Biomedical subjects
Publications and source records attributed to J Lasierra Cirujeda.
The case of a patient who developed deep venous thrombosis of the lower extremities in the late postoperative course after laparoscopic cholecystectomy is presented. Thrombosis occurred in spite of correct prophylactic therapy. Factors influencing and predisposing to thromboembolism are reviewed, in particular the effect of pneumoperitoneum. Longer prophylaxis is probably required.
Contribution of one case of spontaneous retroperitoneal haemorrhage presented after therapy with anticoagulants. Review of causes of transperitoneal haemorrhage, relative frequency, as well as signs and symptoms, and diagnosis. The sparse number of haemorrhagic complications after anticoagulant therapy with heparin and urokinase-associated adjusted heparin are described. Treatment is instituted based on precipitating condition and, in the present case, with suppression of medication and volume replacement together with an strict evolutive monitoring by means of ultrasound, computerized axial tomography (CT) and magnetic nuclear resonance (MNR).
A study is presented which was carried out in twenty-five patients operated on in a surgical service, and who received total parenteral nutrition. Samples were taken to check modifications to the fibrinolytic system occurring after administration of hyperosmotic solutions, principally lipidic emulsions, from a contemporary standpoint. We performed three extractions: on day one, day five and following the withdrawal of the fat emulsion, with study of modifications to antithrombin III, alpha 2 antiplasmin, plasminogen, C protein, plasminogen tissular activator (t-PA), plasminogen tissular activator inhibitor (PAI 1), fibrinogen, and fibrinogen/fibrin degradation products. The laboratory techniques used are shown, along with the results obtained: increased for alpha 2 antiplasmin and antigenic t-PA with significant values (p < 0.05) on the day of withdrawal in comparison with pre-PN values, plus increased values for plasminogen, fibrinogen/fibrin degradation products and t-PA activity. In conclusion, it is suggested that antithrombin III deficiency, along with reduction in C protein levels and increased fibrinogen and PAI 1 concentration predispose patients with t-PA release defects to thrombo-embolic complication.
Tissue plasminogen activator (t-PA) activity was studied in three different experimental models of male Wistar rats; hepatic lesion without portal hypertension, portal hypertension without hepatic lesion and portal hypertension plus function liver suppression by ligation of both portal vein and hepatic artery. t-PA activity was higher in animals with portal hypertension alone than in animals with only hepatic lesion (146%). Maximal values were present in animals with functional liver suppression (1.774% vs. controls, 248% vs. hepatic lesion and 169% vs. portal hypertension only). These results suggest that both reduced hepatic t-PA clearance and portal hypertension could be involved in the increased t-PA activity normally appearing in chronic liver disease.
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This study was carried out to study the safety and efficacy of a fixed dosage of sulodexide compared to adjusted dosages (INR) of acenocoumarol as secondary prophylaxis in patients with deep vein thrombosis (DVT) in lower limbs. An economic evaluation based on the criteria of use in normal clinical practice was also performed. One hundred and fifty patients of both sexes were included, all over 18 years of age and diagnosed with proximal DVT of the lower limbs by color echo-Doppler, and with clinical evolution of less than 1 month. The patients were initially treated with low-molecular-weight heparin (LMWH) and urokinase in accordance with the established protocol. They were then randomized to continue treatment with acenocoumarol and INR adjustments every 30 days, or with sulodexide. Treatment was extended for 3 months with monthly follow-up visits and a final visit at 3 months posttreatment. No differences between the groups were detected concerning demographic or basal characteristics in clinical evolution or adverse reactions. In the group treated with sulodexide, no major/minor hemorrhagic complications were detected. On the other hand, in the acenocoumarol group, 1 major hemorrhage and 9 minor hemorrhages were produced (13.3%), reaching statistical difference in relation to the sulodexide group (p = 0.014; CI from 95% of 4.7% to 19.4%). Regarding the economic impact, treatment costs with sulodexide are much less than those with acenocoumarol, the data confirmed by the sensitivity analyses performed. The results prove the efficacy, safety, and efficiency of sulodexide as a secondary prophylaxis in thromboembolic disease, avoiding hemorrhagic risks and the monitoring of patients, and providing significant savings to the health system.
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