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Ristovska EC, Genadieva-Dimitrova M, Todorovska B, Milivojevic V, Rankovic I, Samardziski I, Bojadzioska M. The Role of Endothelial Dysfunction in the Pathogenesis of Pregnancy-Related Pathological Conditions: A Review. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:113-137. [PMID: 37453122 DOI: 10.2478/prilozi-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In the recent decades, endothelial dysfunction (ED) has been recognized as a significant contributing factor in the pathogenesis of many pathological conditions. In interaction with atherosclerosis, hypercholesterolemia, and hypertension, ED plays a crucial role in the pathogenesis of coronary artery disease, chronic renal disease, and microvascular complications in diabetes mellitus. Although ED plays a significant role in the pathogenesis of several pregnancy-related disorders such as preeclampsia, HELLP syndrome, fetal growth restriction, and gestational diabetes mellitus, the exact pathogenetic mechanisms are still a matter of debate. The increased prevalence of these entities in patients with preexisting vascular diseases highlights the essential pathological role of the preexisting ED in these patients. The abnormal uteroplacental circulation and the release of soluble factors from the ischemic placenta into the maternal bloodstream are the main causes of the maternal ED underlying the characteristic preeclamptic phenotype. Besides the increased risk for maternal and fetal poor outcomes, the preexisting ED also increases the risk of development of future cardiovascular diseases in these patients. This study aimed to look deeper into the role of ED in the pathogenesis of several pregnancy-related hypertensive and liver diseases. Hopefully, it could contribute to improvement of the awareness, knowledge, and management of these conditions and also to the reduction of the adverse outcomes and additional long-term cardiovascular complications.
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Affiliation(s)
- Elena Curakova Ristovska
- 1University Clinic for Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, RN Macedonia
| | - Magdalena Genadieva-Dimitrova
- 1University Clinic for Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, RN Macedonia
| | - Beti Todorovska
- 1University Clinic for Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, RN Macedonia
| | - Vladimir Milivojevic
- 2Section for Internal Medicine, Medcompass Alliance, School of Medicine, Belgrade University, Belgrade, Serbia
| | - Ivan Rankovic
- 3Section for Internal Medicine, Medcompass Alliance, Belgrade, Serbia
| | - Igor Samardziski
- 4University Clinic for Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, RN Macedonia
| | - Maja Bojadzioska
- 5University Clinic for Rheumatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, RN Macedonia
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2
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Kumari S, Lamichhane R, Karki P, Adhikari P. Acute fatty liver of pregnancy complicated by coagulopathy: A case report. Clin Case Rep 2023; 11:e7283. [PMID: 37151940 PMCID: PMC10160430 DOI: 10.1002/ccr3.7283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/01/2023] [Accepted: 04/15/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message We present the case of a rare obstetric emergency, which is usually fatal. Our case highlights suspicion of AFLP in patients presenting with jaundice in the third trimester with good maternal and fetal outcomes after a timely intervention. Abstract Acute fatty liver of pregnancy (AFLP) is a rare, obstetric emergency characterized by maternal liver dysfunction that can lead to maternal and fetal complications. We report a case of 28-year-old primigravida 39 weeks gestation diagnosed with AFLP complicated by coagulopathy with good maternal and fetal outcomes after a timely intervention.
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3
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Wu YJ, Xie Q, Liu YH, Chen XY, Yan XH. Scoring models and test indexes for diagnosis and prognosis of hepatitis B virus-related acute-on-chronic liver failure. Shijie Huaren Xiaohua Zazhi 2023; 31:207-213. [DOI: 10.11569/wcjd.v31.i6.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a common type of liver failure, which can occur in the context of chronic hepatitis B or cirrhosis compensatory period or decompensated period. HBV-ACLF progresses rapidly, is often complicated with multiple organ failure syndrome involving the liver, brain, heart, kidney, etc., and is associated with an extremely high short-term mortality rate. The American College of Gastroenterology (ACG) defines HBV-ACLF as a potentially reversible disease, and early diagnosis and standardized treatment will affect its prognosis. In recent years, the clinical application of some new scoring models and biomarkers has effectively improved the diagnosis and prognosis of HBV-ACLF. This article reviews some scoring models and test indexes recently used in the clinical treatment and explores their value in the diagnosis and prognosis of HBV-ACLF.
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4
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Hamdany AK, Parewangi ML, Saleh S, Bakri S, Akil F, Abadi S, Seweng A. Comparison of plasminogen activator inhibitor-1 levels in chronic hepatitis B patients with hepatic cirrhosis and without hepatic cirrhosis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: One of the hepatic cirrhosis manifestations is bleeding disorders. Among all the substance that plays a pivotal role in maintaining the balance between thrombosis and thrombolysis is PAI-1, synthesized by hepatocytes. The dynamics of increase and decrease of PAI-1 is a natural response to the ongoing hepatic cirrhosis, but may not be seen in non-hepatic cirrhosis. PAI-1 levels also depends on the stage of fibrosis. Several conditions may interfere with PAI-1 levels including age, body mass index, and gender
Objectives: This study aims to find out the comparison of PAI-1 levels in hepatitis B patients with hepatic cirrhosis and without hepatic cirrhosis and to compare it with every stage of hepatic cirrhosis.
Patients and Methods: This study is an observational analytical study with a cross-sectional approach conducted at Wahidin Sudirohusodo hospitals, Makassar. Subjects are chronic hepatitis B patients with and without hepatic cirrhosis which meet inclusion criteria. Serum PAI-1 levels were measured by using Bender MedSystems human plasminogen activator inhibitor-1 ELISA kit (BMS2033) and using the ELISA technique. Statistical analysis was performed using the Kolmogorov Smirnov normality test as well as the Mann-Whitney method. Statistical results are considered significant if the p-value <0.05.
Results: The research was conducted on 60 subjects who meet inclusion criteria, consisting of 33 men and 27 women. There were 16 patients with hepatic cirrhosis. Levels of PAI-1 in hepatic cirrhosis was significantly different which lower than non-hepatic cirrhosis patient (0.43 ng/mL Vs 1.11 ng/mL, p=0.024). By staging of hepatic fibrosis, stage F2 hepatic fibrosis had the highest levels of PAI-1, in contrast with end-stage hepatic fibrosis which had the lowest levels.
Conclusion: Levels of PAI-1 fluctuate through different stages of hepatic fibrosis. The significant difference in PAI-1 levels in hepatic cirrhosis and non-hepatic cirrhosis demonstrates a correlation between PAI-1 and hepatic cirrhosis
Keywords: Chronic hepatitis B, Hepatic cirrhosis, Plasminogen Activator Inhibitor-1
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5
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Sperry JD, Rose AE, Williams E, Dierks MR, Medow JE. Emergent Reversal of Antithrombotics and Treatment of Life-Threatening Bleeding from Coagulopathies: A Clinical Review. J Emerg Med 2022; 63:17-48. [PMID: 35918220 DOI: 10.1016/j.jemermed.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reversal of antithrombotic agents and treatment of life-threatening bleeding episodes from coagulopathies can be a stressful scenario for clinicians, especially when the selection of treatment options should occur quickly. Understanding the options available for these agents requires emergency physicians to be familiar with the current data surrounding new therapies and dosing strategies for the treatment of bleeding from reversible and nonreversible antithrombotics and coagulopathic conditions. OBJECTIVE To provide quick resource guides for the reversal of major or life-threatening bleeding caused by antithrombotic agents or in the setting of coagulopathies. METHODS A literature search for articles published through September 2021 related to antithrombotic reversal and treatment of acute bleeding from coagulopathies was conducted using the PubMed clinical database. Selected articles were used to generate 5 guidance tables in this clinical review. DISCUSSION Four guidance tables for how to treat major or life-threatening bleeding from antithrombotic agents and 1 table for how to manage life-threatening bleeding for coagulopathies are presented as a quick reference tool for the emergency physician. Additional information on upcoming reversal agents and possible treatment options are provided herein. CONCLUSIONS In this clinical review, a series of 5 tables were created to provide quick and comprehensive guidance for the emergency physician when treating major or life-threatening bleeding caused by antithrombotic agents or coagulopathies. © 2022 Elsevier Inc.
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Affiliation(s)
- Jeffrey D Sperry
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Anne E Rose
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Eliot Williams
- Department of Hematology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Matthew R Dierks
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Joshua Eric Medow
- Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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6
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Ohkura N. Potential applications of Chinese herbal medicines with hemostatic properties. Drug Discov Ther 2022; 16:112-117. [PMID: 35753799 DOI: 10.5582/ddt.2022.01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Various herbal medicines with hemostatic properties have been applied for centuries to accelerate hemostasis and control bleeding. However, the mechanisms of action and active constituents remain unknown. This report provides an overview of current clinical hemostatic agents and their disadvantages, then focuses on the clinical value of Chinese herbal medicines with unique hemostatic features that modern medicines lack. A comprehensive review of hemostatic agents derived from Chinese herbal medicines and their potential medical applications is also presented.
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Affiliation(s)
- Naoki Ohkura
- Laboratory of Host Defense, Department of Medical and Pharmaceutical Sciences, School of Pharma-Sciences, Teikyo University, Japan
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7
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Ren W, Zhang J, Chen Y, Wen M, Su Y, Zhao Y, Lu S, Wu J. Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients With or Without Portal Venous Thrombosis. Clin Appl Thromb Hemost 2021; 26:1076029620982666. [PMID: 33356499 PMCID: PMC7768576 DOI: 10.1177/1076029620982666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To evaluate variations in coagulation, fibrinolysis and endothelial marker expression in cirrhotic patients and to explore their clinical value and predictive performance in cirrhotic patients with or without portal vein thrombosis (PVT), we performed a case-control study with 175 cirrhotic patients and 50 healthy individuals. 99 patients had PVT and another 76 patients did not. All participants were evaluated for plasma levels of conventional hemostatic markers. Thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (t-PAIC), von Willebrand factor antigen (vWF: Ag) and coagulation factor Ⅷ (FⅧ: c) were also assessed and the ratio of TAT/t-PAIC was calculated. We analyzed differences in these biomarkers among the three groups and constructed receiver operating characteristic (ROC) curves. Patients with PVT exhibited significantly higher TAT and TAT/t-PAIC than cirrhotic patients without PVT (both P < 0.001). Areas under the curve (AUC) of ROC analyses for TAT and TAT/t-PAIC were 0.68 and 0.66, the cut-off levels were 1.55 ng/ml and 0.46, with sensitivities and specificities of 78.79% and 51.32% regarding TAT, 39.8% and 90.79% regarding TAT/t-PAIC. Levels of FⅧ: c and vWF: Ag in patients with PVT were significantly lower than those without PVT (p = 0.026 and p = 0.027, respectively). The AUCROC, cut-off level, sensitivity and specificity of FⅧ: c were 0.64, 111.1%, 66.67% and 60%, respectively. For vWF: Ag they were 0.61, 429%, 89.66% and 38.71%, respectively. Cirrhotic patients have disorders of coagulation, fibrinolysis and the endothelial system. TAT, TAT/t-PAIC, FⅧ: c and vWF: Ag can be used as potential biomarkers for predicting PVT in cirrhotic patients.
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Affiliation(s)
- Wenhua Ren
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Jing Zhang
- Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuying Chen
- Department of Laboratory Medicine, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Meng Wen
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Yu Su
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Yujing Zhao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Lu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Jun Wu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China.,Department of Laboratory Medicine, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
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8
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Gitto S, Romanelli RG, Cellai AP, Lami D, Vizzutti F, Abbate R, Margheri F, Fibbi G, Del Rosso M, Laffi G. Altered clot formation and lysis are associated with increased fibrinolytic activity in ascites in patients with advanced cirrhosis. Intern Emerg Med 2021; 16:339-347. [PMID: 32445164 DOI: 10.1007/s11739-020-02375-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Analysis of coagulation disorders and assessment of rebalanced hemostasis with the use of traditional coagulation assays is challenging in cirrhotic patients. Therefore, alternative tests are under investigation for the evaluation of coagulopathy in this specific setting. Aim of this study was to analyze the modifications of clot structure and function in cirrhotic patients with different degrees of severity. Cirrhotic patients referred to our Unit were consecutively enrolled. Global test measurements, including clot and lysis assays, clot lysis time, and determination of other fibrinolytic parameters, were performed. Analyses of clot formation, morphology, and lysis were performed with a turbidimetric clotting and lysis assay (EuroCLOT). Lysis of a tissue factor-induced clot by exogenous tissue plasminogen activator was analyzed by studying the modifications of turbidity during clot formation and the following lysis. We evaluated coagulative and fibrinolytic parameters in both plasma and ascites. Urokinase plasminogen activator (uPA) and gelatinase activity in ascites were also measured. We analyzed data from 33 cirrhotic patients (11 in Child-Pugh class A; 22 in class B or C and with ascites) and 21 healthy subjects (HS). In class B/C patients prolonged latency time, a decline in clotting absorbance, and decreased fibrin formation were observed in comparison with class A and HS. Generated curves and Thrombin-Activatable Fibrinolysis Inhibitor (TAFI) progressively declined from HS to class C patients, whereas levels of plasminogen activator inhibitor-1 and tissue plasminogen activator increased. D-dimer levels were markedly increased in ascites, together with significantly smaller levels of TAFI, αlfa2-antiplasmin, and plasminogen. Caseinolytic activity was also present. Class C patients showed smaller amount of uPA and significantly lower levels of matrix metallopeptidases (MMP)2 in ascites in comparison with Class B subjects. Clot formation and lysis are altered in cirrhosis and fibrinolysis is activated in ascites. Ascitic levels of uPA and MMP2 are reduced and inversely related to the severity of liver disease.
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Affiliation(s)
- Stefano Gitto
- Dipartimento Medicina Clinica e Sperimentale (DMSC)-Liver Unit, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Roberto Giulio Romanelli
- Dipartimento Medicina Clinica e Sperimentale (DMSC)-Liver Unit, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Anna Paola Cellai
- Dipartimento Oncologia-Thrombosis Center, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Donatella Lami
- Sezione Malattie Aterotrombotiche-Dipartimento Area Critica Medico/Chirurgica, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Francesco Vizzutti
- Dipartimento Medicina Clinica e Sperimentale (DMSC)-Liver Unit, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Rosanna Abbate
- Sezione Malattie Aterotrombotiche-Dipartimento Area Critica Medico/Chirurgica, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Francesca Margheri
- Dipartimento Scienze Biomediche Sperimentali e Cliniche "Mario Serio", University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Gabriella Fibbi
- Dipartimento Scienze Biomediche Sperimentali e Cliniche "Mario Serio", University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Mario Del Rosso
- Dipartimento Scienze Biomediche Sperimentali e Cliniche "Mario Serio", University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy
| | - Giacomo Laffi
- Dipartimento Medicina Clinica e Sperimentale (DMSC)-Liver Unit, University of Florence, School of Medicine-Azienda Ospedaliero Universitaria Careggi (AOUC), Largo Brambilla, 3 and Viale Morgagni, 50, 50134, Florence, Italy.
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9
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Warrillow S, Fisher C, Tibballs H, Bailey M, McArthur C, Lawson-Smith P, Prasad B, Anstey M, Venkatesh B, Dashwood G, Walsham J, Holt A, Wiersema U, Gattas D, Zoeller M, Garcia Alvarez M, Bellomo R. Coagulation abnormalities, bleeding, thrombosis, and management of patients with acute liver failure in Australia and New Zealand. J Gastroenterol Hepatol 2020; 35:846-854. [PMID: 31689724 DOI: 10.1111/jgh.14876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM To study the management of coagulation and hematological derangements among severe acute liver failure (ALF) patients in Australia and New Zealand liver transplant intensive care units (ICUs). METHODS Analysis of key baseline characteristics, etiology, coagulation and hematological tests, use of blood products, thrombotic complications, and clinical outcomes during the first ICU week. RESULTS We studied 62 ALF patients. The first day median peak international normalized ratio was 5.5 (inter-quartile range [IQR] 3.8-8.7), median longest activated partial thromboplastin time was 62 s (IQR 44-87), and median lowest fibrinogen was 1.1 (IQR 0.8-1.6) g/L. Fibrinogen was only measured in 85% of patients, which was less than other tests (P < 0.0001). Median initial lowest platelet count was 83 (IQR 41-122) × 109 /L. Overall, 58% of patients received fresh frozen plasma, 40% cryoprecipitate, 35% platelets, and 15% prothrombin complex concentrate. Patients with bleeding complications (19%) had more severe overall hypofibrinogenemia and thrombocytopenia. Thrombotic complications were less common (10% of patients), were not associated with consistent patterns of abnormal hemostasis, and were not immediately preceded by clotting factor administration and half occurred only after liver transplantation surgery. CONCLUSION In ALF patients admitted to dedicated Australia and New Zealand ICUs, fibrinogen was measured less frequently than other coagulation parameters but, together with platelets, appeared more relevant to bleeding risk. Blood products and procoagulant factors were administered to most patients at variable levels of hemostatic derangement, and bleeding complications were more common than thrombotic complications. This epidemiologic information and practice variability provide baseline data for the design and powering of interventional studies.
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Affiliation(s)
- Stephen Warrillow
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caleb Fisher
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Heath Tibballs
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Michael Bailey
- Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
| | - Colin McArthur
- Medical Research Institute of New Zealand, Auckland, New Zealand.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Pia Lawson-Smith
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Bala Venkatesh
- Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia
| | - Gemma Dashwood
- Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia
| | - James Walsham
- Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrew Holt
- Department of Intensive Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Ubbo Wiersema
- Department of Intensive Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Gattas
- Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Matthew Zoeller
- Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mercedes Garcia Alvarez
- Department of Anesthesiology and Pain Medicine, Hospital Santa Creu i Sant Pau, University of Barcelona, Barcelona, Spain
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
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10
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Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management. Anesthesiology 2020; 130:446-461. [PMID: 30707120 DOI: 10.1097/aln.0000000000002597] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A narrative review of the pathophysiology, diagnosis, management, delivery implications, obstetric anesthesia care, and potential critical care needs in patients presenting with acute fatty liver of pregnancy.
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11
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Guo R, Xie Y, Yang J, Lu H, Ye P, Jin L, Lin W. Increasing plasma ADAMTS13 activity is associated with HBeAg seroconversion in chronic hepatitis B patients during 5 years of entecavir treatment. Sci Rep 2019; 9:5916. [PMID: 30976044 PMCID: PMC6459868 DOI: 10.1038/s41598-019-42421-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
The relationship between hemostatic system and HBeAg seroconversion (SC) of chronic hepatitis B (CHB) patients is ill-defined. We therefore evaluate the predictive value of plasma ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin motif repeats 13) and VWF (von Willebrand factor) for CHB patients during 5-year entecavir (ETV) treatment. One hundred and fourteen HBeAg positive CHB patients on continuous ETV treatment were recruited. Liver biopsies were evaluated using the METAVIR scoring system, and plasma ADAMTS13 activity (ADAMTS13: AC) and VWF antigen (VWF: Ag) were determined at baseline, 3, 12, 24, 36, and 60 months, respectively. ETV treatment resulted in an increased ADAMTS13: AC and decreased VWF: Ag (both P < 0.001) in CHB patients. Cox multivariate analysis demonstrated that the change of ADAMTS13: AC after 1-year ETV treatment was an independent predictor for HBeAg SC at year 5. The area under the receiver operating characteristic (ROC) curve for the change of ADAMTS13: AC after 1-year ETV treatment plus baseline HBV DNA was 0.873 (P < 0.001) to predict SC at year 5. The results suggested that increased ADAMTS13: AC after 1 year ETV treatment was associated with a higher seroconversion, and could be used surrogate of HBeAg SC in CHB patients during 5-year ETV treatment.
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Affiliation(s)
- Renyong Guo
- Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, 310003, Zhejiang, China
| | - Yirui Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, Zhejiang, China
| | - Jiezuan Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, Zhejiang, China.
| | - Haifeng Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, Zhejiang, China
| | - Ping Ye
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, Zhejiang, China
| | - Linfeng Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, Zhejiang, China
| | - Wenqin Lin
- Reproductive Medicine Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
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12
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Marín F, Roldan V. Assessment of bleeding risk in acute ill medical patients. An essential part of venous thromboembolism prevention. Thromb Haemost 2017; 116:403-4. [DOI: 10.1160/th16-07-0512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 11/05/2022]
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13
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Blaine KP, Sakai T. Viscoelastic Monitoring to Guide Hemostatic Resuscitation in Liver Transplantation Surgery. Semin Cardiothorac Vasc Anesth 2017; 22:150-163. [PMID: 29099334 DOI: 10.1177/1089253217739121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma. The use in these coagulopathic conditions led to its application to LT, although the mechanisms of coagulopathy in these patients are quite different. While VEM is often used during transplant surgeries in Europe and North America, evidence supporting its use is limited to a few small clinical studies. The theoretical and clinical applications of the standard and specialized VEM assays are discussed in the setting of LT and ESLD.
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Affiliation(s)
- Kevin P Blaine
- 1 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tetsuro Sakai
- 2 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
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14
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Hsu N, Wang T, Friedman O, Barjaktarevic I. Medical Management of Pulmonary Embolism: Beyond Anticoagulation. Tech Vasc Interv Radiol 2017; 20:152-161. [PMID: 29029709 DOI: 10.1053/j.tvir.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pulmonary embolism (PE) is a common medical condition that carries significant morbidity and mortality. Although diagnosis, anticoagulation, and interventional clot-burden reduction strategies represent the focus of clinical research and care in PE, appropriate risk stratification and supportive care are crucial to ensure good outcomes. In this chapter, we will discuss the medical management of PE from the time of presentation to discharge, focusing on the critical care of acute right ventricular failure, anticoagulation of special patient populations, and appropriate follow-up testing after acute PE.
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Affiliation(s)
- Nancy Hsu
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tisha Wang
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Oren Friedman
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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15
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Abstract
Acute liver injury and acute liver failure are syndromes characterized by a rapid loss of functional hepatocytes in a patient with no evidence of pre-existing liver disease. A variety of inciting causes have been identified, including toxic, infectious, neoplastic, and drug-induced causes. This article reviews the pathophysiology and clinical approach to the acute liver injury/acute liver failure patient, with a particular emphasis on the diagnostic evaluation and care in the acute setting.
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Affiliation(s)
- Vincent Thawley
- Emergency and Critical Care Medicine, Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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