• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.487-496
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• 2005

Background : 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. Methods : In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. Results : A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHEII and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). Conclusion: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.

• Proceedings of the Korean Society of Community Living Science Conference
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• 2009.09a
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• pp.83-83
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• 2009

암을 제외한 대부분의 성인병은 혈액순환과 관련된 혈관계 질환들로 이들에 의한 사망 비율의 합은 암의 비율과 비슷하게 나타나 혈관계 질환의 심각성을 나타내고 있다. 혈전에 의한 혈관계 질환은 혈전용해제와 트롬빈저해제를 이용하여 치료하고 예방할 수 있으며, a-glucosidase 저해제는 당뇨병 예방과 치료에 이용할 수 있다. 예로부터 민간요법에서 다양하게 이용되어 왔던 반하를 성인병 치료와 예방에 관련된 기능성식품의 자료로 사용하기 위해 반하 열수추출물을 유기 용매로 분획화하고 분획물의 혈전용해활성, 트롬빈저해활성, 혈당강하효과를 측정하였다. 혈전을 직접 용해하는 활성을 측정하기위해 100 mg/ml의 농도로 준비한 시료액을 fibrin plate 방법을 이용하여 혈전용해활성을 측정 결과 hexane 층, chloroform 층, ethyl acetate 층, butanol 층에서는 활성을 나타내지 않았지만 물 층에서 만 0.8 plasmin unit의 높은 혈전용해활성을 나타냈다. 혈전의 형성을 억제하기위해 혈전형성의 필수 효소인 트롬빈의 활성을 저해하는 트롬빈저해활성을 측정하기위해 10 배 희석한 (10 mg/ml) 시료 용액을 이용하여 트롬빈저해활성을 측정결과 hexane 층에서 75.3%의 높은 트롬빈저해활성을 나타냈으며, ethyl acetate 층과 chloroform에서도 각각 43.3%와 39.7%의 활성을 나타냈다. 또한 탄수화물의 소화를 지연시킴으로서 소장에서 포도당의 흡수를 억제하여 혈관내 당의 농도를 조절하는 혈당강하제의 개발을 위해 준비된 조효소액(10 mg/ml)을 이용하여 a-glucosidase 저해활성을 측정한 결과 ethyl acetate 층과 hexane 층에서 각각 24.9%와 23.4%의 저해활성을 확인하였다. 따라서 반하의 hexane 층과 ethyl acetate 층과 물층은 혈전관련 혈관계 질환과 당뇨병 관련 기능성 식품의 개발 소재로 이용할 수 있을 것으로 기대된다. 특히 최근 질병 치료에 효과는 크지만 부작용이 동반되는 화학약품들 대신 활성은 조금 뒤지지만 부작용이 없는 생약을 이용하려는 경향이 커지고 있다. 따라서 오랫동안 민간용법에서 사용되고 있는 반하는 안정성이 확인된 장점을 갖고 있어, 식품재료나 기능성 음료에 이용할 경우 장기간 섭취가 가능해 혈관계 질환의 치료와 예방에 큰 효과를 가져 올 수 있을 것으로 기대된다.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1397-1402
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• 2002

Purpose : One of the major complication of arterial catheterization is the thrombosis of the iliac or femoral arteries. Tissue loss following femoral artery catheterization is rare. However longterm sequelae such as impaired limb growth and future impairment of vascular access, are also important in pediatric cardiac patients. But standard methods to treat thrombotic complication of arterial catheterization in infants and children is not established. The present study was performed to assess the efficacy of intraarterial catheter-directed urokinase infusion in infants and children with limb ischemia due to arterial thrombosis after cardiac catheterization. Methods : From January 1994 to August 2002, 12 patients with thrombotic femoral artery occlusion after arterial catheterization were treated with catheter-directed urokinase infusion in Dong-A University Hospital. Retrospective analysis of the medical records and angiograms was conducted. Results : The incidence of femoral artery thrombosis after retrograde arterial catheterization, which had not responded to systemic infusion of heparin and/or urokinase, was 2.8 percent. The doses of urokinase were 1,000-4,400 unit/kg/hr and duration of infusion was $50.6{\pm}29.2$ hours(18-110 hours). Clot resolution was complete in all patients who started to receive the intraarterial urokinase infusion within four days after catheterization. Only partial thrombolysis was seen in two patients who were treated with intraarterial urokinase on the 12th and 19th days after thrombus formation. Balloon angioplasty was done for these two patients with partial success. Bleeding complications were seen in two cases. Conclusion : Early use of catheter-directed intraarterial infusion of urokinase is safe and effective in thrombolysis of femoral artery occlusion after cardiac catheterization in infants and children.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.326-330
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• 1996

Despite anticoagulation, systemic embolization and anticoagulant-related hemorrhage are the major drawbacks of heart valve replacement with mechanical prostheses. Among many predisposing factors, inadequacy of anticoagulation is the most important one. Surgery can be reserved for patients who do not response to thrombolytic therapy, We have experienced 3 cases of prosthetic valve thrombosis treated by thrombolytic therapy by use of urokinase and heparin. Two patients fully recovered and returned to their employments and active lives but 1 patient,died of intracerebral hemorrhage and infarction. We report prosthetic valve thrombosis thrombolytic therapy with urokinase and heparin which was detected and serially followed by 2-dimensional echocardiography, cinefluoro copy, and monitoring of Swan-Ganz catherterized pressures.

• Neonatal Medicine
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• v.18 no.1
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• pp.34-41
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• 2011

Neonatal coagulation disorders and thromboembolism require timely management. Failure to treat these conditions at the appropriate time may lead to death or the development of significant long-term sequelae. However, most current guidelines for managing neonatal coagulation disorders and thromboembolism are empiric and not based on randomized clinical trials. Thus, it is not easy to choose an appropriate management strategy for these conditions in clinical settings. In this review, therapeutic guidelines currently utilized in clinics and novel therapeutic options still under investigation are presented and reviewed.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.302-307
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• 2003

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.266-272
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• 2010

Background: Deep vein thrombosis (DVT) is a serious disease that causes life-threatening pulmonary embolism and chronic venous insufficiency. Anticoagulation is the standard therapy for DVT. However, the results of standard anticoagulation for treating DVT have been disappointing, so endovascular treatment is commonly performed nowadays. The aim of this study was to evaluate the efficacy of an endovascular procedure for treating patients with DVT. Material and Method: We retrospectively evaluated the clinical data of 29 DVT patients who underwent an endovascular procedure between December 2006 and July 2008. We compared the results of the 29 patients with the results of another 45 patients who were treated with only aspirin and heparin. Result: The patient’s mean age was 55.4 years in the intervention group and 53.7 years in the control group. DVT occurred more frequently in the females. Catheter-directed thrombolysis was performed in 22 patients (75.8%). Aspiration thrombectomy was performed in 18 patients (62%) and a endovascular stent was placed in 25 patients (86.2%). Fifteen patients (51.7%) underwent percutaneous insertion of a retrievable IVC filter for the prevention of pulmonary embolism. In the control group, thirty nine patients (86.7%) were treated with low-molecular heparin, and seven patients (15.6%) who were contraindicated for warfarin were treated with aspirin. No bleeding complications occurred during thrombolysis or anticoagulation. We analyzed the statistical data according to recurrence of DVT and the incidence of post-thrombotic syndrome (PTS) during the follow-up period. The intervention group had a significantly lower incidence of PTS (p-value=0.008), but they had the same result as the control group for the recurrence of DVT. In addition, death from the DVT did not occur in the intervention group. Thus, we obtained better clinical outcomes in the intervention group as compared to those in the anticoagulation only group. Conclusion: Endovascular procedures are effective alternative modalities, as compared to systemic anticoagulation, for the treatment of DVT. But more studies are needed to determine the specific indications and to validate the long-term efficacy of endovascular procedures for the treatment of DVT.

• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.5-14
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• 2003

Background : According to the study in ICOPER (International Cooperative Pulmonary Embolism Registry), the overall mortality rate of acute pulmonary thromboembolism (APTE) at 3 months is 17.4%. According to the study for current status of APTE in Japan, the hospital mortality rate is 14%. Although the incidence and mortality rate of APTE has been increasing, patient characteristics, management strategies, and outcome of APTE in the Korean population have not yet been assessed in large series. We therefore performed the national survey for the current status of APTE in the Korean population. Methods : 808 registry patients with APTE were analyzed with respect to clinical characteristics, risk factors, diagnostic procedures, treatment, and clinical outcome. Results : Main risk factors were immobilization, recent major surgery, and cancer. Common symptoms were dyspnea and chest pain. Common signs were tachypnea and tachycardia. The majority of registry patients underwent lung perfusion scanning. Spiral CT was used in 309 patients(42.9%), and angiography in 48 patients(7.9%). Heparin was the most widely used treatment. On multivariate logistic regression analysis, onset in hospital (odds ratio 1.88, p=0.0385), lung cancer (odds ratio 9.20, p=0.0050), tachypnea (odds ratio 3.50, p=0.0001), shock (odds ratio 6.74, p=0.0001), and cyanosis (odds ratio 3.45, p=0.0153) were identified as significant prognostic factors. The overall mortality rate was 16.9% and mortality associated with APTE was 9.0%. Conclusions : The present registry demonstrated the clinical characteristics, diagnostic strategies, management and outcome of patient with APTE in Korea. The mortality rate was 9.0%, and the predictors of mortality were onset in hospital, lung cancer, tachypnea, shock, and cyanosis. These results may be important for risk stratification as well as for the identification of potential candidates for more aggressive treatment.

• Journal of Life Science
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• v.23 no.12
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• pp.1460-1470
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• 2013

To examine whether miscellaneous cereal grains have an antithrombotic effect, we investigated the anticoagulant activity of 80% ethanol extracts from eleven selected miscellaneous cereal grains. The 80% ethanol extract of hwanggeumchal sorghum (Sorghum bicolor) showed the highest anticoagulant activity, followed by that of green foxtail millet grains, in terms of thrombin time (TT). When the ethanol extract of hwanggeumchal sorghum was sequentially fractionated with n-hexane, methylene chloride, ethyl acetate, and n-butanol, the majority of the TT-inhibitory activity was detected in the hexane and methylene chloride fractions. Whereas aspirin (final conc. 480 ${\mu}g/ml$) prolonged TT by 2-fold, the ethanol extract, hexane fraction, and methylene chloride fraction in the same dose prolonged TT by 2.2-fold, 2.9-fold, and 2.5-fold, respectively. The ethanol extract of hwanggeumchal sorghum could delay activated partial thromboplastin time (APTT) as well as prothrombin time (PT). Although the APTT-inhibitory activity of the ethanol extract was mainly partitioned into the hexane and methylene chloride fractions, the PT-inhibitory activity of the ethanol extract was solely partitioned into the hexane fraction. The APTT- and PT-inhibitory activities of these organic solvent fractions were more potent than those of the control warfarin (final conc. 3.13 mg/ml). The TT-inhibitory activity of the ethanol extract was heat-stable and acid-stable. The ethanol extract, hexane fraction, and methylene chloride fraction of hwanggeumchal sorghum appeared to possess a direct fibrinolytic activity toward fibrin clotting. These results show that hwanggeumchal sorghum can exert anticoagulant and fibrinolytic effects and, thus, have the potential to be applicable as antithrombotic dietary sources.

• Journal of Yeungnam Medical Science
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• v.11 no.2
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• pp.230-239
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• 1994

In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients (89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug. 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A (95.7%), type B (89.5%). There was signfifcantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bend > $45^{\circ}$ and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors. Stenosis severity, thrombus, lesion location at a bend > $45^{\circ}$, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.