Presentation
They present the case of a forty-one-year-old man who presented with spontaneous bleeding despite normal results from coagulation screening tests, platelet count, platelet aggregation studies, platelet force development, and bleeding time. [ncbi.nlm.nih.gov]
Hematological
- Hemophilia A
Hemophilia A- defect in the intrinsic coagulation pathway (Increased clotting time and increased APTT). Factor 8 deficiency. Hemophilia B- defect in the intrinsic coagulation pathway (Increased clotting time and increased APTT). Factor 9 deficiency. [quizlet.com]
Platelets Dysfunction (Platelets Lacking Of Receptors) Coagulation Disorder Hemophilia (Lacking Of Intrinsic Factors) TEAM GENESIS 23. Blood Count Bleeding Time (Diagnose Thrombocytopenia) Prothrombin Time (Measure Extrinsic Factor) PT [slideshare.net]
[…] to and inhibits plasmin Deficiency Inherited (autosomal recessive) Rare incidence Clinical presentation Heterozygotes – usually asymptomatic or with mild mucosal bleeding Homozygotes – may have severe bleeding episodes resembling those of congenital hemophilia [arupconsult.com]
Lack of some coagulation factors may lead to bleeding (e.g., factor VIII or IX in hemophilia) Coagulation cascade: The coagulation cascade is classically divided into three pathways. [coaguchek.com]
This requirement for factors VIII and IX explains why hemophilia type A (deficiency of factor VIII) or type B (deficiency of factor IX) results in bleeding despite an intact extrinsic coagulation pathway initiated by factor VIIa/tissue factor complexes [merckmanuals.com]
Entire Body System
- Pain
We encountered mediastinal hemorrhage in a case of anterior wall myocardial infarction (MI); the patient developed sudden-onset chest pain with hypotension after fibrinolysis. [ncbi.nlm.nih.gov]
Disease activity had significantly decreased by the end of the study in the treated group, and detailed analysis showed improvement in ESR, articular index, duration of morning stiffness and visual analogue pain scale. [academic.oup.com]
An ST-segment elevation myocardial infarction can be diagnosed using a 12-lead ECG obtained prior to reaching the hospital (in a patient with myocardial infarction symptoms such as crushing chest pain, for example). [aclsmedicaltraining.com]
You can do this in the field at the same time you do your TIMI risk score for your chest pain patient. Hand over that information along with the patient to the receiving facility. [ems1.com]
- Congestive Heart Failure
We describe the case of a 57-year-old man with a mechanical aortic valve who had discontinued oral anticoagulants for a long period and presented with symptoms of severe congestive heart failure, including pulmonary oedema and hypotension. [ncbi.nlm.nih.gov]
In 710 STEMI patients undergoing primary percutaneous coronary intervention, SR was observed in 22%, and these patients had a lower incidence of death, congestive heart failure, and recurrent ACS at 30 days than those without SR (12). [content.onlinejacc.org]
Risk factors for hemorrhagic complications include the following: Increasing age Lower body weight Elevated pulse pressure Uncontrolled hypertension Recent stroke or surgery Presence of a bleeding diathesis Severe congestive heart failure In a study that [emedicine.medscape.com]
Respiratoric
- Aspiration
This technique of fibrinolysis employed for 2 days was effective in managing the persistent purulent pericarditis when pericardial aspiration and intravenous and intrapericardial antibiotics failed. [ncbi.nlm.nih.gov]
Furthermore, histopathologic studies evaluating aspirated coronary thrombi from patients with STEMI have demonstrated significant heterogeneity in the composition and age of the culprit thrombi (4–7). [content.onlinejacc.org]
After treatment, aspirate the contents from the cannula limb(s), flush with saline, and reconnect the cannula. [emedicine.medscape.com]
Cardiovascular
- Heart Failure
We describe the case of a 57-year-old man with a mechanical aortic valve who had discontinued oral anticoagulants for a long period and presented with symptoms of severe congestive heart failure, including pulmonary oedema and hypotension. [ncbi.nlm.nih.gov]
In 710 STEMI patients undergoing primary percutaneous coronary intervention, SR was observed in 22%, and these patients had a lower incidence of death, congestive heart failure, and recurrent ACS at 30 days than those without SR (12). [content.onlinejacc.org]
Risk factors for hemorrhagic complications include the following: Increasing age Lower body weight Elevated pulse pressure Uncontrolled hypertension Recent stroke or surgery Presence of a bleeding diathesis Severe congestive heart failure In a study that [emedicine.medscape.com]
- Chest Pain
We encountered mediastinal hemorrhage in a case of anterior wall myocardial infarction (MI); the patient developed sudden-onset chest pain with hypotension after fibrinolysis. [ncbi.nlm.nih.gov]
An ST-segment elevation myocardial infarction can be diagnosed using a 12-lead ECG obtained prior to reaching the hospital (in a patient with myocardial infarction symptoms such as crushing chest pain, for example). [aclsmedicaltraining.com]
You can do this in the field at the same time you do your TIMI risk score for your chest pain patient. Hand over that information along with the patient to the receiving facility. [ems1.com]
These included major bleeding (most common serious adverse event, usually intrapleural), as well as significant chest pain, fever/rash and clinical deterioration. All other studies reported that no adverse events occurred in either group. [cochranelibrary.com]
Workup
[…] may be necessary to definitively diagnose severe PAI-1 deficiency Plasminogen – activity testing Alpha-2-antiplasmin – activity testing tPA – antigen testing Genotyping ( SERPINE1 ) Consider in patient with recurrent deep vein thrombosis and negative workup [arupconsult.com]
QT, RR, ST Intervals
- ST Elevation
METHODS: We retrospectively analysed the data from the Maharaj Nakorn Chiang Mai Hospital acute ST-elevation myocardial infarction (STEMI) registry during the period 2007-2012. [ncbi.nlm.nih.gov]
Five-year survival in patients with ST-segment-elevation myocardial infarction according to modalities of reperfusion therapy: the French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort. [journals.plos.org]
Delays in fibrinolysis as primary reperfusion therapy for acute ST-segment elevation myocardial infarction. Am Heart J. 2010 Jun; 159(6):998-1004.e2. Glickman SW, Cairns CB, Chen AY, Peterson ED, Roe MT. [seth.es]
In specific terms, an ECG that shows ST segment elevation in which the J point is greater than 2 mm in leads V2 and V3 and 1 mm or more in other leads is in ST segment elevation myocardial infarction. [aclsmedicaltraining.com]
Enoxaparin versus unfractionated heparin as antithrombin therapy in patients receiving fibrinolysis for ST-elevation myocardial infarction. [emedicine.medscape.com]
Treatment
MATERIAL AND METHODS: Thrombin generation, fibrinolysis activators and inhibitors were determined before and after 12 months of treatment. [ncbi.nlm.nih.gov]
They found that recovery rates were significantly higher with systemic clot-busting drugs than with no treatment or with conservative treatment ( P Indeed, conservative treatments caused more harm than no treatment, with a number needed to harm of 10. [medpagetoday.com]
Prognosis
A good prognosis can be achieved if the treatment starts within the first 4 to 5 hours after occlusion. [ncbi.nlm.nih.gov]
Identifying symptoms of a stroke quickly and seeking prompt treatment can improve prognosis and maximize patient recovery. Fibrinolytic therapy can be a lifesaving treatment for stroke. [acls.com]
It is possible that the prognosis for some of these patients would have been worse if they had not been closely monitored and promptly treated when decompensation occurred; this notion is supported by the higher rates of death reported in noninterventional [nejm.org]
Etiology
CONCLUSION: In conclusion, acute fibrinolysis SD is not caused by a single etiology, and is clearly associated with PAI-1 activity. [ncbi.nlm.nih.gov]
[…] hemangiomas was first noted in 1940 by Kasabach and Merritt. 1 Since then approximately 50 additional cases have been reported, of which the majority have had sizeable benign hemangiomas, thrombocytopenia, and a severe bleeding diathesis. 2,3 Although many etiologies [jamanetwork.com]
Epidemiology
Most of these were large epidemiological studies assessing thousands of patients. [content.onlinejacc.org]
[…] injury to the myocardium as a result of acute pressure overload. 6,15-20 Fibrinolytic treatment promptly reduces pulmonary-artery resistance and pressure, 21 and trials that included patients with hemodynamic compromise, 11 as well as recently published epidemiologic [nejm.org]
Sepsis: definition, epidemiology, and diagnosis. BMJ. 2007;335:879–83. View Article PubMed Central PubMed Google Scholar Coughlin SR. Thrombin signalling and protease-activated receptors. Nature. 2000;407:258–64. [jintensivecare.biomedcentral.com]
Pathophysiology
The pathophysiology appears to relate to endothelial injury and hypoperfusion, with several molecular markers identified in playing a role. [ncbi.nlm.nih.gov]
SERPINE1 ) Consider in patient with recurrent deep vein thrombosis and negative workup for common defects Differential Diagnosis Factor deficiency Factor VIII or IX deficiency most common von Willebrand disease Functional platelet disorder Background Pathophysiology [arupconsult.com]
Molecular and Systemic Pathophysiology [link.springer.com]
Prevention
We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. [ncbi.nlm.nih.gov]
Definition / general Process of degrading the fibrin clot when it is no longer needed Also prevents extension of clot beyond site of injury Interpretation tPA and uPA Fibrinolysis initiated by tPA (tissue plasminogen activator) or uPA (urokinase-like [pathologyoutlines.com]
Fibrinolysis is a process that prevents blood clots from growing and becoming problematic. This process has two types: primary fibrinolysis and secondary fibrinolysis. [en.wikipedia.org]