In Vitro Comparison of Fibrinolytic Activity of Plasminogen Activators Using a Thrombelastographic Method: In Vivo Evaluation of the B-Chain-Streptokinase Complex in the Dog Model Using Pre-Titered Doses

Summaria, Louis; Sandesara, J; Yang, George C.; Vagher, J P; Caprini, J A

doi:10.1055/s-0038-1661606

Cited by 25 publications

(12 citation statements)

References 6 publications

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“…27 Recently, Summaria et al showed a progressive decrease in whole blood clot lysis time when incremental doses of the plasminogen activator, β-chain-streptokinase, were added to whole blood. 28 Streptokinase that was given to patients with thrombotic conditions showed similar changes in whole blood clot lysis time.…”

Section: Discussionmentioning

confidence: 94%

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Epsilon-aminocaproic Acid for Treatment of Fibrinolysis during Liver Transplantation

Kang¹,

Lewis²,

Navalgund³

et al. 1987

Anesthesiology

212

103

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In 97 adult patients receiving liver transplants, the coagulation system was monitored by thrombelastography and by coagulation profile including PT; aPTT; platelet count; level of factors I, II, V, VII, VIII, IX, X, XI, and XII; fibrin degradation products; ethanol gel test; protamine gel test; and euglobulin lysis time. Preoperatively, fibrinolysis defined as a whole blood clot lysis index of less than 80% was present in 29 patients (29.9%), and a euglobulin lysis time of less than 1 h was present in 13 patients. Fibrinolysis increased progressively during surgery in 80 patients (82.5%) and was most severe on reperfusion of the graft liver in 33 patients (34%). When whole blood clot lysis (F < 180 min) was observed during reperfusion of the graft liver, blood coagulability was tested by thrombelastography using both a blood sample treated in vitro with ε-aminocaproic acid (0.09%) and an untreated sample. Blood treated with ε-aminocaproic acid showed improved coagulation without fibrinolytic activity in all 74 tests. When whole blood clot lysis time was less than 120 min, generalized oozing occurred, and the effectiveness of ε-aminocaproic acid was demonstrated in vitro during the pre-anhepatic and post-anhepatic stages, ε-aminocaproic acid (1 g, single intravenous dose) was administered. In all 20 patients treated with ε-aminocaproic acid, fibrinolytic activity disappeared; whole blood clot lysis was not seen on thrombelastography during a 5-h observation period, and whole blood clot lysis index improved from 28.5 ± 29.5% to 94.8 ± 7.4% (mean ± SD, P < 0.001). None of the treated patients had hemorrhagic or thrombotic complications. In patients undergoing liver transplantation, the judicious use of a small dose of ε-aminocaproic acid, when its efficacy was confirmed in vitro, effectively treated the severe fibrinolysis without clinical thrombotic complications. KeywordsBlood; coagulation; fibrinolysis; Liver; transplantation; Measurement techniques; thrombelastography; Pharmacology; ε-aminocaproic acid Orthotopic liver transplantation is frequently associated with surgical bleeding that requires massive blood transfusion. 1 The surgical bleeding is compounded by preexisting coagulopathy, dilutional coagulopathy, fibrinolysis, and, possibly, disseminated intravascular In a recent series of patients undergoing liver transplantation, the degree of coagulopathy and volume of transfusion decreased with the introduction of replacement therapy guided by the frequent thrombelastographic monitoring of the coagulation system and the use of heparin-coated veno-venous bypass. 3,4 However, active fibrinolysis, manifest as generalized oozing from a previously dry surgical field and unresponsive to replacement therapy, has been a major difficulty in the intraoperative management of liver transplantation.Since the early experience in hepatic transplantation, activation of the fibrinolytic system has been recognized, 5,6 and, although antifibrinolytic treatment appears beneficial, it has been used only sporadically. Vo...

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Section: Discussionmentioning

confidence: 94%

“…28 Streptokinase that was given to patients with thrombotic conditions showed similar changes in whole blood clot lysis time.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 94%

Epsilon-aminocaproic Acid for Treatment of Fibrinolysis during Liver Transplantation

Kang¹,

Lewis²,

Navalgund³

et al. 1987

Anesthesiology

212

103

View full text Add to dashboard Cite

show abstract

“…In a canine model with controlled levels of streptokinase, TEG could detect clot dissolution before changes were noted in plasma fibrinogen or plasminogen levels (52). The activated clotting time, PT, and aPTT do not provide information about fibrinolysis (they measure aspects of coagulation only up to the formation of the fibrin clot) (16).…”

Section: Discussionmentioning

confidence: 99%

Thromboelastography as a Better Indicator of Hypercoagulable State After Injury Than Prothrombin Time or Activated Partial Thromboplastin Time

Park

Martini

Dubick

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

274

233

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Objectives To investigate the hemostatic status of critically ill, nonbleeding trauma patients. We hypothesized that a hypercoagulable state exists in patients early after severe injury and that the pattern of clotting and fibrinolysis are similar between burned and nonburn trauma patients. Materials and Methods Patients admitted to the surgical or burn intensive care unit within 24 hours after injury were enrolled. Blood samples were drawn on days 0 through 7. Laboratory tests included prothrombin time (PT), activated partial thromboplastin time (aPTT), levels of activated factor XI (FXIa), D-dimer, protein C percent activity, and antithrombin III (AT III) percent activity, and thromboelastography (TEG). Results Study subjects were enrolled from April 1, 2004, through May 31, 2005, and included nonburn trauma patients (n=33), burned patients (n=25), and healthy (control) subjects (n=20). Despite aggressive thromboprophylaxis, 3 subjects (2 burned and 1 nonburn trauma patients [6%]) had pulmonary embolism during hospitalization. Compared with controls, all patients had prolonged PT and aPTT (P<.05). The rate of clot formation (α angle) and maximal clot strength were higher for patients compared with controls (P<.05), indicating a hypercoagulable state. Injured patients also had lower protein C and AT III percent activities and higher fibrinogen levels (P<.05 for all). FXIa was elevated in 38% of patients (control subjects had undetectable levels). Discussion TEG analysis of whole blood showed patients were in a hypercoagulable state; this was not detected by plasma PT or aPTT. The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved.

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“…29 In dogs with experimentally induced thrombus formation, there was good agreement between TEG fibrinolysis variables, FDPs, thrombus size, and local blood flow at the site of the thrombus after fibrinolytic therapy. 36 However, in a recent case series of dogs with disseminated intravascular coagulation (DIC) and subsequent secondary fibrinolysis, there was no association between D-dimer concentration and increased rhTF-Haemoscope TEG fibrinolytic variables. 29 Similar results were reported in a study in which human patients with severe sepsis, with or without overt DIC, had increased D-dimer concentration with no concurrent increase in ROTEM fibrinolytic markers using TF activation.…”

Section: Teg Variables and Correlation With Routine Coagulation Assaysmentioning

confidence: 99%

Application of thrombelastography/thromboelastometry to veterinary medicine

Kol

Borjesson

2010

Veterinary Clinical Pathol

102

135

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Thrombelastograph analyzers are point-of-care hemostatic analyzers that provide global assessment of the hemostatic process. Thrombelastography (TEG) detects and provides a continuous recording of the changes in the viscoelastic properties of whole blood from initial clot formation through fibinolysis. TEG has been validated for use in dogs, horses, and cats. Hemostasis research using TEG has focused on test validation, alterations of TEG tracings in animals with naturally occurring diseases, and the use of TEG for monitoring various therapeutic modalities. This article reviews TEG methodology and terminology, including potential sources of preanalytical and analytical errors, the correlation between TEG and other routine hemostatic assays, and current clinical applications of TEG, with emphasis on veterinary medical practice. Data suggest that TEG may be a sensitive and useful adjunctive tool for evaluating an animal with an underlying coagulopathy, including hypercoagulability and hypocoagulability. Additional prospective studies are needed to (1) correlate TEG tracing patterns with a clinical predisposition for bleeding or thrombosis in various disease states and (2) determine whether monitoring and treating hemostatic disorders based on TEG tracings improve clinical outcome.

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In Vitro Comparison of Fibrinolytic Activity of Plasminogen Activators Using a Thrombelastographic Method: In Vivo Evaluation of the B-Chain-Streptokinase Complex in the Dog Model Using Pre-Titered Doses

Cited by 25 publications

References 6 publications

Epsilon-aminocaproic Acid for Treatment of Fibrinolysis during Liver Transplantation

Epsilon-aminocaproic Acid for Treatment of Fibrinolysis during Liver Transplantation

Thromboelastography as a Better Indicator of Hypercoagulable State After Injury Than Prothrombin Time or Activated Partial Thromboplastin Time

Application of thrombelastography/thromboelastometry to veterinary medicine

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