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Antiphospholipid Antibodies and Their Significance in Thomboembolic Diseases
Hirmerová, Jana ; Filipovský, Jan (advisor) ; Roztočil, Karel (referee) ; Malý, Jaroslav (referee)
The diagnostic workup in patients with venous thromboembolism (VTE) consists of imaging methods as well as laboratory assays and concentrates not only on diagnostic and follow-up procedures but also on the evaluation of the possible cause of VTE event. In the absence of an obvious clinical provoking factor, occult malignancy or thrombophilic disorder should be searched for. From the practical point of view, the most relevant are those thrombophilic states that are associated with an increased risk of recurrence and may therefore play a role in the decision about the length of the anticoagulation therapy (usually with warfarin) following the event. However, the most common inherited thrombophilic disorders are associated with only mildly increased risk of VTE recurrence and their detection does not usually warrant prolonged warfarin therapy. Antiphospholipid syndrome (APS) is an acquired thrombophilic state with a significantly higher risk of VTE recurrence, especially after warfarin withdrawal. The laboratory diagnostics of APS consists of coagulation assays (detection of lupus anticoagulans) as well as serologic tests of antiphospholipid antibodies (APA). APAs are very heterogeneous and only some of them are considered "diagnostic" - anticardiolipin antibodies (ACA) and newly also antibodies...
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Thrombophilia and thrombotic complications in severe septic patients
Zenáhlíková, Zuzana ; Kvasnička, Jan (advisor) ; Maruna, Pavel (referee) ; Malý, Jaroslav (referee)
Introduction: Thrombotic events are among the most serious complications of sepsis and also the most frequent causes of morbidity and mortality in patients with sepsis. Currently, the administration of low molecular weight heparins (LMWH) is recommended in patients with severe sepsis for prophylaxis of these complications. However, this prophylaxis often fails. Objectives of the study: One of the objectives of our study was to examine changes in haemostasis in relation to the inflammatory response during 15 days of severe sepsis. The next objective was to determine whether a prophylactic inhibition of F Xa in the range from 0.2 to 0.4 IU/mL is achieved in these patients, if they receive the recommended prophylaxis with LMWH. We also recorded the dynamics of changes in the F Xa inhibition during the entire study period. Moreover, we tried to identify the factors that may affect the antithrombotic efficacy of the subcutaneously administered enoxaparin. Patient population and methods: A total of 35 ICU patients meeting the criteria of severe sepsis were enrolled in the study. Only 16 of these patients could be followed throughout the entire 15-day period. Patients were treated according to the current guidelines, including LMWH prophylaxis; enoxaparin (40 mg sc per day) was used in this study....
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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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Importance of Concomitant Fibromyalgia in Rheumatoid Arthritis and Systemic Lupus
Tomš, Jan ; Malý, Jaroslav (advisor) ; Pavelka, Karel (referee) ; Horák, Pavel (referee)
Background: Fibromyalgia (FM) is a chronic syndrom characterized by dysfunction of pain processing and regulation. It occurs relatively often in concomitance with the connective tissue diseases (CTD), in particular rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). FM may be involved in their final clinical manifestation and may have important consequencies for diagnosis and treatment. Objectives: To examine frequency of FM in the prime CTD, FM impact on their clinical manifestation and relationship to assessment of the clinical activity in regional, monocentric, cross- sectional, descriptive study. Methods: Study groups of 120 adult patients with RA, 91 with SLE, 30 with polymyositis/ dermatomyositis (PM/DM) and 28 with systemic sclerosis (SSc) were evaluated. Each patient was examined on the presence of concomitant FM according to ACR (American College of Rheumatology) classification criteria (1990). The following data were recorded: sociodemographic data, history including comorbidities, contemporary immunosupressive and analgesic therapy, laboratory parameters (serum inflammatory markers, relevant autoantibodies). Pain, fatigue and muskuloskeletal stiffness were assessed on horizontal 100 mm visual analogue scale. Patients' function status was evaluated using HAQ (Health...
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Thrombophilia and thrombotic complications in severe septic patients
Zenáhlíková, Zuzana ; Kvasnička, Jan (advisor) ; Maruna, Pavel (referee) ; Malý, Jaroslav (referee)
Introduction: Thrombotic events are among the most serious complications of sepsis and also the most frequent causes of morbidity and mortality in patients with sepsis. Currently, the administration of low molecular weight heparins (LMWH) is recommended in patients with severe sepsis for prophylaxis of these complications. However, this prophylaxis often fails. Objectives of the study: One of the objectives of our study was to examine changes in haemostasis in relation to the inflammatory response during 15 days of severe sepsis. The next objective was to determine whether a prophylactic inhibition of F Xa in the range from 0.2 to 0.4 IU/mL is achieved in these patients, if they receive the recommended prophylaxis with LMWH. We also recorded the dynamics of changes in the F Xa inhibition during the entire study period. Moreover, we tried to identify the factors that may affect the antithrombotic efficacy of the subcutaneously administered enoxaparin. Patient population and methods: A total of 35 ICU patients meeting the criteria of severe sepsis were enrolled in the study. Only 16 of these patients could be followed throughout the entire 15-day period. Patients were treated according to the current guidelines, including LMWH prophylaxis; enoxaparin (40 mg sc per day) was used in this study....
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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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Antiphospholipid Antibodies and Their Significance in Thomboembolic Diseases
Hirmerová, Jana ; Filipovský, Jan (advisor) ; Roztočil, Karel (referee) ; Malý, Jaroslav (referee)
The diagnostic workup in patients with venous thromboembolism (VTE) consists of imaging methods as well as laboratory assays and concentrates not only on diagnostic and follow-up procedures but also on the evaluation of the possible cause of VTE event. In the absence of an obvious clinical provoking factor, occult malignancy or thrombophilic disorder should be searched for. From the practical point of view, the most relevant are those thrombophilic states that are associated with an increased risk of recurrence and may therefore play a role in the decision about the length of the anticoagulation therapy (usually with warfarin) following the event. However, the most common inherited thrombophilic disorders are associated with only mildly increased risk of VTE recurrence and their detection does not usually warrant prolonged warfarin therapy. Antiphospholipid syndrome (APS) is an acquired thrombophilic state with a significantly higher risk of VTE recurrence, especially after warfarin withdrawal. The laboratory diagnostics of APS consists of coagulation assays (detection of lupus anticoagulans) as well as serologic tests of antiphospholipid antibodies (APA). APAs are very heterogeneous and only some of them are considered "diagnostic" - anticardiolipin antibodies (ACA) and newly also antibodies...
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