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Thrombin generation in pathophysiological conditions
Malíková, Ivana ; Kvasnička, Tomáš (advisor) ; Hirmerová, Jana (referee) ; Úlehlová, Jana (referee)
Introduction: Thrombophilic conditions may be accompanied by increased thrombin generation (TG), especially during pregnancy when the increase in thrombin generation results from a series of changes in the haemostatic system. During administration of anticoagulant treatment, it is desirable to reduce the increase in thrombin generation. Aims of the study: The first aim of our study was to compare TG in individuals with a proven factor V Leiden mutation and individuals with elevated levels of factor VIII. Another aim was to compare patients with VTE and also with or without proven FV Leiden mutation that are taking different anticoagulation treatments. The final aim was to assess thrombin generation in pregnant women and their response to LMWH administration during severe thrombophilic conditions. Group of patients and methods: There were included 170 healthy blood donors in the control group, the congenital and acquired thrombophilia group included 44 individuals with FV Leiden mutation and 38 individuals with factor VIII level >150 % without other proven thrombophilia. 347 subjects with VTE taking direct coagulation inhibitors were included in the anticoagulation group. Sixty women with a prophylactic dose of LMWH were included in the group of pregnant women. Kit Technothrombin® TGA RC Low and RC...
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Determination of platelet activation markers expression in the pathophysiology of thrombotic states
Řádek, Martin ; Kvasnička, Tomáš (advisor) ; Dulíček, Petr (referee) ; Říhová, Lucie (referee)
Background/Aims: Thrombophilia, ie an increased predisposition to venous and arterial thrombosis, is a complex disease caused by disorders of platelets and endothelial, among others. Circulating endothelial cells (CEC) and endothelial progenitor cells (EPC) have been described as markers of endothelial damage and dysfunction, respectively as markers of its recovery in many diseases, including thrombotic complications. However, their significance in patients with known thrombophilia has not yet been investigated. Both CEC and EPC represent extremely rare cell populations found in peripheral blood. Therefore, it is essential to use exclusively standardized and sensitive methods for their identification and quantification. The aim of the study was to identify and quantify CEC and EPC in the peripheral blood of patients with congenital thrombophilia and to evaluate their importance as markers of endothelial and platelet activity in context with the risk of thrombosis occuring and recurrence. Methods: Analysis of the number of CEC and EPC in the peripheral blood of patients with thrombophilia with or without a history of thrombosis and patients with acute thrombosis was performed by multicolor flow cytometry. The CEC and EPC reference values were determined on a group of healthy controls. Patients with...
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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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Hyperkoagulační stavy v graviditě a jejich komplikace
KABELOVÁ, Kristýna
Hypercoagulable states occur when the process of hemostasis is disturbed. It manifests as a deep vein thrombosis or a pulmonary embolism. It is also one of the most common cardiovascular diseases. There are two factors- genetic and acquired. Inherent factors involve coagulation inhibitor deficiency, prothrombin gene mutation and activated protein C resistance. Acquired factors include antiphospolipid syndrome, pregnancy, overweight etc. The analytic part of the thesis is focused on the effect of a low molecular weight heparin. It was shown in many theses that the LMWH could have a negative impact on a parturition complications or a week of parturition, a birth weight. The results of statistical analysis show that there is a coherence between the week of parturition and the type of parturition. What is more, the anticoagulation drug therapy shows a positive effect on the week of parturion. The data used in the thesis originate in laboratory information management system of Clinical Haematology ward in the hospital Nemocnice České Budějovice a.s.
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Vztah Leidenské mutace a rezistence na aktivovaný protein C
ZEMANOVÁ, Vendula
This thesis was about the relationship of the Factor V Leiden mutation and activated protein C resistance. I looked up patients with Leiden mutation and activated protein C resistance. I monitored the frequency of thromboembolism and miscarriages in the personal and family case history of patients. Subsequently, I looked up if other risk factors which affect clinical manifestations in patients with this mutation can be found.
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Vliv vrozených hyperkoagulačních stavů na hladinu D-d se zaměřením na gravidní ženy
ŠTÍCHOVÁ, Zuzana
The thesis analyses the female patients' data from Clinical hematology department in České Budějovice hospital from year 2014 to 2015 and tries to statistically confirm connection between D-dimer level and hypercoagulable states described in previous bachelor thesis. D-dimer assay is due to negative predictive value and high sensitivity an initial laboratory test to rule out tromboembolic disease. However, it has low specificity. The elevated level of D-dimer is observed in conditions like infection, trauma, acute cancer, recent surgery or pregnancy and last studies showed increased D-dimer level even in combination with inherited hypercoagulable states. Thus, it is necessary to analyse the level of D-dimer in pregnant women related to specific hypercoagulable states. Moreover, the thesis analyses the influence of other factors like anticoagulation therapy on D-dimer level and tries to find connection between D-dimer level and pregnancy associated complication, birth weight or a type of delivery.
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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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