Detection and management of hypercoagulability

Global anticoagulant effects of a novel sulfated pentomanan oligosaccharide mixture

PI-88 is a potent antiproliferative agent, which is developed for various indications in cancer. This agent is obtained from yeast fermentation and is primarily composed of pentamannose and tetramannose oligosaccharide units. PI-88 is capable of producing anticoagulant effects, which are mediated by heparin cofactor II. The purpose of this study was to determine the anticoagulant properties of PI-88 in native whole blood, freshly drawn from human volunteers, supplemented with PI-88 at various concentrations (0-100 microg/mL). Whole blood activated clotting time (ACT) was measured using Hemochron instruments. PI-88 produced a strong anticoagulant effect at 100 microg/mL (479.0+/-59.5 sec). This anticoagulant effect was comparable to that observed in interventional cardiology and open-heart surgery. At the lower level, PI-88 produced concentration-dependent effects on ACT. Using thromboelastographic techniques (TEG), the effect of PI-88 was measured in terms of various parameters. PI-88 produced potent anticoagulant effects in the TEG studies. At the concentration of 25 microg/mL, it produced a complete anticoagulant effect in whole blood. Whole blood samples supplemented with PI-88 showed a concentration-dependent decrease in the generation of various markers of clotting activation. These results clearly suggest that PI-88 exerts an anticoagulant effect in whole blood. Because of the low-molecular-weight nature and a novel mechanism of action, this new drug may be considered for further development, particularly in cancer patients.

Relationship of triglyceride levels to thrombosis in patients with coronary artery disease

The relationship of triglyceride levels to coagulation abnormalities was studied in 43 patients, who were divided into two groups. Group 1 consisted of patients with triglyceride levels less than 200 mg% (range, 75 to 190 mg%), and Group 2 consisted of patients with triglyceride levels greater than 250 mg% (range, 255 to 890 mg%). Analysis of the data revealed that patients with high triglyceride levels also have a high incidence of low antithrombin III activity and increased platelet aggregation. It is likely that hyperlipidemic patients are more prone to thrombosis of diseased coronary arteries or saphenous vein bypass grafts, and should definitely be placed on appropriate anticoagulants.

Detection of hypercoagulability by the measurement of the dynamic loss modulus of clotting blood

The dynamic loss modulus of clotting whole blood was measured in thrombotic patients to characterize the physical properties of coagulation in the hypercoagulable state. The dynamic loss modulus was measured by a Sonoclot. Thrombotic patients consisted of 30 with deep vein thrombosis and 25 with arterial thrombosis. An accelerated increment rate of the dynamic loss modulus at the beginning of gelling was the characteristic of hypercoagulability. This characteristic occurred more frequently than other abnormalities in other tests for hypercoagulability (beta-thromboglobulin, antithrombin III and TEG). Only in deep vein thrombosis, a moderately positive correlation was noted between the increment rate of the dynamic loss modulus and the plasma fibrinogen level.

Pitfalls in peripheral vascular surgery: Disseminated intravascular coagulation

Disseminated intravascular coagulation is infrequently encountered in the practice of peripheral vascular surgery. Nonetheless, it has devastating and often fatal effects. In our series of eight cases, the mortality rate was 62.5 per cent. A better understanding of the basic disease process as prompted by this review, earlier diagnosis, and rational treatment should lead to higher survival rates and lowered morbidity.