| 1. |
- Henriksson, Anders E., et al.
(författare)
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Bleeding time and concentrations of von Willebrand factor in patients with acute upper gastrointestinal bleeding.
- 1996
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 162:8, s. 627-31
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the prevalence of impaired primary haemostasis in patients with acute upper gastrointestinal bleeding.DESIGN: Prospective open study.SETTING: County hospital, Sweden.SUBJECTS: 160 consecutive patients admitted with haematemesis or melaena, or both.INTERVENTIONS: Diagnosis verified on admission by endoscopy. Consumption of non-steroidal anti-inflammatory drugs (NSAID), transfusion requirements, presence of chronic liver disease, and age were recorded.MAIN OUTCOME MEASURES: Skin bleeding time was measured on admission with a modified Ivy method using the Simplate II bleeding time device; von Willebrand factor and routine haematological tests were analysed.RESULTS: In 31 of the patients (19%) the skin bleeding time was prolonged (over 10 minutes), and these patients also had a significantly lower packed cell volume on admission. In all patients the concentration of von Willebrand factor was increased which might explain why there was no significant difference in bleeding time between those who did and those who did not take NSAIDs.CONCLUSION: We recommend measurement of bleeding time in patients who present with haematemesis or melaena, or both, to detect those with impaired primary haemostasis.
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| 2. |
- Henriksson, Anders E., et al.
(författare)
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Experimental haemorrhage and blood component transfusion in humans : no change in plasma concentration of thrombin-antithrombin complex and plasmin-antiplasmin complex.
- 1996
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 82:5, s. 409-15
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Tidskriftsartikel (refereegranskat)abstract
- The influence of haemorrhage and blood transfusion on primary haemostasis, coagulation and fibrinolysis was investigated in ten healthy male volunteers. Acute loss of 10% of the blood volume did not give any significant alteration in thrombin- antithrombin III (TAT) complex and plasmin-alpha 2-antiplasmin (PAP) complex levels compared with a control series. The skin bleeding time with the Simplate II device was not altered after the 10% blood loss. Acute loss of 10% of blood volume followed by transfusion of packed red cells or stored plasma did not resulted in any significant change in bleeding time, TAT and PAP complex levels. It could be concluded that a controlled haemorrhage does not give any detectable changes of the platelet dependent primary haemostasis, blood coagulation and fibrinolysis. Transfusion of one unit of packed red cells or stored plasma does not seem to adversely affect the haemostasis.
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| 3. |
- Bergqvist, D, et al.
(författare)
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Comparison of the cost of preventing postoperative deep vein thrombosis with either unfractionated or low molecular weight heparin
- 1996
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 83:11, s. 1548-1552
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Tidskriftsartikel (refereegranskat)abstract
- The relative costs were analysed of (1) no prophylaxis against deep vein thrombosis (DVT), (2) selective treatment of DVT after confirmation of diagnosis, (3) general prophylaxis with standard low-dose unfractionated heparin and (4) general prophylaxis with low molecular weight heparin (LMWH) in patients undergoing elective general abdominal surgery or elective hip surgery. The mean calculated costs per patient undergoing general abdominal surgery were: Swedish crowns (SEK) 1950 for no prophylaxis, SEK 5710 for selective treatment of DVT, SEK 735 for prophylaxis with unfractionated heparin and SEK 665 for prophylaxis with LMWH. The corresponding costs for hip surgery were SEK 3930, SEK 10790, SEK 1730 and SEK 1390 respectively. Thus, the least expensive management strategy in patients undergoing elective general abdominal or hip surgery would appear to be general prophylaxis with either unfractionated heparin or LMWH. Furthermore, general prophylaxis with LMWH would appear to be more cost-effective than general prophylaxis with unfractionated heparin.
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| 4. |
- Bergqvist, D, et al.
(författare)
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Thromboprophylaxis with a low molecular weight heparin (tinzaparin) in emergency abdominal surgery. A double-blind multicenter trial
- 1996
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Ingår i: Vasa: European Journal of Vascular Medicine. - 0301-1526. ; 25:2, s. 156-160
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Tidskriftsartikel (refereegranskat)abstract
- In this prospective randomized double-blind study the thromboprophylactic effect of postoperative low molecular weight heparin (tinzaparin) was compared with placebo in 80 patients undergoing emergency abdominal surgery. The fibrinogen uptake test was used but because of withdrawal of the labelled fibrinogen from the market the calculated number of patients was not reached. However, this is one of the few studies in emergency abdominal surgery we thought it important to report. The frequency of deep vein thrombosis was reduced with prophylaxis from 22% (95% conf. intervall 11-38%) to 8% (2-21%), a risk reduction of 65%, which is however not significant. Together with data from the few previously published studies it can be concluded that patients undergoing emergency abdominal surgery seem to benefit from prophylaxis, which should be instituted either before operation or at latest 24 hours after. The exact prophylactic relation between pre- and post-operative start would, however, require a separate, randomized study.
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| 5. |
- Hansen, F, et al.
(författare)
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Accuracy of duplex sonography before carotid endarterectomy--a comparison with angiography
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 12:3, s. 331-336
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this prospective study was to contribute to the evaluation of the reliability of Duplex sonography (DS) before carotid endarterectomy (CEA). DESIGN: The study was performed prospectively in a university hospital setting. METHODS: Eighty-one consecutive patients aged 49-83 years were examined with DS and carotid angiography (CAG) before CEA. The results of the DS were judged as either confident, or CAG was assessed to be necessary preoperatively. The results from the DS and the CAG were then compared. RESULTS: DS was judged as confident in 148 of the 162 arteries examined. In none of these 148 arteries did CAG change patient management in any way, and the agreement between DS and CAG was good. In the remaining 14 arteries CAG was judged necessary, in 11 arteries because DS assessed the internal carotid artery (ICA) as occluded, which was confirmed by CAG in 10 arteries. In three arteries the reason was poor quality of the DS, however these three arteries were correctly assessed as severely diseased. CONCLUSIONS: This study confirms that DS alone is sufficient in the preoperative evaluation before CEA, provided that CAG is performed whenever DS shows occlusion of the ICA, or when the quality of the DS is poor.
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| 6. |
- Mangell, Peter, et al.
(författare)
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Regional differences in mechanical properties between major arteries--an experimental study in sheep
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 12:2, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study possible differences in mechanical properties between central (abdominal aorta) and more peripheral (common carotid and common femoral) arteries validating an earlier non-invasive study in children showing that central arteries are more distensible than peripheral ones. As invasive blood pressure was needed, but ethically impossible to obtain in children in an experimental setting, an animal model was chosen. DESIGN: Open experimental study. SETTING: Animal laboratory at university hospital. MATERIAL AND METHODS: The pulsatile vessel wall movements of the abdominal aorta (AA), common femoral (CFA) and common carotid (CCA) artery of nine sheep were examined using an ultrasound phase-locked echo-tracking technique. Intra-arterial blood pressure was measured and pressure-diameter relations, pressure strain elastic modulus (Ep) and stiffness (beta) calculated. Distensibility was defined as the inverse of Ep and stiffness. RESULTS: The AA showed lower values for Ep and stiffness (beta) than the CFA (p = 0.002) and CCA (p = 0.006), i.e. the latter two vessels were stiffer. The pressure-diameter relations confirmed these differences and showed a non-linearity for all three vessels with increased stiffness above 70-90 mm Hg. CONCLUSION: This study on young animals supports earlier findings of differences in mechanical properties between central and more peripheral arteries seen in healthy children. As pathologies between these vessels differ, with dilatation of the abdominal aorta and occlusive disease in the more peripheral vessels, part of the explanation might be found in the mechanical properties of the healthy vessels, characterised here with the echo-tracking technique.
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