Search

The success of microsurgical operations with use free tissue flaps depends on many factors. Ensuring optimal vascular flow in the postoperative period often determines the final effect of the procedure. Surgical trauma of the vessel inducing the coagulation cascade leads to three formation of thrombus at the site of anastomosis. The use of flap blood monitoring along with the coagulation system assessment minimizes the risk of failure and enables a possible operational decision to be made quickly. Currently, there is no standardized pharmacological treatment of anticoagulant prophylaxis in microsurgery. In our department, patient undergoing microsurgical operations receive perioperative thrombophylaxis based on among others, heparin preparations (UFH, LMWH). Therefore we decide to assess the state of coagulations and with the use of heparin preparations. In our own study based on the analysis of thromboelastometry and flow aggregometry the results indicate, that the in vitro dilution of blood with balanced infusions fluids by 20-25% does not deteriorate the coagulation and clot formation parameters. Dilution in the range of 30-35% cause clear disturbances in the form of prolonged occlusion time in aggregometry and prolonged clotting time and clot formation time in tromboelastography, while the stability of the clot is deteriorated. The coagulopathy observed in this dilution range is not yet reflected in the results of the standard coagulation system, but only in thromboelastography and aggregometry. Hemodilution exceeding 40% significantly disrupts the coagulation process, induces coagulopathy aggravated by the specific properties of colloids. Modern coagulation tests, including aggregometry and thromboelastography compared to standard coagulation tests are more sensitive, faster and comprehensive, thanks to which they will be increasingly used in clinical settings. [ABSTRACT FROM AUTHOR]

Unlabelled: Multiple myeloma (MM) is associated with the increased risk of thrombosis. Hypofibrinolysis is among the various identified abnormalities in the hemostasis system that may cause a prothrombotic state. The aim of the study was intended to evaluate the association between certain rotational thromboelastometry (ROTEM) parameters with tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) levels and myeloma proteins in patients with MM and in controls., Material and Methods: The study included 21 patients with MM at the time of diagnosis and 15 healthy volunteers. Maximum clot lysis (ML), clot lysis index at 30, 45 and 60 minutes (LI 30, LI 45, LI 60 respectively), t-PA and PAI-1 activity were among the parameters studied., Results: According to the FIB TEM test, ML readings were markedly lower (1% v. 3%, p = 0.04) while LI 45, LI60 parameters were significantly higher (p = 0.01 and p = 0.04) in MM group than in controls. Also median, MCF readings (22 mm v. 16 mm, p = 0.01) and alpha-angle values (80 degrees v 74, p = 0.002) were significantly higher in MM according to the FIBTEM assay. Statistically significant higher median values of PAL-1 levels were observed in the MM group than in controls. In MM patients correlations between PAI-1 a LI 45-FIBTEM (r = - 0.65) and between t-PA a LI60- EXTEM (r = 0.45) were discovered. In MM IgG group correlation between IgG protein concentration and MCF-FIBTEM (r = 0.62) was shown., Conclusions: Changes in ROTEM parameters and PAI-1 levels which may indicate a hypofibrinolytic state were found to occur in patients with MM at the time of diagnosis. There are correlations between t-PA, PAI-1 and some ROTEM parameters.

Use of cardiopulmonary bypass in cardiac surgery strongly influences haemostatic system, activating fibrinolysis as well. The widespread use of antiplatelet and fibrinolytic drugs creates haemostatic disturbances in the perioperative period. Thromboelastography seems to be a useful tool in the assessment of this complex process, particularly in the early postoperative period.

In 34 healthy children at school-age the availability of the 3rd platelet factor was determined using plasma of mean concentrations of 100 000 and 342 000 platelets/mm3. The concentration of 100 000 platelets/mm3 gives very approximate results to those obtained with the higher concentration. Both curves of availability of this factor showed many features in common. The highest activity of the factor was observed from 0 to 10--15 min. of the incubation and after this peak it decreased gradually. The authors present and discuss the types of curves indicating physiological values.