted for revision knee replacement due to prosthesis aseptic instability or periprosthetic infection. Patients/Methods. Patients with progressing inflammatory complications admitted for revision knee replacement were divided into two groups: 28 patients with aseptic inflammation and 24 patients with infectious inflammation. Based on TGA findings these groups were divided into subgroups: patients with adequate reaction and those with expressed hemostasis reactions (total of four groups). Plasma hemostasis was assessed by screening coagulogram tests. Inflammation severity was assessed by C-reactive protein (CRP) and fibrinogen levels. Results. It has been demonstrated that patients of these four groups had different adaptive abilities of their blood clotting systems. The most threatened patents for thrombohemorrhagic complications were found in groups 3 and 4 with their responses of thrombin generation process being paradoxical. The impact of inflammation on hypercoagulable syndrome in patients of group 4 proved correlations between TGA and CRP. Conclusions. Analysis of the data obtained revealed the diversity of adaptive abilities of hemostasis in patients with inflammation complications after total knee replacement.

The coagulation hemostasis dynamics in rats in the post-ischemic time

Introduction. Ischemic injury to the endothelium influences on a coagulation hemostasis, worsening hemodynamics of cerebral microcirculation as a result of rheological occlusion. The long-term post-ischemic blood clotting system changes are not studied well by now.The work purpose – to study a coagulation hemostasis and endothelial prostacyclin – synthetic activity of pial vessels within 21 days after single short-term transient cerebral ischemia in rat.Material and Methods. Ischemia was reproduced by means of 12-minute time occlusion of both carotids with the simultaneous arterial hypotension. Post-ischemic changes were investigated in 4 groups of rats: on the 3rd, 7th, 14th and 21st day after ischemia. The state of blood clotting system was estimated on time of clot formation in the blood plasma by an automatic optical method with use of screening tests of definition of prothrombin and thrombin clotting time and concentration of fibrinogen. Endothelial prostacyclin – synthetic activity was estimated by pial vessel reaction to indometacin.Results. On the 3rd day after ischemia the increase in prothrombin time was observed. Level of fibrinogen increased on the 3rd and the 14th days of the post-ischemic time. On the 21st day after ischemia thrombin time decreased. The inverse correlation of pial vessel endothelial prostacyclin – synthetic activity with the fibrinogen level and direct correlation with vessel cross-sectional area of these vessels is established.Conclusions. Short-time global cerebral ischemia causes changes of blood clotting system mechanisms lasting for 21 days of the post-ischemic time. Post-ischemic abnormalities in hemostasis system are connected with changes in endothelial prostacyclin – synthetic activity of cerebral vessels that, along with decreased anti-aggregation ability of vascular system, is also the reason of narrowing of the lumen in pial vessels.

Parameters of hemostatic potential in various stages of bladder cancer

Bladder cancer is characterized by a high mortality rate and is the 9th most common cancerous disease in the world. With a wide array of diagnostic bases, which include cystoscopy, ultrasound, computer and magnetic resonance imaging, cytology of urine deposition, it is difficult to accurately determine the extent of development of the tumor. It is important to find molecular and biochemical predictive parameters that would be characterized by high specificity and sensitivity to the tumor development. According to modern scientific data, an imbalance in the coagulation system is observed in cancer patients, the manifestation of which is the activation of the blood clotting system. Activation of the hemostatic system is accompanied by the appearance in the bloodstream of specific markers that reflect increase the hemostatic potential of the blood, such as the level of fibrin, fibrinogen, prothrombin time, activated partial thromboplastin time, activated plasma recalcification time. The results of a study of various cancers indicate an increased level of components of the plasminogen activation system, including the inhibitor of plasminogen activator-1 (PAI-1). The literature data that would indicate the prognostic significance of changes in the parameters of the blood clotting system and the proteolytic system in the blood in bladder cancer are few and have not completed. There are no data indicating the link between the studied parameters with histopathological gradation. In a detailed review of markers, it is possible to identify the optimal combination of markers of pathological processes, including the pathogenesis of oncological processes at various stages. During the study, we have investigated a significant increase in the level of fibrin, fibrinogen, and PAI-1, depending on the degree of bladder cancer. The test scores can make a significant contribution to the characterization of bladder cancer, depending on the grade according to the histopathological classification.

Thromboelastometry - diagnostic examination method of clot formation in pigs subjected to experimental procedures of the left atrial appendage

ABSTRACT: The aim of the study was to evaluate the usefulness of thromboelastometry in evaluations of the blood clotting system in pigs subjected to clip occlusion of the left atrial appendage. In this study, blood samples for thromboelastometry were collected, after clip occlusion of the left atrial appendage, from five pigs, in order to assess clot quality formation. Thromboelastometry with three ROTEM assays were performed: INTEM, EXTEM and FIBTEM. Results of the test were presented in TEMograms. The shape of the graph demonstrates hypercoagulability. In the thromboelastometry examination clot quality was stable in all animals.