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Biomedical subjects

S Ziemer

Publications and source records attributed to S Ziemer.

At least 37 records · Page 2Linked to original sources
PubMed1999

Bleeding after intermittent or continuous r-hirudin during CVVH.

OBJECTIVE: To demonstrate bleeding complications encountered in patients after cardiac surgery on continuous venovenous haemofiltration (CVVH) treated with continuous versus intermittent r-hirudin for heparin-induced thrombocytopenia (HIT) type II. DESIGN: Case description. SETTING: Cardiothoracic intensive care unit at a university hospital. PATIENTS: 5 consecutive patients with proven HIT type II on CVVH after major cardiac surgery. INTERVENTIONS: Recombinant hirudin (r-hirudin) was given continuously at a dose of 0.01 mg/kg per h in three patients or in repeated bolus administration of 0.05 mg/kg in two patients. MEASUREMENTS AND RESULTS: Since the ecarin clotting time assay was not available at that time to monitor hirudin effects on coagulation, the activated partial thromboplastin time (normal range 26-38 s, target range 50-60 s) was used. The continuously treated patients suffered from major bleeding complications. Therefore, the regimen was changed to repeated bolus administration, reducing the incidence of bleeding complications probably due to a threefold diminished cumulative hirudin dose per day in comparison to continuous administration. CONCLUSIONS: If ecarin clotting time, the most suitable monitor for hirudin activation, is not available, we would prefer to give r-hirudin in repeated boluses to avoid major bleeding complications in cardiac surgery patients on CVVH.

Aged↗
PubMed1998

Fibrinogen breakdown, long-lasting systemic fibrinolysis, and procoagulant activation during alteplase double-bolus regimen in acute myocardial infarction.

Recent clinical studies comparing accelerated versus bolus administration of alteplase tissue plasminogen activator (t-PA) suggest similar thrombolytic efficacy, but reveal higher bleeding complications among older patients during the double-bolus regimen. The objective of the present study was to characterize the hemostatic profile of t-PA administered as double-bolus doses of 50 mg, at intervals of 30 minutes. Among 50 patients with acute myocardial infarction treated by double-bolus t-PA thrombolysis, coagulation and fibrinolysis parameters, as well as t-PA levels, were monitored. Monitored t-PA levels peaked at 5 and 35 minutes and were detectable within the therapeutic range even after 90 minutes. Marked systemic fibrinolytic activation was indicated by 75% depletion of both plasminogen and fibrinogen, as well as by 19-fold and 300-fold increases of fibrin degradation and fibrinogen degradation products. Plasminogen-activator inhibitor activity was completely suppressed. Pronounced procoagulant activation was reflected by a 3.4-fold increase of both factor XIIa and prothrombin fragment 1+2, and by a threefold increase of thrombin-antithrombin complex. Independent of t-PA weight dosage, fibrinolytic activation was more pronounced among older patients (> or = 63 years). We conclude that t-PA after bolus administration has a long half-life. Double-bolus regimen leads to a long-lasting systemic fibrinolytic state, which is even more remarkable among older patients--a fact that may explain the higher bleeding complications reported for this age group.

Aged↗
PubMed1998

Increased rate of factor V Leiden mutation in patients with cerebral venous thrombosis.

We investigated the association between cerebral venous thrombosis and hereditary resistance to activated protein C (APC) in 12 consecutive German patients with non-fatal cerebral venous thrombosis and in 187 controls without a history of thrombotic disorder. Three patients (25%) had a mutation in the factor V Leiden gene against only one subject in the control group. This difference was significant (P < 0.05), with an odds ratio of 11.7 (1.5-87; 95% confidence interval). Two patients carrying the mutation had additional common risk factors for thrombosis, and 2 had a positive family history of thromboembolism. We conclude that inherited APC resistance by a mutation in factor V Leiden is an important risk factor in non-fatal cerebral venous thrombosis. We recommend testing for APC resistance and, if abnormal for factor V Leiden mutation in patients with cerebral venous thrombosis.

Adult↗
PubMed1998

Evaluation of erythropoietic activity on the basis of the red cell and reticulocyte distribution widths during epoetin beta therapy in patients undergoing cardiac surgery.

The changes in the red cell and reticulocyte distribution widths during preoperative treatment with recombinant human erythropoietin (rhEPO) were evaluated in a double-blind, placebo-controlled trial in cardiac surgery patients. The increases in the reticulocyte count, in the hemoglobin and in all distribution widths are the expression of the marked preoperative stimulation of erythropoiesis in the patients treated with rhEPO. Only placebo patients with a hemoglobin < or = 7.5 mmol/l or a transferrin > 4.0 g/l at baseline showed an increase in the red cell distribution width or in the reticulocyte hemoglobin distribution width on oral iron therapy alone. While the reticulocyte count and the distribution widths of red cells in the rhEPO patients decreased postoperatively, only the increases in the distribution widths of reticulocytes after the second postoperative day indicate that stimulation oferythropoiesis had taken place. In patients with a low hemoglobin or a high transferrin the rhEPO therapy should be preceded by iron therapy in order to raise the hemoglobin level and reduce the cost of treatment.

Adult↗
PubMed1997

Paediatric thrombo-embolism: the influence of non-genetic factors and the role of activated protein C resistance and protein C deficiency.

UNLABELLED: In many children, the pathogenesis of thrombo-embolism remains unexplained. This study examines the role of non-genetic risk factors in 37 children with venous or arterial thrombosis. Included were 17 patients with portal vein thrombosis following umbilical vein catheterisation, 6 with portal vein thrombosis and an uneventful neonatal period, 4 with deep vein thrombosis, 4 with renal vein thrombosis after kidney transplantation, 1 haemodialysis patient with thromboses of arteriovenous shunts, and 5 with arterial thromboses at various sites. In 25 of these 37 patients (68%) exogenic risk factors and particularly vascular manipulations (24/37) were related to the thrombotic event. Resistance to activated protein C was identified in 5 patients and protein C deficiency in 2 (7/37; 19%). This prevalence was significantly higher than that of the control group (14/243; 5.8%; chi 2, P < 0.008). CONCLUSION: Our data show that non-genetic and particular iatrogenic risk factors can often be identified in children with thrombosis, but activated protein C resistance and protein C deficiency are significant genetic risk factors in this age group.

Adolescent↗
PubMed1997

The effect of preoperative recombinant human erythropoietin therapy on platelets and hemostasis in patients undergoing cardiac surgery.

In a double-blind, randomized, placebo-controlled trial we evaluated the effects of the administration of recombinant human erythropoietin (5 x 500 U epoetin beta/kg body weight intravenously over a 14-day period before surgery) in patients undergoing cardiac surgery and in whom autologous blood donation was contraindicated on platelet count, platelet distribution width, mean platelet volume (MPV), and certain hemostaseologic parameters. All patients received 3 x 70 IU heparin/kg per day s.c. from 2 days before operation. No thromboembolic events were associated with epoetin beta therapy during the study period. The thrombocytic parameters showed no significant changes in the placebo group before surgery, and the preoperative hematocrit increase in the epoetin beta group was accompanied with an MPV drop (in contrast to the known MPV rise in recombinant human erythropoietin-treated patients with uremia) by a mean of 0.85 fl and a platelet distribution width rise by 3.3% without a significant change in platelet count. In the epoetin beta group the coagulation time (K) of thromboelastogram (TEG) showed an increase from 4.8 to 5.4 minutes by the seventh study day and after the initiation of heparin therapy a further increase to 7.5 minutes. The higher preoperative K increase in the epoetin beta group may partly be a result of the MPV reduction, because smaller platelets are less reactive, a fact underlined by the negative correlation between the preoperative changes of MPV and reaction time of TEG (r = -0.58, p = 0.0148). In contrast, in the placebo group the K of TEG increased only after the start of heparin therapy (from 5.1 to 6.4 minutes). The significant drop in MPV in the epoetin beta group and the higher increase in K of TEG and the other investigated hemostatic parameters do not suggest any increased thromboembolic risk during the preoperative epoetin beta therapy. Therefore this treatment seems to be a safe way for increasing mean hematocrit by approximately 0.06 within the normal range and reducing the homologous blood requirement in patients undergoing elective cardiac surgery.

Adolescent↗
PubMed1992

Age-dependent regeneration of plasma proteins after donor plasmapheresis.

To analyze age-dependent effects of a plasma donation on the regeneration of plasma proteins two groups of first time plasma donors were selected (less than 25 years, greater than 50 years). By measurements of hematological and biochemical parameter, immunoglobulins, procoagulators and inhibitors of coagulation before and after a plasma donation the kinetic of regeneration until three weeks was followed up. It can be concluded that a single plasma donation affects the generation in younger and older donors in a different way. Procoagulators and inhibitors show the same behavior, except the donation related elevation of fibrinogen in young donors. Especially the retarded regeneration of cholinesterase and immunoglobulins in the male young group should be taken into consideration for frequent plasma donations and autologous preoperative plasma donations.

Adult↗
PubMed1992

Age-dependent regeneration of plasma proteins after donor plasmapheresis.

To analyze age-dependent effects of a plasma donation on the regeneration of plasma proteins, two groups of first-time plasma donors were selected (< 25 and > 50 years). The regeneration kinetics of different plasma proteins until 3 weeks after donation was followed up. It can be concluded that a single plasma donation has an age-dependent effect on regeneration, especially on the prolonged regeneration of cholinesterase and immunoglobulins.

Adult↗
PubMed1991

False-negative prenatal exclusion of Wiskott-Aldrich syndrome by measurement of fetal platelet count and size.

The study of the fetal platelet count and size can, according to the literature, be used for the prenatal diagnosis of the Wiskott-Aldrich syndrome (WAS). So far, no affected fetuses have been identified by this method. All pregnancies in which this method had been applied to resulted, as correctly predicted, in the birth of normal children. Here we report on a familial case of WAS where the haematological parameters failed to reveal the affected second child. Hence we assume that the platelet count and size of platelets remain normal in fetuses with WAS to the gestational age of 22 weeks and cannot be used for prenatal diagnosis.

Adult↗
PubMed1990

[Antibodies to anticoagulants in rheumatic autoimmune diseases].

The systemic lupus erythematosus (SLE) and the rheumatoid arthritis (RA) as the classic autoimmune diseases exhibit a great number of autoantibodies. Some of them are anticoagulants. Besides inactivating inhibitors against single coagulation factors interfering anticoagulants are known, belonging to the group of anti-phospholipid antibodies and detected as the lupus anticoagulants or anticardiolipin antibodies. Anti-phospholipid antibodies 184 patients with SLE or RA had been checked for. An enzyme immuno assay was used for detection of the anti-cardiolipin antibodies. The relations between occurrence of the anti-cardiolipin antibodies and vascular processes as well as other immunologic parameters had been tested for clinical relevancy.

Adult↗
PubMed1989

[The adhesive strength of tissue adhesives].

Twenty concentrates were produced of the blood from voluntary healthy donors by a method for producing autologous tissue adhesive. Their adhesive strength were tested by means of Thermo-fleece-specimens. A review was elaborated about the kinetics and the testing of the fibrin fixation. Methodical faults were found out. Possible ways for improving autologous adhesive variants and for producing homologue tissue adhesive are shown.

Adhesiveness↗
PubMed1989

[Local intravasal fibrinolysis in acute cerebrovascular occlusions].

The development of local intravasal fibrinolysis in acute cerebrovascular obturations is lined out and the precautions, indications and contraindications as well as our results from 10 patients are described. The requirements of dosage, procedure and of a close cooperation and combination with further clinical treatment are given. Furthermore close cooperation with hemostaseology is stressed.

Acute Disease↗
PubMed1988

Treatment with AT III concentrates in hereditary and acquired AT III deficiency.

41 patients with hereditary and acquired antithrombin II deficiency received a substitution therapy with human plasma fraction of antithrombin III from the GDR blood-transfusion service. In 6 patients a hereditary AT III deficiency was substituted and in this context the substitution in case of thromboses during pregnancy was explained. 35 patients with acquired AT III deficiency were substituted with AT III concentrate because of thromboembolic complication in the macro-circulatory system in case of AT III deficiency due to reduced synthesis, loss, increased consumption or a combination of these conditions or because of DIC. The substitution effect was good. Dosage and injection intervals depend on the clinical condition. Side-effects have not been observed.

Adolescent↗
PubMed1988

Therapeutic plasmapheresis and haemostatic system.

The influence of therapeutic plasmapheresis by using membrane filter was investigated in 38 patients with 108 procedures. Fibrinogen and AT III reached most pronounced reduced levels in the course of three plasma exchanges while factors II, V, X, Hepato-Quick, Reptilase time and thrombocyte count remained relatively unchanged. There was no bleeding or thrombotic event in the patients. We concluded that at least determination of fibrinogen and AT III levels must be done just prior to each individual plasmapheresis to prevent dangerous imbalances in haemostatic system.

Antithrombin III↗
PubMed1988

[Percutaneous removal of kidney calculi and extracorporeal shockwave lithotripsy in patients with hemorrhagic diatheses].

Hemorrhage is the main complication of percutaneous kidney stone removal. Shock-wave lithotripsy also may causes bleeding complications. It seems that both procedures are contraindicated on patients with coagulation disorders. On the base of two cases the specification of treatment by patients with hemorrhagic diatheses is demonstrated. Modern treatment modalities of urinary stone disease are also applicable to those patients, when attention is paid to some conditions and attentive measures are taken.

Adult↗