Clinical screening for menorrhagia and other bleeding symptoms in Nigerian women.

Objective: The objective of the study was to evaluate the prevalence of perceived bleeding symptoms in Nigerian women and the usefulness of a simple clinical screening tool for bleeding symptoms. Materials and Methods: A population-based cross-sectional survey of 1524 women of 16-50 years in Southeast Nigeria using a structured, prevalidated, pretested questionnaire was conducted. Results: A total of 1524 (85%) women responded with the mean age of 26 (10.6) years. Prevalence of bleeding symptoms was 24.6% and 11% of the women reported a positive family history of bleeding symptoms. There was a significant association between having a positive family history of bleeding disorder and experiencing bleeding symptoms (adjusted odds ratio: 0.12, 95% confidence interval: 0.06-0.22 P < 0.0001). Two hundred and six women experienced at least one bleeding symptom, 125 (8.2%) experienced at least two, whereas 43 (2.8%) experienced >3 bleeding symptoms. The most common perceived bleeding symptom was heavy menstrual bleeding (HMB) present in 83 women (22.2%), 141 (9.3%) reported a past history of HMB, 202 (13.3%) had heavy bleeds during most of their monthly cycle, and 351 (23%) requiring resuscitation with blood support. Conclusion: The prevalence of perceived bleeding symptoms among women is high, and HMB is the most common bleeding symptom. This clinical screening tool is easy and cost-effective in routinely identifying women with bleeding symptoms needing further hemostatic and obstetrics evaluation.

RésuméObjectif: L'objectif de l'étude était d'évaluer la prévalence des symptômes hémorragiques perçus chez les femmes nigérianes et l'utilité d'un outil de dépistage clinique simple des symptômes hémorragiques. Matériel et méthodes: enquête transversale auprès de la population auprès de 1 524 femmes de 16 à 50 ans dans le sud-est du Nigéria à l'aide d'un questionnaire structuré, prévalidé et prétesté. Résultats: Un total de 1524 (85%) les femmes ont répondu avec l'âge moyen de 26 (10,6) ans. La prévalence des symptômes hémorragiques était de 24,6% et 11% des femmes ont signalé un antécédents familiaux positifs de symptômes hémorragiques. Il y avait une association significative entre avoir des antécédents familiaux de saignement positifs trouble et présentant des symptômes hémorragiques (rapport de cotes ajusté: 0,12, intervalle de confiance à 95%: 0,06­0,22 P <0,0001). Deux cent et six femmes ont présenté au moins un symptôme de saignement, 125 (8,2%) en ont eu au moins deux, tandis que 43 (2,8%) ont eu> 3 saignements symptômes. Le symptôme de saignement perçu le plus courant était le saignement menstruel abondant (HMB) présent chez 83 femmes (22,2%), 141 (9,3%) ont signalé des antécédents de HMB, 202 (13,3%) ont eu des saignements abondants pendant la majeure partie de leur cycle mensuel et 351 (23%) ont dû être réanimés avec support sanguin. Conclusion: la prévalence des symptômes hémorragiques perçus chez les femmes est élevée et le HMB est le plus courant symptôme de saignement. Cet outil de dépistage clinique est simple et économique pour identifier systématiquement les femmes présentant des symptômes hémorragiques nécessitant évaluation hémostatique et obstétrique plus poussée.

Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement.

BACKGROUND: Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES: The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS: Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS: Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS: MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.

Introduction: The Complexity and Challenge of Preventing, Treating, and Managing Blood Diseases in the Developing Countries.

Managing hematologic disorders in developing countries poses problems not encountered in Western societies. The clinical features of hematologic conditions may be modified by malnutrition, chronic bacterial infection, or parasitic illness. Iron deficiency is the major factor in anemia worldwide. Anemia is more common in the wet season when malaria transmission peaks. After anemia, eosinophilia is the next most common hematologic abnormality in children in the tropics. Infection with the human immunodeficiency virus can cause hematologic abnormalities. The pattern of distribution of primary disorders of the blood varies among populations and some disorders are unique to certain parts of the world.

Alteraciones de la hemostasia durante la cirugía con quimioterapia intraperitoneal hipertérmica en pacientes con carcinomatosis peritoneal / Alterations in hemostasis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis

INTRODUCCIÓN: La cirugía citorreductora seguida de quimioterapia intraperitoneal hipertérmica (HIPEC) se asocia frecuentemente a alteraciones de la hemostasia y a elevados requerimientos transfusionales perioperatorios. El propósito de este estudio fue analizar los trastornos hemostáticos asociados a cada una de las fases de este procedimiento terapéutico mediante tromboelastometría rotacional (ROTEM), niveles de fibrinógeno y recuento plaquetario, así como su posible relación con las necesidades transfusionales. MÉTODOS: Se efectuó un estudio prospectivo longitudinal. Se registraron niveles de hemoglobina, recuento plaquetario, niveles de fibrinógeno y parámetros tromboelastométricos: tiempo de coagulación (CT), tiempo de formación del coágulo (CFT), firmeza máxima del coágulo (MCF), y ángulo α (EXTEM, INTEM, FIBTEM). Las mencionadas determinaciones se realizaron: antes del inicio de la cirugía; al finalizar la cirugía citorreductora y al concluir la HIPEC. Se utilizaron los test estadísticos apropiados. Los valores de p < 0,05 se consideraron estadísticamente significativos. RESULTADOS: Se incluyó en el estudio a 41 mujeres con una mediana de edad de 54 años (rango: 34-76). Tras la cirugía citorreductora se observó una caída de la tasa de hemoglobina desde 11,4 ± 1,5 a 10,6 ± 1,6 g/dl; un descenso del fibrinógeno sérico desde 269 ± 69 hasta 230 ± 48 mg/dl (p < 0,01) y una reducción de MCF en FIBTEM desde 20 ± 10 hasta 16 ± 8 mm (p < 0,01). La HIPEC no se asoció a alteraciones hemostáticas. Se observó una moderada relación negativa entre el número de concentrados de hematíes administrados y los niveles de fibrinógeno (ρ = −0,5; p = 0,002) y los valores de MCF EXTEM (ρ = −0,43; p = 0,006) registrados tras la HIPEC. CONCLUSIONES: Las alteraciones hemostáticas observadas aparecen tras la cirugía citorreductora, probablemente a consecuencia de la hemorragia quirúrgica. Se requieren más estudios para confirmar una correlación entre las necesidades transfusionales y las pruebas de coagulación postoperatorias

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is frequently associated with coagulation impairment and perioperative blood transfusion. Our aim was to investigate the impact of each procedure step on hemostasis, as measured by rotational thromboelastometry™ (ROTEM), fibrinogen level and platelet count as a primary outcome, along with its relationship with transfusion needs. METHODS: A prospective longitudinal study was performed. Hemoglobin level, fibrinogen level, platelet count and ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle (EXTEM, INTEM, FIBTEM) were measured before the procedure, at the end of cytoreductive surgery and after HIPEC. Appropriate statistical tests were used for comparison. A P<.05 was considered as significant. RESULTS: Forty-one women, with median age 54 (range 34-76) were recruited. Cytoreductive surgery was followed by a reduction of hemoglobin level from 11,4 ± 1,5 g/dl to 10,6 ± 1,6 g/dl, a reduction of serum fibrinogen level from 269 ± 69 mg/dl to 230 ± 48 mg/dl (P<.01) and MCF decline from 20 ± 10 to 16 ± 8 mm (P<.01), in the FIBTEM test. HIPEC was followed by no hemostatic impairment. The number of packed red blood cells administered during patients stay kept a mild significant relationship with both fibrinogen level (ρ = −0.5, P=.002), and MCF EXTEM values (ρ= -0.43, P=0.006), recorded after HIPEC. CONCLUSIONS: The mild observed hemostatic impairment appeared after cytoreductive surgery instead of HIPEC, involving surgical hemorrhage as the most likely responsible factor. Further studies are required to confirm a correlation between transfusion needs and postoperative hemostatic tests

Constructing protein-protein interaction network of hypertension with blood stasis syndrome via digital gene expression sequencing and database mining.

OBJECTIVE: To construct a protein-protein interaction (PPI) network in hypertension patients with blood-stasis syndrome (BSS) by using digital gene expression (DGE) sequencing and database mining techniques. METHODS: DGE analysis based on the Solexa Genome Analyzer platform was performed on vascular endothelial cells incubated with serum of hypertension patients with BSS. The differentially expressed genes were filtered by comparing the expression levels between the different experimental groups. Then functional categories and enriched pathways of the unique genes for BSS were analyzed using Database for Annotation, Visualization and Integrated Discovery (DAVID) to select those in the enrichment pathways. Interologous Interaction Database (I2D) was used to construct PPI networks with the selected genes for hypertension patients with BSS. The potential candidate genes related to BSS were identified by comparing the number of relationships among genes. Confirmed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), gene ontology (GO) analysis was used to infer the functional annotations of the potential candidate genes for BSS. RESULTS: With gene enrichment analysis using DAVID, a list of 58 genes was chosen from the unique genes. The selected 58 genes were analyzed using I2D, and a PPI network was constructed. Based on the network analysis results, candidate genes for BSS were identified: DDIT3, JUN, HSPA8, NFIL3, HSPA5, HIST2H2BE, H3F3B, CEBPB, SAT1 and GADD45A. Verified through qRT-PCR and analyzed by GO, the functional annotations of the potential candidate genes were explored. CONCLUSION: Compared with previous methodologies reported in the literature, the present DGE analysis and data mining method have shown a great improvement in analyzing BSS.

[Haemostatic abnormalities and thyroid disorders: the prospective observational MITH study]. / Alterazioni emostatiche e patologia tiroidea: lo studio prospettico osservazionale MITH.

Haemostatic abnormalities are a common phenomenon in patients with thyroid diseases. On one hand the condition of hyperthyroidism is associated with an increased risk of thrombotic events, on the other in severe hypothyroidism can be found a haemorrhagic tendency, as opposed to the subclinical hypothyroidism seems to correlate with increased thrombotic risk. The prospective, single center, observational MITH study (Mantua Investigation on Thyroid and Haemostasis), whose results are presented, aims to evaluate coagulation parameters in patients with thyroid disease, to establish the prevalence of haemostatic abnormalities in various conditions, to analyse the implications and clinical response to therapy established.

Prevalence of hemostatic disorders in adolescents with abnormal uterine bleeding.

STUDY OBJECTIVE: To evaluate the incidence of hemostatic disorders in a population of adolescents with various patterns of abnormal uterine bleeding (AUB). DESIGN: Retrospective observational study. SETTING: University hospital. PARTICIPANTS: One hundred thirteen adolescents with AUB; mean age at menarche and mean age at the onset of symptoms 12 ± 1.2 years and 13.5 ± 2.8 years, respectively. MAIN OUTCOME MEASURES: Data on menstrual history, bleeding symptoms, co-existing medical conditions, and medical therapies were assessed. All patients were screened for hemostatic disorders with laboratory testing. The incidence of the disorders was calculated. Subjects were further divided in 2 groups based on whether the AUB started in the first 2 years from menarche (group 1) or later (group 2). A statistical analysis was performed using a chi-square test to compare incidence of hemostatic disorders between the groups. RESULTS: One hundred thirteen adolescents with AUB were identified. Overall, 54 (47.8%) patients had some underlying hemostatic disorder, of which a platelet dysfunction was the most common (17.7%). Von Willebrand disease was detected in 13.3% of cases and a deficiency of a coagulation factor in 12.4%. In 7.1% of patients an isolated increase of bleeding time was observed. When divided in 2 groups, 44.2% of patients in group 1 and 59.2% in group 2 had a coagulation disorders, with no statistically significant difference between the 2 groups (P = .17). CONCLUSION: AUB in adolescents is frequently associated with an underlying disorder of hemostasis, most commonly a platelet function disorder. The results highlight the importance of screening for coagulation disorders in adolescents with AUB, independently from the gynecologic age at onset.

Estrogen and thrombosis: controversies and common sense.

Soon after the introduction of hormonal oral contraceptive agents reports of thrombotic complications appeared. In the past several decades, large epidemiological studies helped defined these risks for both arterial and venous complications. Clinicians can assess a patient's risk of thrombosis by both composition of the agent and patients' personal risk factors. For women with bleeding disorders these prothrombotic changes can help decrease bleeding complications. There is now also abundant data on future management of patients with estrogen related thrombosis.

Early homeostatic disturbances of human growth and maturation by endocrine disrupters.

PURPOSE OF REVIEW: We attempt to delineate and integrate aspects of growth and development that could be affected by endocrine disrupters [endocrine-disrupting compounds (EDC)], an increasing public health concern. RECENT FINDINGS: Epidemiological and experimental data substantiate that fetal and early postnatal life are critical periods of exposure to endocrine disrupters, with possible transgenerational effects. The EDC effects include several disorders of the reproductive system throughout life (abnormalities of sexual differentiation, infertility or subfertility and some neoplasia) and disorders of energy balance (obesity and metabolic syndrome). The mechanisms are consistent with the concept of 'developmental origin of adult disease'. They could involve cross-talk between the factors controlling reproduction and those controlling energy balance, both in the hypothalamus and peripherally. SUMMARY: Due to ubiquity of endocrine disrupters and lifelong stakes of early exposure, individual families should be provided by pediatricians with recommendations following the precautionary principle, that is prevention or attenuation of conditions possibly detrimental to health before the evidence of such adverse effects is complete and undisputable.

Hemostatic defects in Thai adolescents with menorrhagia.

Twenty-eight adolescents with menorrhagia by pictorial blood loss assessment chart (PBAC) criteria were investigated for underlying hemostatic defect. CBC, ABO blood group, bleeding time, APTT, PT, TT FVIII:C, VWF:Ag, RiCoF and platelet aggregation study were evaluated. Six patients (21.4%) were addressed with underlying hemostatic defect. Of these, severe aplastic anemia (n=1) and thrombotic thrombocytopenicpurpura (n=1) were identified in 2 patients with low platelets after an initial CBC. Four patients with prolonged bleeding time demonstrated inherited hemostatic defect: von Willebranddisease (VWD) type 3 (n=1), Glanzmann thrombasthenia (n=1) and Bernard-Soulier syndrome (n=2). Median PBAC score of patients with hemostatic defect was significantly higher than that of patients with unknown cause of menorrhagia (436.5 vs. 251.3, p = 0.01). After the exclusion of six patients with well-identified bleeding risks, isolated abnormal platelet aggregation response to adrenaline was detected in 11 (50%) adolescents using platelet aggregation study. No significant difference of median PBAC score was noted among patients with and without evidence of this impaired responsiveness to adrenaline. In addition, the authors also found an abnormal platelet aggregation with adrenaline stimulant in 15 (75%) among 20 healthy female controls who had no history of bleeding diathesis. No significant difference infrequency of abnormal platelet aggregation to adrenaline was observed between affected cases and controls. In summary, an impaired responsiveness of platelets to adrenaline in the present study is insufficient to support its risk of bleeding. On the contrary, the simple test such as CBC and bleeding time revealed a worthy contribution to investigate coexisting coagulopathy in adolescents with menorrhagia.

Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study.

BACKGROUND: Inflammatory and hemostasis-related biomarkers may identify women at risk of stroke. METHODS: Hormones and Biomarkers Predicting Stroke is a study of ischemic stroke among postmenopausal women participating in the Women's Health Initiative observational study (n = 972 case-control pairs). A Biomarker Risk Score (BRS) was derived from levels of 7 inflammatory and hemostasis-related biomarkers that appeared individually to predict risk of ischemic stroke: C-reactive protein (CRP), interleukin-6, tissue plasminogen activator, D-dimer, white blood cell count, neopterin, and homocysteine. The c index was used to evaluate discrimination. RESULTS: Of all the individual biomarkers examined, CRP emerged as the only independent single predictor of ischemic stroke (adjusted odds ratio comparing Quartile(4)v Quartile(1) = 1.64, 95% confidence interval: 1.15-2.32, P = .01) after adjustment for other biomarkers and standard stroke risk factors. The BRS identified a gradient of increasing stroke risk with a greater number of elevated inflammatory/hemostasis biomarkers, and improved the c index significantly compared with standard stroke risk factors (P = .02). Among the subset of individuals who met current criteria for high-risk levels of CRP (>3.0 mg/L), the BRS defined an approximately 2-fold gradient of risk. We found no evidence for a relationship between stroke and levels of E-selectin, fibrinogen, tumor necrosis factor-alpha, vascular cell adhesion molecule-1, prothrombin fragment 1+2, Factor VIIC, or plasminogen activator inhibitor-1 antigen (P > .15). DISCUSSION: The findings support the further exploration of multiple biomarker panels to develop approaches for stratifying an individual's risk of stroke.

[Hemostatic coronary risk factors in a healthy population of Maracaibo, Venezuela]. / Factores hemostáticos de riesgo coronario en una población sana de la ciudad de Maracaibo, Venezuela.

The purpose of the present work was to determine the plasma concentrations of fibrinogen and Von Willebrand Factor (VWF) as well as platelet aggregation, in an apparently healthy population of 306 men and 41 women, 33 to 65 years of age, workers of the national oil industry (PDVSA, Maracaibo), as a base investigation in a 5-year prospective national collaborative study. The participants were previously subjected to a thorough clinical examination with cardiovascular evaluation and laboratory tests. Clottable fibrinogen and VWF concentrations were determined in platelet poor plasma, the last one by immunoclectrophoresis, and a multimeric analysis of VWF was performed on those plasmas with concentrations higher than 150 U/dL by SDS agarose electrophoresis, followed by cellulose membrane transference. Platelet aggregation was studied in platelet rich plasma with no addition of stimulants and after collagen and ristocetin were added. Forty per cent of men and 65.8% of women, showed fibrinogen concentrations above 300 mg/dL (p < 0.01) and 12.2% of men and 15.4% of women had VWF values higher than 150 U/dL, with normal multimeric distribution. Fourteen individuals presented spontancous platelet aggregation and increased aggregation in 12 and 13 of them, after induction with collagen and ristocetin respectively. Comparing these findings with those of previous collaborative studies from other countries, the present results could mean that an important proportion of the population here studied, could be at risk for a future coronary event; however, as these are the base findings in Maracaibo, the significance of our results will be better evaluated at the end of the five year study.

Patrón de hemostasia de alto riesgo en pacientes con sobrepeso y diabetes tipo 2 / High risk haemostasis patterns in overweight patients with type 2 diabetes mellitus

Introducción. Algunos estudios han demostrado un estado de hipercoagulabilidad en los pacientes diabéticos. Objetivo. Comparar el patrón de hemostasia entre pacientes diabéticos con sobrepeso y controles. Diseño. Un total de 23 pacientes con diabetes mellitus tipo 2 y sobrepeso atendidos en nuestra unidad fueron incluidos en el estudio (16 varones/7 mujeres). Las características clínicas de los pacientes fueron: 61,3 ñ 12,3 años, índice de masa corporal (IMC) 27,2 ñ 3,9 kg /m2 y duración de la diabetes 8,4 ñ 6,7 años. Un grupo de 23 voluntarios sanos fue elegido al azar entre donantes de sangre sin diabetes mellitus (15 varones/8 mujeres). Las características clínica de estos pacientes fueron: 62 + 13 años a IMC 27,6 ñ 3,1 kg/m2. A todos los sujetos, casos y controles, se les realizaron las siguientes pruebas: inhibidor del activador del plasminógeno: tipol (PAI-1), complejo trombina/antitrombina 111 (TAT), activador tisular del palsminógeno (t-PA), antígeno Von Willebrand (vW), proteína C (PC), proteína S (PS), trombomodulina (TH), factor Vi¡ activado, dímero D (DD), plasmina-antiplasmina (PAP) y fragmento activado protrombina Fl + 2 (F12). Estos parámetros fueron comparados en ambos grupos y dentro de los diabéticos en los grupos con y sin micro y macroangiopatía. En ambos grupos; se realizó un análisis de correlación entre los parámetros clínicos y los hemostásicos. Resultados. Los pacientes diabéticos con sobrepeso evidenciaron un incremento en los factores procoagulantes (F12 1,38 ñ 0,4 frente a 1,21 ñ 0,25 nmol/i; p < 0,05); VII[a] 94,6 ñ 48 frente a 81,7ñ 28 (MU/m]); p < 0,05), y un descenso en los parámetros fibrinolíticos (PAP 262,9 ñ 107,5 frente a 348,5 ñ 143 ng/I; p < 0,05), así como en los parámetros anticoagulantes (trombomodulina 27,4 ñ 11,7 frente a 45,1 ñ 21,7 ng/ml; p < 0,05), con un incremento en los niveles de dímero D (DD 22;3 ñ 26;8 frente a 9,7 ñ 5,4 ug/l; p < 0.05) v (t-PA 12.6 ñ 5.1 frente a 7.4 ñ 3.1 ng/ml; p < 0,05). En los pacientes diabéticos no hubo diferencia en función de la ausencia o presencia de micro o macroangiopatía. La proteína C y tPA mostraron una correlación negativa (r = -0,34; p < 0,01; y r = -0,32; p < 0,05, respectivamente) con la hemoglobina glucosilada (HbA1c) 1 FVW se correlacionó de una manera positiva con el IMC (r = 0,32; p < 0,05). No se encontraron correlaciones entre los parámetros de hemostasia, con el IMC y HbA1c en los sujetos control. Conclusión. En los pacientes con diabetes tipo 2, hay un estado de hipercoagulabilidad que puede influir en las complicaciones crónicas de esta población (AU)

Estrategias para mejorar la función endotelial y las alteraciones hemostáticas en pacientes con aterosclerosis / Therapeutic options to improve endothelial function and hemostatic properties in atherosclerotic disease

Las células endoteliales (CE) que recubren la capa íntima de las arterias intervienen de forma importante en la regulación de la hemostasia. En reposo, las CE mantienen la fluidez circulatoria y promueven la activación de numerosas funciones anticoagulantes. Tras lesión vascular, como ocurre en la aterosclerosis, las CE se convierten en una superficie trombogénica a través de la inducción de sustancias procoagulantes, inhibición de los mecanismos anticoagulantes naturales y favoreciendo el depósito intravascular de fibrina. Diversas estrategias terapéuticas y modificaciones del estilo de vida pueden modular la función endotelial. Estudios recientes indican que algunos de los beneficios que se obtienen tras la administración de hipolipemiantes, antioxidantes, estrógenos e inhibidores del enzima convertidor de la angiotensina (IECAs), pueden deberse a sus efectos sobre la función endotelial y los mecanismos hemostáticos. Investigaciones en curso permitirán establecer el papel fisiopatológico de la disfunción endotelial y de las medidas encaminadas a la prevención y tratamiento de la aterosclerosis (AU)

Endothelial cells (EC) form the luminal surface and thus have a central role in the regulation of hemostasis. In the quiescent state, EC mantain blood fluidity and inhibit clot formation by promoting the activity of numerous anticoagulant pathways. However, following vascular injury, such as in atherosclerotic diseases, the EC can promote the deposition and persistence of fibrin through coordinate induction of procoagulants and suppression of anticoagulant mechanisms. A growing list of therapeutic modalities and life style changes have been shown to modulate endothelial dysfunction. Among them, lipid—lowering agents, estrogens, antioxidants and angiotensin-converting-enzyme inhibitors (ACEI) achieve much of their benefit through effects improving EC function and hemostatic mechanisms. Future investigations will shed more light on the pathophysiology of endothelial dysfunction to provide new options for the prevention and treatment of atherosclerotic disease (AU)

[Critical analysis of hemostasis disorders in the course of eclampsia. Report of 106 cases]. / Analyse critique des troubles de l'hémostase au cours de l'éclampsie. A propos de 106 cas.

OBJECTIVE: Study of hemostatic disorders during eclampsia, their risk factors, maternal complications and associated mortality. METHODS: Retrospective study concerning 106 cases of severe eclampsia treated in intensive care between September 1992 and December 96. Patients with or without hemostatic disorders were compared for laboratory findings, maternal complications and mortality. RESULTS: Forty patients had hemostasis disorders as follows: isolated thrombopenia in 19 cases, disseminated intravascular coagulation (DIC) in 5 cases, Hellp syndrome associated to DIC in 7 cases and Hellp syndrome in 9 cases. Hemostasis disorders were associated to maternal advanced age, but not with gestational age or blood pressure in admission or time of convulsions. Complications and mortality associated with hemostasis disorders were more frequent compared to patients without hemostasis disorders. Among the 17 deaths of our series, 10 had hemostasis disorders. CONCLUSION: Hemostasis disorders were prognosis factors in eclampsia requiring systematic laboratory tests at admission and immediate delivery.