Trombectomía mecánica mediante técnica de aspiración directa de primer paso en pacientes con ictus isquémico y trombosis del seno venoso / Mechanical thrombectomy by a direct aspiration first pass technique in patients with stroke and sinus venous thrombosis.

INTRODUCCIÓN. La enfermedad cerebrovascular ha sido una de las primeras causas de muerte y la principal causa de discapacidad a nivel mundial, que incluye a nuestro país. La utilidad y efectividad de la trombectomía mecánica es aceptada por la comunidad médica especializada y el no considerar en forma consistente este recurso a los pacientes candidatos para la misma ha constituido un retraso para nuestra práctica médica. Se relata la experiencia con pacientes de ictus isquémico y trombosis venosa de seno lateral. OBJETIVO. Reportar la experiencia de los resultados obtenidos en el tratamiento del ictus isquémico y trombosis venosa intracraneal mediante trombectomía mecánica por aspiración. MATERIALES Y MÉTO-DOS. Se presentó tres casos de pacientes con sintomatología neurológica relacionada a ictus isquémico y trombosis venosa cerebral, que fueron tratados mediante trombectomía mecánica entre diciembre del 2018 y Noviembre del 2019 mediante técnica de aspiración directa de primer paso. Se aplicó la Escala de Accidentes Cerebrovasculares del Instituto Nacional de Salud. RESULTADOS. La oclusión se produjo en territorio de arteria cerebral media y venoso superficial intracraneal. La recanalización fue satisfactoria en los tres casos, no presentaron complicaciones y con mejoría neurológica inmediata post procedimiento, sin secuelas. DISCUSIÓN. El ictus isquémico y la trombosis venosa son patologías de etiología múltiple dentro de las patologías vasculares neurológicas, de manera principal ateroscleróticas, cardioembólicas o condiciones protrombóticas, sin embargo al tratarse de eventos agudos requirió de la resolución inmediata mediante técnicas mecánicas neurointervencionistas, para evitar secuelas graves y permanentes e incluso el deceso del enfermo. CONCLUSIÓN. La utilización de modernas técnicas de neurointervencionismo, en especial la técnica de aspiración de primer paso, ha permitido dar mayor oportunidad de recuperación y so-brevida a quienes padecen de tromboembolias agudas en vasos cerebrales, tanto arteriales como venosas y se demostró por el nivel de evidencia que en manos entrenadas son la única alternativa de tratamiento en oclusión de vasos mayores.

INTRODUCTION. Cerebrovascular disease is one of the leading causes of death and the leading cause of disability worldwide, including our country. The usefulness and effectiveness of mechanical thrombectomy is accepted by the specialized medical community and the failure to consistently consider this resource to pa-tients who are candidates for it has constituted a delay in our medical practice. The experience with patients with ischemic stroke and lateral sinus venous thrombosis is reported. OBJECTIVE. Report the experience of the results obtained in the treatment of ischemic stroke and intracranial venous thrombosis by mecha-nical aspiration thrombectomy. MATERIALS AND METHODS. Three cases of patients with neurological symptoms related to ischemic stroke and cerebral venous thrombosis were presented, who were treated by mechanical thrombectomy between december 2018 and November 2019 using the first step direct aspira-tion technique. The Stroke Scale of the National Institute of Health was applied. RESULTS. The occlusion occurred in the territory of the middle cerebral artery and intracranial superficial venous. Recanalization was satisfactory in all three cases, there were no complications and immediate neurological improvement after the procedure, without sequelae. DISCUSSION. ischemic stroke and venous thrombosis are pathologies of multiple etiology within neurological vascular pathologies, mainly atherosclerotic, cardioembolic or prothrom-botic conditions, however, when dealing with acute events, they required immediate resolution by means of neurointerventional mechanical techniques, to avoid serious sequelae and permanent and even the death of the patient. CONCLUSION. The use of modern neurointerventional techniques, especially the first step aspiration technique, has given a greater chance of recovery and survival to those who suffer from acute thromboembolism in cerebral vessels, both arterial and venous, and it was demonstrated by the level of evidence that in trained hands they are the only treatment alternative for occlusion of major vessels.

Frequency of bleeding disorders diagnosed at armed forces institute of pathology Rawalpindi

To determine the frequency of bleeding disorders diagnosed at Armed Forces Institute of Pathology, Rawalpindi [AFIP Rwp]. Descriptive study. Department of Hematology, AFIP Rwp from January 2006 to June 2009. A total of 1836 patients of bleeding diathesis were included in the study. Hess test was done to investigate the vascular defects. Bleeding Time [BT] was done to screen platelet function defects. The 'clotting screen' and mixing studies were done to detect coagulation protein defects. Clot solubility test was performed to screen factor XIII deficiency. Out of 1836 patietns of bleeding diathesis 435 [23.7%] were diagnosed as having haemostatic defects. Out of these 435 patients 273 [62.8%] had coagulation factor deficiency, 81 [18.6%] had platelet function defects and 81 [18.6%] had vWF deficiency. Among the 273 coagulation factor deficiency patients, factor VIII deficiency was in 121 [44.3%], factor IX deficiency in 32 [11.7%], factor V deficiency in 18 [6.6%], factor XIII deficiency in 15 [5.5%], factor VII deficiency in 12 [4.4%], factor X deficiency in 9 [3.3%], factor I deficiency in 8 [2.9%] and factor II deficiency was in 3 [1.1%]. Multiple factor deficiency was 55 [20.1%]. No defects of vasculature were identified. Coagulation factor deficiencies, with factor VII deficiency being the commonest are the most frequent bleeding disorders. Platelet function defects and vWF deficiency also comprise significant proportion of the bleeding disorders

[ effect of garlic on coagulation tests]

There are many reports on anti-thrombotic properties of garlic. Also, regarding the simultaneous consumption of garlic and Warfarine or non-steroid anti-inflammatory drugs [NSAIDs], some warning recommendations are published. The aim of present study was to evaluate the effects of garlic on coagulation tests, and in case of any demonstrative anticoagulation effect, the patients, particularly those with coagulation disorders, could be given appropriate advice on proper consumption of garlic. This was a clinical trial in which 50 volunteer students were selected based on information collected using appropriate questionnaires. The students were tested for coagulation assays including bleeding time [BT], clotting time [CT], prothrombin time [PT], partial thromboplastin time [PIT], clot retraction [CR], and platelets count [PC] before and after consumption of garlic. Data were analyzed using SPPS and T-test. The average values of tests obtained in two stages of experiment were further compared statistically. The results of our study on subjects [30 females and 20 males] with an average age of 21.7 years showed that there was no significant change in values obtained for CT, PT, PC and CR [p>0.05] following consumption of garlic. However, a significant increase in PTT values was found following consumption of garlic [the p values for samples collected after 24 hours and 4 hours were 0.001 and 0.012 respectively]. There was also a significant difference [p=0.027] in BT 24 hours after garlic consumption. Regarding the results of similar tests among two genders, no significant difference was found. Following consumption of garlic, there was a significant increase in PIT and BT, the effect being more obvious after 24 hours. The data of present study regarding the inhibitory effects of garlic on platelet activities is consistent with those reported by some other researches with is also indicative of interference of garlic with PIT assays

experimental study of albino rats fed on nigella sativa and aspirin for four weeks duration: determination of coagulation profile

Ninety albino rats were selected and were divided into six groups on the basis of different diets given. Control group [I] was fed on synthetic diet and experimental groups [IIA, IIB, IIC, IID and IIE] were fed on 1 mg aspirin, 15mg, 30 mg, 45 mg Nigella Sativa per kg body weight respectively while HE was given 30 mg NS and 1 mg aspirin/kg body wt. Blood samples were collected by heart puncture and Coagulation parameters were done. BT was prolonged in groups taking aspirin only. APTT was reduced significantly in groups taking different concentration of NS when compared with control. Percentage of clot retraction was weak significantly in groups taking aspirin only when comparing with other groups

Analysis of Platelet Membrane Glycoprotein Iib-IIIa Complex in Whole Blood of Glanzmann's Thrombasthenia by Flow Cytometry

Glanzmann's thrombasthenia is a rare autosomal recessive hemorrhagic disorder characterized by prolonged bleeding time, ad deficient or absent clot retraction in the presence of normal platelet count. The major underlying abnormality in this disease is grossly defective first-phase aggregation of platelet, which are unresponsive to ADP or other platelet agonists such as epinephrine, collagen, thrombin in any concentration. This disability is caused by a decrease or absence of the platelet membrans glycoprotein IIb-IIIa complex, a member of the integrin family of adhesive receptors involved in cell-cell and cell-matrix fibronectin, and vitronectin On the development of surface labeling technique, a variety of biochemical techniques such as radioimmunoassay, crossed immunoelectrophoresis and SDS-PAGE have been used to study the structure and the function of platelet membrane glycoproteins, and to detect the platelet functional defect. But all of these techniques demand a relatively large amount of homogeneous paletelet population that requires manipulation through isolation and washing procedures before analysis. In order to eliminaste such an intricate procedure, we have applied method for analyzing platelet surface components in whole blood using monoclonal antibody and flow cytometry to recognize the absence of severe reduction of platelet membrane glycoprotien llb-llla complex. Platelet analysis by flow cytometry is a successful alternative rapid diagnostic technique for Glanzmann's thrombasthenia patients as well as well as for carriers of this disease. Fow cytometry technique provides a sensitive tool for investigating platelet functional defects caused by altered expression or deficiency of platelet surface proteins.

Método de Dugdale para la Retracción del Coágulo. Estandarización, Evaluación y Comparación con el Método de MacFarlane / Dugdale Method for Clot Retraction. Standardization, Evaluation and Comparison with the MacFarlane Method

Se efectuó un estudio comparativo entre los métodos de Dugdale y de MacFarlane para determinar la retracción del coágulo. El método de Dugdale proporciona resultados de 7,5 a 24,8% de suero retenido en el coágulo y hay una estrecha asociación entre éstos y la edad de los sujetos estudiados. Los resultados del método de MacFarlane oscilan entre 35,2 y 54,3% de suero expulsado por el coágulo para los varones y entre 40,5 y 62,5% para las mujeres, siendo estadísticamente significativa esta diferencia. No se halló asociación entre los resultados proporcionados por ambos métodos.

Platelet dysfunction in malaria.

Platelet function tests including platelet aggregation, PF3, bleeding time and clot retraction were studied in 48 malarial patients. The suppression of platelet aggregation was demonstrated in both P. vivax and P. falciparum infection. However, this abnormality was more prominent in malarial patients who had systemic complications and bleeding. The recovery of the impaired platelet aggregation was observed at period of 7 and 14 days after parasitemia in malarial patients without and with systemic complications. The correlation between the suppression of platelet aggregation and thrombocytopenia was observed. From this study, bleeding in malaria are operated by two mechanisms: thrombocytopenia and severely depressed platelet aggregation.

Reacción de liberación en tromboastenia de Glanzmann / Release reaction in Glanzmann's thrombasthenia

Se estudiaron siete pacientes con tromboastenia de Glanzmann. Se realizó agregación plaquetaria con reacción de liberación en un agregómetro Lumi. No se observó agregación con ADP, adrenalina o colágeno. El ácido araquidónico indujo una agregación de sólo 14,9%. Con ristocetina y con factor VIII bovino la aglutinación fue marcadamente disminuida. La liberación de ATP estuvo ausente con todos los agentes agregantes excepto con ácido araquidónico que provocó una liberación normal. Se realizó curva dosis respuesta con análogo de PGH2. Con dosis de 1 micronM a 100 micronM sólo se obtuvo una mínima agregación mientras que la liberación de ATP fue normal. Los resultados confirmarían la independencia de los mecanismos de agregación y liberación. La liberación de ATP inducida por ácido araquidónico o análogo de endoperóxido no parece requerir la exposición y fijación del fibrinógeno a su receptor

Retraçäo do coagulo quantitativa: uma ou outra alternativa técnica para o seu cálculo e interpretaçäo / Quantitative clot retraction test: an alternative technic for its calculation and interpretation

A equipe de Hematologia do Laboratório da AMICO realizou retraçöes do coágulo pelo método descrito a seguir, cujos dados aplicados nas equaçöes deduzidas pelo autor no presente trabalho, fornecem dois parâmetros: a porcentagem de retraçäo do coágulo (%RC) e a porcentagem de hemácias residuais (%HR) que, em conjunto, contribuem para a interpretaçäo e para o diagnóstico diferencial de algumas coagulopatias

A case of Thrombasthenia

A 6 year 6month-old boy was admitted with complains of severe spontaneou epistaxis and easy brusability. He was one of five siblings, and two of them died of recurred severe epistaxis at their age of six years. There was no history of bleeding tendency to his antecedents and parents, whose marriage was unrelated. Platelet count and partial thromboplastin time were noraml with prolonged bleeding time, but clot retraction was poor. Platelet adhesion(Salzman method) was decreased and platelet aggregation test showed flat curve with no response to epinephrine and ADP. These tests of other were normal. Diagnosis of thrombasthenia was made with the above history and laboratory results.

A case of Thrombasthenia

A 6 year 6month-old boy was admitted with complains of severe spontaneou epistaxis and easy brusability. He was one of five siblings, and two of them died of recurred severe epistaxis at their age of six years. There was no history of bleeding tendency to his antecedents and parents, whose marriage was unrelated. Platelet count and partial thromboplastin time were noraml with prolonged bleeding time, but clot retraction was poor. Platelet adhesion(Salzman method) was decreased and platelet aggregation test showed flat curve with no response to epinephrine and ADP. These tests of other were normal. Diagnosis of thrombasthenia was made with the above history and laboratory results.

Functional platelet defects and their laboratory evaluation.

Primary diseases of platelet function include Glanzmann's thrombasthenia, hereditary platelet release abnormalities (storage pool disease and release defect), Bernard-Soulier giant platelet syndrome, and platelet factor 3 defects. Qualitative defects of platelets are associated with many diseases, notably of the liver and kidney, and with the use of many drugs, particularly aspirin.