• The Journal of Korean Medicine
• /
• v.23 no.4
• /
• pp.105-112
• /
• 2002

목적: 한의학에서 어혈증으로 야기되는 여러 가지 증상의 개선에 사용되는 실소산가미의 범발성혈관내응고증 및 혈전증에 미치는 영향을 연구하는 것이다. 방법 : 동물은 Wistar-King atrain Rats(150-200g)를 사용하였고, 혈전증은 세포내독소로 유발하였다. 측정은 실소산가미와 각 구성약물들에 대한 혈소판, 섬유소원, 프로트롬빈시간, 섬유소섬유소원분해산물에 미치는 영향을 연구하였다. 결과: 항혈전의 특성에 관한 것은 실소산가미와 구성약물중 포황, 오령지, 적작약, 도인 그리고 울금에서 억제특성이 나타났으며, 또한 실소산가미와 구성약물은 정상쥐에서 범발성혈관내응고증에서 혈소판과 섬유소원의 감소가 억제되었고, 섬유소분해산물의 증가가 억제 되었다. 실험관 실험에서 실소산가미와 구성약물은 트롬빈에 의해 섬유소원에서 섬유소로 전환이 억제되었으며, 플라스미노겐 또는 플라스민의 활성을 억제하였다. 결론: 실소산가미가 세포내독소로 유발된 혈전증에 대한 억제작용을 보이므로, 혈전증으로 야기되는 심혈관계질환등의 치료 및 예방에 응용가능성이 있을 것으로 사료된다.

• Journal of Chest Surgery
• /
• v.31 no.12
• /
• pp.1172-1182
• /
• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• The Korean Journal of Blood Transfusion
• /
• v.29 no.3
• /
• pp.240-252
• /
• 2018

Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.5
• /
• pp.474-482
• /
• 1993

Background: As a physiologic plasminogen activator, tissue-type plasminogen activator (t-PA) could induce effective thrombolysis in massive pulmonary embolism, without the risk of systemic hemorrhage. However, therapeutic doses of t-PA has been associated with systemic lytic state, and fibrin selectivity may be influenced by the dosing regimen of t-PA. To investigate the effects of duration of t-PA infusion on blood coagulation system, we performed this study. Method: In a canine model of pulmonary embolism, which was induced by injection of autologous blood clots, we administered equal doses of t-PA (1 mg/kg) over 15 minutes in $t-PA_{15}$ group, over 180 minutes in $t-PA_{180}$ group, and only saline in control group. Then serial blood samplings were made to check complete blood count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrin, plasminogen, ${\alpha}_2$-antiplasmin, coagulation factor V and VIII, and fibrin(ogen) degradation products. Results: 1) In all 3 groups, complete blood count showed same changes. Hemoglobin, hematocrit and platelet count decreased, but WBC count increased. 2) Prothrombin time, activated partial thromboplastin time, and thrombin time were prolonged during 15-60 minutes after t-PA administration in $t-PA_{15}$ group, and from 30 minutes through 180 minutes after administration in $t-PA_{180}$ gorup. 3) Fibrin, ${\alpha}_2$-antiplasmin, and cogulation factor V and VIII decreased in both $t-PA_{15}$ and $t-PA_{180}$ group, but returned to basal levels earlier in $t-PA_{15}$ group. 4) Fibrin(ogen) degradation products increased after pulmonary embolism in all groups, and further increased in both $t-PA_{15}$ and $t-PA_{180}$ groups after t-PA infusion. But more pronounced increment was noted in $t-PA_{180}$ gorup. Conclusion: In pulmonary embolism, the shorter (15 minutes) infusion of t-PA would have less risk of systemic hemorrhage than the longer (180 minutes) infusion when the doses is equal. And, this suggests that manipulating the duration of t-PA infusion can reduce the risk of major bleeding.

• Journal of Chest Surgery
• /
• v.30 no.5
• /
• pp.537-539
• /
• 1997

An orthotopic cardiac transplantation was successfully performed in a 40 year-old Jehovah's witness without use of any blood product. Preoperatively, the patient had been on coumadin to prevent left atrial thrombi and the INR(Internation Normalized Ratio)of prothrombin titre was 2.4. During the operation, cell saver was used for shed blood and aprotinin was admini tered intravenously for platelet function. Total postoperative drainage was 860cc and the lowest hemoglobin was 12.2 gmldl. Postoperative course was complicated by central nervous system infection by wisteria monocytogenes and two episodes of rejection, both of which were effectively treated. The patient is on his 5th postoperative month and doing well.

• Journal of Hospice and Palliative Care
• /
• v.1 no.1
• /
• pp.30-38
• /
• 1998

Background : Hepatocellular carcinomoma is the 3rd most common malignancy and the 2nd most common cause of death in Korea. The prediction of life-expectancy in terminal cancer patients is a major problem for patients, families, and physicians. We would like to investigate the prognostic factors of hepatocellular carcinoma, and therefore contribute to the prediction of the survival time of patients with hepatocellular carcinoma. Methods : A total of 91 patients(male 73, female 18) with hepatocellular carcinoma who were admitted to the hospital between January and lune 1995 were entered into the study, and data were collected prospectively on 28 clinical parameters through medical obligation record. We surveyed an obligation and local district office records, and confirmed the surivival of patients till July, 1996. Using Cox-proportional hazard model, give the significant variables related to survival. These determined prognostic factors. Life regressional analysis was used, there were calculated predicted survival day based on combinations of the significant prognostic factors. Results : 1) Out of 91 patients, 73 were male, and 18 were female. The mean age was $56.7{\pm}10.6$ ears. During the study, except for 16 patients who could not follow up, out of 75 patients, the number of deaths was 57(76%) and the number of survivals was 18(24%). 2) Out of the 28 clinical parameters, the prognostic factors related to reduced survival rate were prothrombin time<40%(relative risk:10.8), weight loss(RR:4.4), past history of hypertension (RR:3.2), ascites(RR:2.8), hypocalcemia(RR:2.5)(P<0.001). 3) Out of five factors, the survival day is 1.7 in all of five, $4.2{\sim}10.0$ in four, $10.4{\sim}41.9$ in three, $29.5{\sim}118.1$ in two, $124.0{\sim}296.6$ in one, 724.0 in none. Conclusion : In hepatocellular carcinoma we found that the prognostic factors related to reduce survival rate were prolonged prothrombin time(<40%), weight loss, past history of hypertension, ascites, and hypocalcemia(<8.7mg/dl). The five prognostic factors enabled the prediction of life-expectancy in patients with hepatocellular carcinoma and may assist in managing patients with hepatocellular carcinomal.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.6
• /
• pp.471-475
• /
• 2008

Background: In order to achieve a maintenance level and to prevent hemorrhagic complications, regular monitoring of the INR is mandatory for patients on oral anticoagulation therapy (OAT). A point-of-care instrument for INR monitoring is convenient for users, but the accuracy of the results has been controversial, and so this calls for exact evaluation of the point-of-care instrument that is used for INR monitoring. Methods: From Aug 2007 through Feb 2008, 85 patients on OAT among the all the patients who were admitted to Soonchunhyang University Bucheon Hospital were involved in this study. Parallel measurements of the PT INR were performed using a CoaguChek-XS and, a CA-7000 laboratory reference instrument and the results were analyzed. In addition, the patients' clinical data, including the diagnosis and the frequency and interval of the INR measurements, were also analyzed. Results: Of the 85 patients, 25 were admitted more than once to undergo INR testing and the mean interval between testing was 8.6 weeks with 39% and 38% of the tests being less than INR 2 units with using the CoaguChek-XS and the reference method, respectively. The coefficients of variation of CoaguChek-XS were 4.50 and 2.45 for the high and low INR patients, respectively. An excellent correlation was found between the two methods with a $R^2$ of 0.966 (p<0.001). Through Bland-Altman analysis, the mean INR difference between the two methods was 0.13 with the limit of agreement being -0.47~+0.72 with a 95% confidence interval. CoaguChek-XS was shown to overestimate the INR value for patients with an increasing INR, as compared to the reference method. Conclusion: CoaguChek-XS demonstrated great precision and accuracy for patients on OAT when compared to the laboratory INR results. Accordingly, the instrument should help to monitor the INR in the patients on OAT.

• Journal of Chest Surgery
• /
• v.30 no.7
• /
• pp.677-685
• /
• 1997

Thromboelastography(TEG) is the unique measure that gives rapid information about the whole clotting process. Simplifying the diagnosis of coagulopathy during operations, TEG can provide an adequate therapy for postoperative bleeding. Remarkable improvement in hemostasis after cardiopulmonary bypass(CPB) has been achieved by the treatment with proteinase inhibitor aprotinin, but the hemostatic mechanism of aprotinin during CPB is still unclear. This study was designed to evaluate the effects of aprotinin on coagulation system during CPB by using TEG. Forty patients who underwent CPB were divided into two groups: aprotinin(2u 106 kallikrein inhibition units, as a single dose into the cardiopulmonary bypass priming solution) treatment group(male 14, female 8, mean age=50.Byears) and no aprotinin treatment(control) group(male 10, female 8, mean age=53.4 years). TEG, activated clotting time, prothrombin time, activated partial thromboplastin time, platelet counts, fibrinogen an (ibrinogen degradation product(FDP) concentrations were checked before and after CPB(30 minutes after neutralization of heparin effect by protamine sulfate). There was no significant difference in other conventional coagulation tests of two groups except postcardiopulmonary bypass FDP concentration in control group, which was significantly increased compared to that in aprotinin group(p<0.05). In TEG variables of both groups, clot formation time(K) and alpha $angle(\alpha^{\circ})$ were significantly increased and decreased, respectively, after CPB(p<0.05), but fibrinolytic index(LYS60) was not changed during CPB. In aprotinin group, reaction time(R) was decreased significantly after CPB(p<0.05) but maximum amplitude(MA) was not changed(p>0.05). On the contrary, R was not changed markedly but MA was decreased significantly in control group after CPB(p<0.05). This result shows that main change in coagulation system during CPB is not hyperfibrinolysis but cecrease in clot strength by platelet dys unction, and the main effect of aprotinin during cardiopulmonary bypass is the maintenance of clot strength to the pre-CPB level by the preservation of platelet function.

• Journal of Life Science
• /
• v.30 no.5
• /
• pp.443-451
• /
• 2020

Recently, thrombotic diseases have become rapidly more prevalent due to Westernized lifestyles and high-fat diets. In this study, the anti-thrombosis activities of the aerial parts of Sageretia thea were evaluated using ethanol extracts of the leaf (ST-L), branch (ST-B), and fruit (ST-F), and their anti-coagulation, platelet aggregation inhibition, and hemolytic toxicity were assessed. In comparison to the ST-F extract, the ST-B exhibited 6.7 times more polyphenol content, and the ST-L had 2.7 times more total flavonoid content. The ST-L and ST-B extracts showed stronger inhibitions of thrombin, prothrombin, and blood coagulation factors than aspirin, berry extracts, or commercial oriental herbs. Furthermore, ST-L and ST-B showed superior platelet aggregation-inhibitory activities than aspirin. The ST-F extract demonstrated only minor anti-thrombosis effects, and none of the extracts showed hemolysis against red blood cells up to 1 mg/ml. Phenolic acid and flavonoid analysis of the ST-L and ST-B extracts showed abundant rutin, isoquercitrin, and astragalin as the major active compounds. Further research on the anti-thrombotic activity of isoquercitrin, a rare flavonoid from quercetin, is necessary. This is the first report of isoquercitrin in Sageretia thea, and our results suggest that ST-L and ST-B extracts could therefore developed as anti-thrombosis agents.

• Journal of Yeungnam Medical Science
• /
• v.16 no.2
• /
• pp.219-227
• /
• 1999

Background: In contrast to a healthy person, patients who have acute lower respiratory tract infection with underlying pulmonary diseases have various pathogens, a rapidly progressive downhill course, and a poor response to prior antimicrobial therapy. Broad spectrum antibacterial therapy is needed for full evaluation. Materials and Methods: To evaluate the efficacy and safety of cefpirome, we administered 1gm cefpirome, twice a day to 30 patients, who had signs and symptoms of acute lower respiratory infection regardless of their underlying disease, except to those who had an allergic history to antibiotics or severe systemic diseases. Results: The results were as follows: 1) Among 30 cases, 21 cases(70.0%) showed excellent improvement, and 7 cases(23.3%) showed good improvement in their symptoms and signs of acute lower respiratory infection. 2) In 14 cases with isolated pathogens, we observed bacteriologic eradication in 11 cases(78. 6%). 3) Significant side effects were not found. Conclusion: Above results suggest that cefpirome was effective as a monotherapy in patients with acute lower respiratory infection, especially on those with an underlying chronic obstructive pulmonary disease(COPD).