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Trombophilic states during pregnancy
Košatová, Andrea ; Ehler, Edvard (advisor) ; Pavlasová, Lenka (referee)
The aim of this thesis is to summarize the available data concerning the influence of trombophilic states on the process of pregnancy and to present the results obtained by investigating the prevalence of congenital trombophilia in infertile women and its influence on the success rate of assisted reproduction. It is aimed at those interested in the problematics - be it professionals, medical students or women planning pregnancy or cannot get pregnant. The theoretical part draws data from literature written by leading Czech experts in the field and from scientific journals, included are also foreign sources. The practical part was executed with the kind permission of the PRONATAL s.r.o. centre for assisted reproduction. Key words: venous thromboembolism, trombophilia, trombophylaxis, gravidity, mutation, screening
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Thrombophilia in pregnancy
Vítková, Magda ; Kvasnička, Jan (advisor) ; Hájek, Zdeněk (referee) ; Penka, Jaroslav (referee)
5 ABSTRACT Background: Thromboembolic disease is one of the most common causes of pregnant women morbidity and mortality. The pregnancy period is often the first time, when the apparent congenital or acquired thrombophilia is identi- fied. Patients with thrombophilia have an increased risk of pregnancy compli- cations. The optimal anticoagulant prophylaxis helps to prevent these compli- cations. Methods: The presented work is focused on monitoring of coagulation param- eters, blood counts and acute phase proteins in pregnant women (N = 68) with thrombophilia treated with enoxaparin during pregnancy and it is also con- cerned with evaluation of effectiveness of anticoagulant therapy during preg- nancy using anti FXa activity determination based on inhibition of FXa weight, coagulation parameters and acute phase proteins. In the first and the second part of the study, there is no control group of pregnant patients with severe thrombophilia, but no anticoagulation - this is justified by ethical rea- sons. In the third part, we examined by questionnaire our patients for enoxap- arin adverse reactions at the injection site. Finally, the last part is focused on evaluation of enoxaparin effects on bone remodelling markers, compared with a group of pregnant women without anticoagulation. Results: During the...
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Contribution to the pathophysiology of thrombophilic state after fractures surgery in patients over 75 years old
Kudrnová, Zuzana ; Kvasnička, Jan (advisor) ; Dyr, Jan (referee) ; Malý, Jaroslav (referee)
Introduction: Hip fracture surgery is the particular problem of very old patinets (>75 years), with high risk of VTE (up to 80%). It is essential to provide VTE prophylaxis. Patients advanced age and their polymorbidity contribute to the thrombophilic status. Objectives and methods: The aim of the study was to determine the changes of coagulation within the 28 post-operative days in 41 patients over 75 years who underwent hip fracture surgery. Another object was to determine acute phase response and an endothelial activation. The third task was to determine how affected is a key component of hemostasis, FXa activity by its specific inhibitor fondaparinux and enoxaparin, which inhibits FXa and thrombin in a 4:1 ratio and if there is bleeding complication in such a risk group patiens after antithrombotics long-term administration. Patients were randomly divided into two anticoagulant groups: fondaparinux (n = 23) and enoxaparin (n = 18). Results: Thrombophilia is demonstrated by a reactive increase of the most of these parameters preoperatively and reveals the effect of the initial trauma. A surgery further aggravates this reaction. This inflammatory and secondary prothrombogenic condition persisted until postoperative day 28. Both antithrombotics effectively inhibit thrombin generation without...
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Application of the method RFLP PCR , PCR ARMS and reverse hybridization for detecting the most common thrombophilic mutations in the Czech population
MATĚJKOVÁ, Markéta
Recently the term thrombophilia is becoming a current topic. It is an increased precondition for the creation of tromboses and the following complications as the result of increased blood coagulation which could be very serious or even fatal. A timely diagnosis of thrombophilia mutations helps patients to avoid many critical situations (e.g. in case of operations, pregnancy etc.). In these days there are at least 30 genetic laboratories in the Czech Republic which research thrombophilia mutations. Unfortunately this medical examination is covered by insurance companies just in case of indicated symptoms which are under strict criteria. If someone is interested in a medical examination and a doctor does not indicate him with the symptoms, they are forced to pay the examination on their own. There are a few insurance companies which contribute with some amount for these examinations as a part of their preventive programmes (e.g. Česká průmyslová zdravotní pojišťovna, Zdravotní pojišťovna ministerstva vnitra ČR or Zdravotní pojišťovnu Revírní bratrská pokladna). The aim of my bachelor thesis was a practical mastery RFLP-PCR method, PCR ARMS method and a reverse hybridization on strips to detect the most common mutations of thrombophilia in the population of the Czech Republic and deviloving on the issue. In the theoretical part, I focus on a description of the most important thrombophilic mutations in the Czech population and their risks. I also describe particular genetic methods by which each of thrombophilia mutations is being examined in genetic laboratories. My own results of the examination of four major thrombophilia mutations and polymorphs are shown in the practical part. These are the Leiden mutation, prothrombin mutation, MTHFR 1298 and MTHFR 677 polymorphs. For my examinations I used these genetic methods: RFLP-PCR method, PCR ARMS method, reverse hybridization on strips. I made all these methods in the genetic laboratory Genlabs in České Budějovice. For the examinations I used DNA samples of my family.
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Diagnostics of Hypercoagulation Status by D-dimer Concentration Measurement
STIEBLEROVÁ, Romana
In common thrombofilia is the state of the vessel system in arterial, venous or microcirculation part when the probability of thrombs-creation is increased, but thrombs are not present yet. It is the pre-state of thrombotization. Thrombofilia is denoted as hypercoagulation status. Thrombofilia also is a common term for hereditary and acquired prothrombotic states in arterial, venous and microcirculation system. Progress in thrombotic and anticoagulation treatment and high-powered clinical research in pathogenesis together enable the radical progress in modern conception of pathophysiology in clinical diagnostic and introduce usage of very efficient treatments. Results of big multi-central studies show clearly how the precise fibrinolytic and coagulation tests and treatments can help in long-term surviving of patients with thrombosis. The search part of this study shows a summary of last information in pathophysiology and last potentialities in laboratory tests and interpretations focused on clinical exposure and diagnostic of PE and DVT. Inspiration for this study are results published in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. 1507-1513, 201, doi:10.3324/haematol.2011.060657. In this part also the need of Good Laboratory Praxis for pre-analytics extraction and transportation of whole blood samples for coagulation and fibrinolytic tests is highlighted. The practical part of this study covers either the laboratory results aimed to confirm the diagnosis or the results of D-dimer concentration done for preventive reasons and selected in specific files. D dimer is the specific fissile product of fibrin and the presence of D-dimer in plasma testifies the activation of coagulation and fibrinolysis. D-dimer tests were done on the automatic coagulation analyzer ACT Elite Pro. D-dimer test has been done by immunological method based on reaction between antigen and antibody. Analyzer ACL Elite PRO uses nephelometry for detection of blood clogs and reads the intensity of scattered 90° angle light in the sample. Results of sonography are from data stored in hospital information system FONS Akord STAPRO Hospital Jindřichův Hradec a.s. All data were collected in several data-files. This study verificates the hypothesis of predicted difference of D-dimers in patients from preventive file and patients in file with thrombofilia diagnosis. The hypothesis of D-dimer test positivity in venous thrombosis was confirmed as well, D-dimer as a marker of thrombofilia shows an actual activation in-vivo system and increased D-dimer concentration confirmed venous thrombosis DVT together with a positive sonography. The most interesting and the most important result of this study is the confirmation of the hypothesis of using an age-dependent D-dimer cut-off in patients over 50 of age with suspect DVT or/and PE diagnosis. The importance of using an age-dependent D-dimer cut-off was published in articles in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded.
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Hypercoagulable states and the effect of hormonal contraception.
ČERNÁ, Iva
Venous thrombosis is a multifactorial disease frequently related to the interaction of genetic and acquired factors. The inherited thrombophilia does not always appear, but in certain situations can be life threatening. This danger is especially for women who use hormonal contraception or plan to become pregnant. This work focuses on the frequency occurrence of factor V Leiden and prothrombin G20210A mutations by patients in a hospital of Česke Budějovice. Acquired frequencies are compared with the values given in the literature. Another point of the study is devoted to the examination of women before prescribing contraception. It is evident from the acquired data that gynecologists do not investigate women so completely and there is potentially possible leakage of women affected by inherited thrombophilia.
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