<b>Influence of Fibrinogen and Hematocrit on the Early Outcome of Angioplasty in Patients With PAOD</b>

Rudofsky, Gottfried; Strubel, Gerson; Michler, Eveline; Kuegler, Christian; Bíró, Ferenc

doi:10.1583/01-651r.1

Cited by 6 publications

(8 citation statements)

References 25 publications

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“…We have observed that fibrinogen and D-dimer measuring fibrin turnover associated with the functional severity of stable PAD, a finding which has been later confirmed (9 –11). Ankle-brachial index correlated with fibrinogen and with D-dimer with the exactly same correlation coefficient, 0.57, suggesting that common mechanisms are involved (9).…”

Section: Coagulation Disorderssupporting

confidence: 61%

Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Lassila

2012

Scand J Surg

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peripheral arterial disease (pad) has often underlying risk factors, of which diabetes and cigarette smoking are the most common. enhanced platelet activation and interaction with vessel wall associate with atherothrombotic disease, but also increased fibrinogen levels, thrombin generation and fibrin turnover are typical for pad. the pathogenic role of fibrinogen, thrombin formation and fibrin degradation is suggested not only in acute thrombotic complications, but also in the stable form of pad, where these markers associate with the functional severity (ankle-brachial blood pressure index). the coagulation-specific etiologies of pad should be suspected if the atherothrombotic disease has severe manifestations, especially while the traditional risk factors are absent, or if the patient has also a history of venous thromboembolism. malignant disease may be present in form of peripheral arterial thrombosis as well. thrombophilia may expose patients to idiopathic thrombosis -both spontaneously and after vascular interventions. the management of these patients includes often combination therapies with antiplatelet agents and anticoagulants. obviously, the strict policy to avoid risk factors and to treat them well in avoidance of progression of arterial disease is highly important. in the absence of published follow-up data the evidence to support the management strategies is weak and individual tailoring of efficacious and safe antithrombotic drug therapy remains our challenge. these patients benefit from continuous medical attention by the experts in the field of angiology. management of pad is an excellent example of the multidisciplinary approach where the hematologist meets the vascular surgeon or interventional radiologist to secure the best available patient care.

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Section: Coagulation Disorderssupporting

confidence: 61%

Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Lassila

2012

Scand J Surg

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“…In the treatment of peripheral arterial occlusive disease, anemia can affect the success of early angioplasty [33]. It is reasonable to find that lower levels of Hct can serve as an independent clinical correlate for PVD in our study.…”

Section: Discussionmentioning

confidence: 59%

Clustering of Unconventional Cardiovascular Risk Factors among Taiwanese Hemodialysis Patients

Hung

Liou

Ger³

et al. 2009

Am J Nephrol

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Background: Cardiovascular disease (CAVD) is the most common cause of mortality for chronic hemodialysis (HD) patients, yet the risk factors for the events have not been well established. Methods: We conducted a multicenter cross-sectional survey in 995 chronic HD patients recruited from 12 HD centers in Taiwan to investigate the prevalence of CAVD, including coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), and related them to 30 different parameters. Results: The mean age of 995 patients (499 males/496 females) was 56.4 ± 12.3 years, and average HD duration was 59.8 ± 51.2 months. The prevalence rates of CHD, CVD, and PVD were 24.0, 6.0, and 5.3%, respectively. Results of our multivariate logistic regression analysis showed that out of the conventional CAVD risk factors, only old age and diabetes could be significantly associated with CAVD. Meanwhile, we found some novel clinical correlates, including low apolipoprotein A-I and creatinine for CHD, low uric acid for CVD, and low hematocrit and low diastolic blood pressure for PVD. Interestingly, left ventricular hypertrophy was found to be an independent correlate for all three: CHD, CVD, and PVD. Conclusions: Our study suggests that consideration of conventional cardiovascular risk factors as well as unconventional risk factors might better assess the risk for CAVD among HD patients.

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“…13 In locally decreased perfusion pressure, such as in peripheral arterial disease, it has been demonstrated that a lower than normal hematocrit is beneficial. [60][61][62] We conclude that the optimal hematocrit for oxygen transport in vitro decreases with decreasing flow rate. For flow in larger vessels, viscometry suggests that it is lower than the normal hematocrit; whereas, for microvascular perfusion, it may be higher than the normal value.…”

Section: Discussionmentioning

confidence: 72%

“…Thus, current guidelines recommend a restrictive RBC transfusion strategy with a hemoglobin threshold of 7 to 8 g/dL . In locally decreased perfusion pressure, such as in peripheral arterial disease, it has been demonstrated that a lower than normal hematocrit is beneficial …”

Section: Discussionmentioning

confidence: 99%

Optimal hematocrit in an artificial microvascular network

et al. 2017

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BACKGROUND Higher hematocrit increases oxygen carrying capacity of blood, but also increases blood viscosity, thus decreasing blood flow through the microvasculature and reducing the oxygen delivery to tissues. Therefore, an optimal value of hematocrit that maximizes tissue oxygenation must exist. STUDY DESIGN AND METHODS We used viscometry and an artificial microvascular network (AMVN) device to determine optimal hematocrit in vitro. Suspensions of fresh red blood cells (RBCs) in plasma, normal saline or a protein-containing buffer, and suspensions of stored RBCs (at week 6 of standard hypothermic storage) in plasma with hematocrits ranging 10 – 80% were evaluated. RESULTS For viscometry, optimal hematocrits were 10, 25.2, 31.9, 37.1 and 37.5% for fresh RBCs in plasma at shear rates of ≤3.2, 11.0, 27.7, 69.5, and 128.5 s−1. For the AMVN, optimal hematocrits were 51.1, 55.6, 59.2, 60.9, 62.3 and 64.6% for fresh RBCs in plasma and 46.4, 48.1, 54.8, 61.4, 65.7 and 66.5% for stored RBCs in plasma at pressures of 2.5, 5, 10, 20, 40 and 60 cmH2O. CONCLUSION Although exact values of optimal hematocrit may depend on specific microvascular architecture, our results suggest that optimal hematocrit for oxygen delivery in the microvasculature depends on perfusion pressure. Anemia in chronic disorders may, therefore, represent a beneficial physiological response to reduced perfusion pressure resulting from decreased heart function and/or vascular stenosis. Our results may help explain why therapeutically increasing hematocrit in such conditions with RBC transfusion frequently leads to worse clinical outcomes.

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Influence of Fibrinogen and Hematocrit on the Early Outcome of Angioplasty in Patients With PAOD

Cited by 6 publications

References 25 publications

Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Clustering of Unconventional Cardiovascular Risk Factors among Taiwanese Hemodialysis Patients

Optimal hematocrit in an artificial microvascular network

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