DOCSLIB.ORG

A 74-Year-Old Woman with Abdominal Pain and Fever

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A 74-Year-Old Woman with Abdominal Pain and Fever A SELF-TEST IM BOARD REVIEW DAVID L. LONGWORTH, MO, JAMES K. STOLLER, MD, EDITORS OF CLINICAL PETER MAZZONE, MD CRAIG NIELSEN, MD RECOGNITION Department of Pulmonary and Critical Department of General Internal Care Medicine, Cleveland Clinic Medicine, Cleveland Clinic A 74-year-old woman with abdominal pain and fever 74-YEAR-OLD WOMAN was transferred pulmonary embolism, and a subsequent pul- from a local hospital for further evalua- monary angiogram was read as normal. A tion and management of abdominal pain with chest CT scan did not reveal anything other fever. than the small bilateral pleural effusions seen The patient had presented to the local on the chest radiograph. A thoracentesis hospital 11 days before with a 1-day history of revealed transudative fluid only. Intravenous bilateral upper-quadrant abdominal pain. She heparin was discontinued. described the pain as a constant ache with Past history. The patient had had essen- intermittent sharper pains accompanied by tial thrombocythemia for 5 years, for which nausea, but she could not identify any precip- she took hydroxyurea until 2 months before itants of the pain. She was also constipated. admission. Hydroxyurea was restarted at the A few days after being admitted to the local hospital because her platelet count was local hospital, the patient had developed a high at 750 x 109/L (normal 150-400 x fever and mild shortness of breath. She was 109/L), but it was stopped 3 days later because treated empirically for a possible pulmonary of mucositis. More than 30 years ago, the infection with a variety of antibiotics (ceftri- patient had been diagnosed with "pernicious Her platelet axone, ticarcillin-clavulanate, erythromycin, anemia. count dropped metronidazole, cefazolin, and vancomycin). Family history was unremarkable. The Blood, urine, and sputum cultures remained patient lived with her husband on a farm, had from 750 to negative throughout her hospitalization. two healthy children, and had not recently 272 x 109/L At the local hospital she had also under- traveled. gone an upper gastrointestinal (GI) series, a in only a few small bowel follow-through, a barium enema, Physical examination days and computed tomography (CT) of the On presentation to our hospital the patient abdomen. These revealed colonic diverticulo- was experiencing diffuse abdominal pain, nau- sis and a dilated gallbladder with no gall- sea, vomiting, fatigue, and sweats. stones. A hepato-iminodiacetic acid scan was On physical examination, the patient reported as suspicious for acute cholecystitis. appeared ill. Her temperature was 38.2°C, CT-guided aspiration of the gall bladder heart rate 102/minute and regular, blood revealed "non-purulent fluid." Cultures of the pressure 123/67 mm Hg, respiratory rate fluid from the gallbladder were negative. A 16/minute, and oxygen saturation 96% by chest radiograph revealed only small bilateral pulse oximetry while receiving oxygen at pleural effusions. 2 L/minute per nasal cannula. She had mild During the barium enema the patient had oral mucositis, decreased basal breath sounds become hypoxic, requiring supplemental oxy- bilaterally, and a grade 2/6 systolic ejection gen and transfer to the intensive care unit. murmur (reported in the past). Her Her physicians started intravenous heparin abdomen was soft with diffuse tenderness therapy empirically while investigations were but without palpable organomegaly or peri- performed. A ventilation-perfusion scan was toneal signs. Her stool was negative for interpreted as showing a low probability of occult blood. She had no focal neurologic CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 66 • NUMBER 8 SEPTEMBER 1999 469 Downloaded from www.ccjm.org on October 6, 2021. For personal use only. All other uses require permission. IM BOARD REVIEW MAZZONE AND NIELSEN TABLE 1 At this point our patient had had an upper The patient's laboratory values CI series, a small bowel follow-through, a bar- ium enema, CT scans of the chest and at the time of admission abdomen, a hepato-iminodiacetic acid scan, aspiration and later removal of her gallbladder, TEST VALUE UNITS NORMAL RANGE a pulmonary angiogram, a bone marrow aspi- White blood cell count 4.07 X 109/L 4.2-5.4 ration, and multiple cultures, none of which Hemoglobin 9.2 g/dL 12.0-16.0 provided an adequate explanation for her Platelet count 272 x 109/L 150-400 symptoms and fever. Sodium 135 mmol/L 132-148 Potassium 4.5 mmol/L 3.5-5.0 • FEVER OF UNKNOWN ORIGIN Chloride 108 mmol/L 98-110 Carbon dioxide 22 mmol/L 24-32 Which of the following choices is not part Blood urea nitrogen 11 mg/dL 8-25 of the standard definition of fever of Creatinine 1.0 mg/dL 0.7-1.4 1 unknown origin? Glucose 112 mg/dL 65-110 • Temperature greater than 38.3 °C • Fever for at least 3 weeks deficits, TABLE 1 shows her laboratory values at • Fever that defies diagnosis after 1 week of the time of admission. Coagulation studies inpatient investigation were normal. • Fever that cannot be suppressed by Her medications on transfer included antipyretics ticarcillin-clavulanate and heparin in prophy- lactic, subcutaneous doses. The standard definition of fever of unknown origin has been a temperature higher than • HOSPITAL COURSE 38.3 °C for at least 3 weeks that defies diagno- sis after 1 week of inpatient investigation. The Fever of We continued to give ticarcillin-clavulanate, ability of antipyretics to suppress the fever is unknown origin performed bone marrow aspiration to assess not part of the definition. the patient's essential thrombocythemia and A new classification scheme divides fever has a new set to look for a cause of her fever, and obtained a of unknown origin into four categories: classic, of criteria general surgery consult. The surgeons believed nosocomial, neutropenic, and HIV-associated. that the patient might have acute cholecysti- In each, the definition differs somewhat from tis and so scheduled her for a laparoscopic the older, standard definition. cholecystectomy the following day. The Classic fever of unknown origin (an patient tolerated the operation well. The ini- unexplained temperature higher than tial pathology study suggested an acute exac- 38.3 °C for at least 2 weeks, or three outpa- erbation of chronic cholecystitis. tient visits, or 3 days in the hospital). There Two days passed, but the patient's condi- are many potential causes. Infectious causes tion did not change significantly. She contin- are numerous (tuberculosis being the most ued to spike fevers with temperatures as high common). If a typical infection cannot be as 39°C and complained of nausea, vomiting, found, occult infections must be considered abdominal pain, and weakness. Blood, urine, (eg, abscesses, osteomyelitis, endocarditis, and sputum cultures remained negative, and prostatitis), as should viral infections (eg, her laboratory values remained about the cytomegalovirus, Epstein-Barr virus) and same. She noted some swelling of her right infections with less common organisms such lower extremity. A duplex ultrasound scan as fungi, Plasmodium (the agents of malaria), revealed a popliteal deep venous thrombosis, or Rickettsia. Some neoplastic diseases can which we monitored by serial duplex ultra- cause fever; the most common being lym- sound examinations. Her bone marrow aspira- phomas, leukemias, renal cell carcinoma, tion results were consistent with the prior and hepatomas. Collagen vascular diseases, diagnosis of essential thrombocythemia. granulomatous disorders, and miscellaneous 470 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 66 • NUMBER 8 SEPTEMBER 1999 Downloaded from www.ccjm.org on October 6, 2021. For personal use only. All other uses require permission. causes such as drug fever, gout, cirrhosis, TABLE 2 recurrent pulmonary emboli, and metabolic Causes of primary adrenal disorders round out the list. insufficiency Nosocomial fever of unknown origin (an unexplained temperature higher than Anatomic destruction 38.3°C in a hospitalized patient in whom Idiopathic Autoimmune fever was not present at admission; there Adrenoleukodystrophy must be at least 3 days of investigation with Infections 2 days of culture incubation). Investigation Tuberculosis should focus on sites where occult infec- Fungal Viral tions might be sequestered, such as intravas- Infiltration cular lines, sinuses (with nasogastric tubes), Metastatic disease prosthetic devices, acalculous cholecystitis, Amyloid and Clostridium difficile colitis. Drugs and Sarcoid transfusion-related fevers must also be con- Hemorrhage sidered. Waterhouse-Friderichsen syndrome Neutropenic fever of unknown origin (a Antiphospholipid syndrome temperature higher than 38.3 °C in a patient Heparin-induced thrombocytopenia with a neutrophil count lower than 500/pL Metabolic failure Congenital adrenal hyperplasia after 3 days of investigation with 2 days of cul- Cytotoxic agents ture incubation). All types of infections, Drugs including fungal, viral, and gram-positive and gram-negative bacterial organisms, must be considered. A cause of the fever is often not found. In general, patients do well with sup- • ADRENAL INSUFFICIENCY portive care, including empiric antimicrobial Which of the following laboratory find- therapy, while awaiting a rise in the neu- 2 ings is consistent with a diagnosis of pri- trophil count. mary adrenal insufficiency? In spite of HIV-associated fever of unknown origin persistent (a temperature higher than 38.3°C for more • Increased serum sodium than 4 weeks for outpatients or 3 days of in- • Increased serum chloride vomiting,
Load more

Recommended publications
  • Surfen, a Small Molecule Antagonist of Heparan Sulfate
    Surfen, a small molecule antagonist of heparan sulfate Manuela Schuksz*†, Mark M. Fuster‡, Jillian R. Brown§, Brett E. Crawford§, David P. Ditto¶, Roger Lawrence*, Charles A. Glass§, Lianchun Wang*, Yitzhak Torʈ, and Jeffrey D. Esko*,** *Department of Cellular and Molecular Medicine, Glycobiology Research and Training Center, †Biomedical Sciences Graduate Program, ‡Department of Medicine, Division of Pulmonary and Critical Care Medicine and Veteran’s Administration San Diego Medical Center, ¶Moores Cancer Center, and ʈDepartment of Chemistry and Biochemistry, University of California at San Diego, La Jolla, CA 92093; and §Zacharon Pharmaceuticals, Inc, 505 Coast Blvd, South, La Jolla, CA 92037 Communicated by Carolyn R. Bertozzi, University of California, Berkeley, CA, June 18, 2008 (received for review May 26, 2007) In a search for small molecule antagonists of heparan sulfate, Surfen (bis-2-methyl-4-amino-quinolyl-6-carbamide) was first we examined the activity of bis-2-methyl-4-amino-quinolyl-6- described in 1938 as an excipient for the production of depot carbamide, also known as surfen. Fluorescence-based titrations insulin (16). Subsequent studies have shown that surfen can indicated that surfen bound to glycosaminoglycans, and the extent block C5a receptor binding (17) and lethal factor (LF) produced of binding increased according to charge density in the order by anthrax (18). It was also reported to have modest heparin- heparin > dermatan sulfate > heparan sulfate > chondroitin neutralizing effects in an oral feeding experiments in rats (19), sulfate. All charged groups in heparin (N-sulfates, O-sulfates, and but to our knowledge, no further studies involving heparin have carboxyl groups) contributed to binding, consistent with the idea been conducted, and its effects on HS are completely unknown.
    [Show full text]
  • Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory
    Review Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory: Strategies for the Safe and Rational Use of Dalteparin or Enoxaparin during Percutaneous Coronary Intervention Jonathan D. Marmur, MD, Renee P. Bullock-Palmer, MD, Shyam Poludasu, MD, Erdal Cavusoglu, MD ABSTRACT: Low-molecular-weight heparin (LMWH) has been a of unstable angina (UA) and non-ST-segment elevation myocardial mainstay for the management of acute coronary syndromes (ACS) for infarction (NSTEMI). The ESSENCE and TIMI 11B trials support almost a decade. However, several recent developments have seriously the use of LMWH over unfractionated heparin (UFH) in acute coro - threatened the prominence of this drug class: (i) the adoption of an nary syndromes managed with a predominantly medical approach early invasive strategy, frequently leading to percutaneous coronary in - 1,2 tervention (PCI) where the dosing and monitoring of LMWH is un - as opposed to an invasive initial strategy. familiar to most operators, (ii) the results of the SYNERGY trial, which Since the publication of the ESSENCE and TIMI 11B trials, not only failed to establish the superiority of enoxaparin over unfrac - the management of acute coronary syndromes (ACS) has tionated heparin with respect to efficacy, but also demonstrated more evolved to favor an early invasive strategy. This evolution is sup - bleeding with LMWH, and (iii) the results of the REPLACE-2 and ported by a number of studies, including the FRISC II and the ACUITY trials, which have demonstrated the advantages of an ACS TACTICS TIMI-18 trials. 3,4 The Superior Yield of the New and PCI treatment strategy based on direct thrombin inhibition with bivalirudin.
    [Show full text]
  • Low Molecular Weight Heparinoid, ORG 10172 (Danaparoid), and Outcome After Acute Ischemic Stroke a Randomized Controlled Trial
    Original Contributions Low Molecular Weight Heparinoid, ORG 10172 (Danaparoid), and Outcome After Acute Ischemic Stroke A Randomized Controlled Trial The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators Context.—Anticoagulation with unfractionated heparin is used commonly for ANTICOAGULATION with unfrac- treatment of acute ischemic stroke, but its use remains controversial because it has tionated heparin commonly is used to not been shown to be effective or safe. Low molecular weight heparins and hepa- treat persons with acute ischemic 1 rinoids have been shown to be effective in preventing deep vein thrombosis in per- stroke. However, the use of heparin re- mains controversial because it is not es- sons with stroke, and they might be effective in reducing unfavorable outcomes fol- 2-6 lowing ischemic stroke. tablished as safe or effective. A recent open trial demonstrated a modest effect Objective.—To test whether an intravenously administered low molecular from subcutaneously administered hep- weight heparinoid, ORG 10172 (danaparoid sodium), increases the likelihood of a arin in preventing recurrent stroke favorable outcome at 3 months after acute ischemic stroke. within 14 days but no improvement in Design.—Randomized, double-blind, placebo-controlled, multicenter trial. outcomes.7 Thus, whether an intrave- Setting and Participants.—Between December 22, 1990, and December 6, nously administered anticoagulant that 1997, 1281 persons with acute stroke were enrolled at 36 centers across the United would act more rapidly would be effec- States. tiveremainsunanswered.Thesearchfor Intervention.—A 7-day course of ORG 10172 or placebo was given initially as alternative medications that possess the a bolus within 24 hours of stroke, followed by continuous infusion in addition to the antithrombotic characteristics of hepa- best medical care.
    [Show full text]
  • Heparin-Induced Thrombocytopenia1
    Heparin-Induced Thrombocytopenia1 Authors: Professor Andreas Greinacher2 and Doctor Norbert Lubenow Creation date: December 2003 Scientific Editor: Doctor Silvia Bellucci 1This review is based on a book chapter for the ETRO course 2003: Arnout J, de Gaetano G, Hoylaerts M, Peerlinck K, van Geet C, Verhaeghe R (Eds) Thrombosis: Fundamental and Clinical Aspects. Leuven University Press, 2003 2Ernst-Moritz-Arndt Universität, Institut für Immunologie und Transfusionsmedizin Klinikum, Sauerbruchstrasse, 17489 Greifswald, Germany. mailto:[email protected] Abstract Key words Definition Differential Diagnosis Pathogenesis Clinical Presentation Prognosis Laboratory Diagnosis Incidence Treatment Legal Aspects of HIT References Abstract Heparin-induced thrombocytopenia (HIT) is a relatively common immune-mediated disorder with the potential for serious thromboembolic complications. It is associated with the use of unfractionated heparin (UFH) and may be defined as a decrease in platelet count during or shortly after exposure to this anticoagulant. HIT occurs in up to 5% of patients who are exposed to UFH. Characteristic signs of HIT are a drop in platelet count of >50% and/or new thromboembolic complications during heparin therapy. Two types of HIT are recognized. Nonimmune heparin-associated thrombocytopenia is due to a direct interaction between heparin and platelets. The other type of HIT, immune-mediated HIT, is caused by heparin-dependent IgG (HIT-IgG) that recognizes a complex of heparin and platelet factor 4 (PF4), leading to platelet activation via the platelet Fc gammaRIIa receptor. Regular platelet count monitoring is best suited for early diagnosis of HIT, especially if UFH is used. Functional and antigen assays are available to confirm HIT. Heparin withdrawal and treatment with an agent that directly inhibits thrombin or decreases thrombin generation should be initiated prior to laboratory confirmation because of the rapidity with which thrombotic complications occur following platelet decline.
    [Show full text]
  • Treating Ischemic Stroke As an Emergency
    NEUROLOGICAL REVIEW Treating Ischemic Stroke as an Emergency Harold P. Adams, Jr, MD he success of treatment with tissue plasminogen activator serves as an impetus to ap- proach stroke as a medical emergency; diagnosis and treatment must be accurate and prompt. The initial evaluation should be straightforward and aimed at confirming is- chemic stroke as the cause of the patient’s acute neurologic impairments. Until the Tusefulness of diagnostic tests to demonstrate an arterial occlusion is established in emergent man- agement, their application before treatment should not be mandated. Most individuals with acute ischemic stroke will receive their initial, key treatment in a community setting. Thus, strategies for emergent treatment should aim at management of patients whose strokes are diagnosed and first treated by emergency treatment and primary care physicians with the collaboration of neu- rologists. Arch Neurol. 1998;55:457-461 Ischemic stroke is the most common acute ment also is influenced by the patient’s neurologic illness and a leading cause of condition and his/her wishes. Most pa- death, disability, and human suffering. Fi- tients with acute ischemic stroke will not nancially, it also is an expensive disease. be treated initially by neurologists or stroke Stroke costs the US economy more than care specialists. Because of limited avail- $40 billion per year.1 Thus, successful ability of acute stroke care units, most pa- management of ischemic stroke has vast tients are admitted to community hospi- public health implications. In the past, is- tals that do not have special expertise in chemic stroke was approached with ni- the treatment of cerebrovascular disease.
    [Show full text]
  • Kingdom Representative of MAST-I, for Her United Kingdom. Results. We
    Matters arising 255 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.57.2.255 on 1 February 1994. Downloaded from stroke, Orgaran is superior to low-dose aspirin should be used as well as streptoki- ignored. Until a treatment is found that heparin. nase, or avoided. These presuppositions are works, acute ischaemic stroke treatment Our main conclusion, that the available foolish, especially as we already have the trials should proceed in the most practical randomised trials included in our overview example of the large myocardial infarction and sensible manner possible by adopting were wholly inadequate to determine trials in which, by testing thrombolysis and wide entry criteria and avoiding presupposi- whether or not antithrombotic therapy with aspirin beyond six hours from symptom tions about the effects of treatment. or are onset, and in a very heterogeneous group of J M WARDLAW aspirin, heparin, other agents safe Department ofClinical Neuroradiology, and effective when used in patients with patients with acute myocardial infarction, it Southern General Hospital, acute stroke, is unaltered and will remain so was possible to establish the true time 1345 Govan Road, Glasgow until the large trials in progress (IST, window to treatment (12 hours), the effect G51 4TF, UK TOAST, National Study of Stroke in of age (benefit at all ages) and that throm- China, MAST-I) are completed. bolysis and aspiin together work better 1 Morris AD, Grosset DG, Squire IB, Lees KR, Bone I, Reid JL. The experiences of an PAG SANDERCOCK than either individually.23 acute stroke unit-implications for multi- RI LINDLEY No wonder 95 5% of the patients in the J SLATTERY centre acute stroke trials.
    [Show full text]
  • Thrombolytic Therapy in Cerebral Venous Sinus Thrombosis. Ayeesha Kamran Kamal Agha Khan University, [email protected]
    eCommons@AKU Department of Medicine Department of Medicine November 2006 Thrombolytic therapy in cerebral venous sinus thrombosis. Ayeesha Kamran Kamal Agha Khan University, [email protected] Follow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med Part of the Neurology Commons Recommended Citation Kamal, A. (2006). Thrombolytic therapy in cerebral venous sinus thrombosis.. JPMA. The Journal of the Pakistan Medical Association, 56(11), 538-540. Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/402 Review Article Thrombolytic therapy in Cerebral Venous Sinus Thrombosis Ayeesha K. Kamal Department of Medicine, The Aga Khan University Hospital, Karachi. Abstract be unpredictable with potentially dangerous deterioration. The use of thrombolytic agents to rapidly lyse the Thrombolytics or fibrinolytics are agents which lyse clot has emerged as a therapeutic modality, in concert with the formed clot. The platelet - fibrin composition of a spe- interventional neuroradiologic approaches to deliver the cific thrombus depends on the local development of fibrin, agent locally at the site of thrombosis.There are no random- platelet activation, and regional blood flow. At arterial flow ized, double blind, placebo, controlled trials to support rates, thrombi are predominantly platelet rich, and at venous thrombolysis as a first line therapy in patients with cerebral flow rates, more relevant to the pathology of CVT, coagula- venous sinus thrombosis compared to standard therapy tion seems to predominate. Thrombin (Factor II a) cleaves using anticoagulation with weight based dose adjusted fibrinogen to form fibrin which is the scaffolding for the unfractionated Heparin. Numerous case reports and a single clot. Thrombus growth is limited by the endogenous fibri- non randomized trial have shown that it is comparatively nolytic system.
    [Show full text]
  • Aspirin Versus Anticoagulation for Prevention of Venous Thromboembolism Major Lower Extremity Orthopedic Surgery: a Systematic Review and Meta-Analysis
    ORIGINAL RESEARCH Aspirin Versus Anticoagulation for Prevention of Venous Thromboembolism Major Lower Extremity Orthopedic Surgery: A Systematic Review and Meta-Analysis Frank S. Drescher, MD1*, Brenda E. Sirovich, MD, MS2, Alexandra Lee, MS3, Daniel H. Morrison, MD, MS4, Wesley H. Chiang, MS2, Robin J. Larson, MD, MPH2 1Geisel School of Medicine at Dartmouth, Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, White River Junction, Vermont; 2Geisel School of Medicine at Dartmouth, and the Dartmouth Institute for Health Policy and Clinical Practice, Center for Education, Lebanon, New Hampshire; 3Herbert Wertheim College of Medicine at Florida International University, Miami, Florida; 4Geisel School of Medicine at Dartmouth, Sec- tion of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. BACKGROUND: Hip fracture surgery and lower extremity screened participants for deep venous thrombosis (DVT). arthroplasty are associated with increased risk of both Overall rates of DVT did not differ statistically between aspi- venous thromboembolism and bleeding. The best pharma- rin and anticoagulants (relative risk [RR]: 1.15 [95% confi- cologic strategy for reducing these opposing risks is dence interval {CI}: 0.68–1.96]). Subgrouped by type of uncertain. surgery, there was a nonsignificant trend favoring anticoa- gulation following hip fracture repair but not knee or hip PURPOSE: To compare venous thromboembolism (VTE) arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80–3.20], 2 tri- and bleeding rates in adult patients receiving aspirin versus als; arthroplasty RR: 1.00 [95% CI: 0.49–2.05], 5 trials). The anticoagulants after major lower extremity orthopedic risk of bleeding was lower with aspirin than anticoagulants surgery.
    [Show full text]
  • Isolation and Characterization of a Heparin-Like Compound with Potent Anticoagulant and Fibrinolytic Activity from the Clam Coelomactra Antiquata
    marine drugs Article Isolation and Characterization of a Heparin-Like Compound with Potent Anticoagulant and Fibrinolytic Activity from the Clam Coelomactra antiquata ZhenXing Du 1,2,3 , XueJing Jia 1,3, Jing Chen 1,2,3, SiYi Zhou 1,2,3, JianPing Chen 1, XiaoFei Liu 1, XiaoHuang Cao 1 , SaiYi Zhong 1,2,3,4,* and PengZhi Hong 1,2,3 1 School of Food Science and Technology, Guangdong Ocean University, Zhan Jiang 524088, China; [email protected] (Z.D.); [email protected] (X.J.); [email protected] (J.C.); [email protected] (S.Z.); [email protected] (J.C.); [email protected] (X.L.); [email protected] (X.C.); [email protected] (P.H.) 2 Shenzhen institute, Guangdong Ocean University, Shen Zhen 518108, China 3 Guangdong Provincial Key Laboratory of Aquatic Products Processing and Safety, Guangdong Province Engineering Laboratory for Marine Biological Products, Zhan Jiang 524088, China 4 Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China * Correspondence: [email protected]; Tel.: +86-188-2669-9336 Received: 19 October 2019; Accepted: 3 December 2019; Published: 19 December 2019 Abstract: Heparin from mollusks with unique sulfated glycosaminoglycan exhibits strong anti-thrombotic activities. This study reports on a purified heparinoid from Coelomactra antiquata, which shows potent anticoagulant and fibrinolytic abilities. Its structure was characterized by infrared spectroscopy, high-performance liquid chromatography, and one-dimensional and two-dimensional nuclear magnetic resonance spectroscopy. Its fibrinolytic activity was determined in vitro and in vivo. Its anticoagulant activity was determined by activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT).
    [Show full text]
  • Heparin-Induced Thrombocytopenia
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector JACC Vol. 31, No. 7 1449 June 1998:1449–59 REVIEW ARTICLE Heparin-Induced Thrombocytopenia DAVID B. BRIEGER, MB, BS, PHD, KOON-HOU MAK, MB, BS, KANDICE KOTTKE-MARCHANT, MD, PHD, ERIC J. TOPOL, MD, FACC Cleveland, Ohio Heparin-induced thrombocytopenia (HIT) is a potentially se- and elimination of heparin from all flushes and ports are man- rious complication of heparin therapy and is being encountered datory. Further management of patients with HIT is problematic more frequently in patients with cardiovascular disease as use of at present, as there are no readily available alternative anticoag- anticoagulant therapy becomes more widespread. Our under- ulant agents in the United States with proven efficacy in acute standing of the pathophysiology of this immune-mediated condi- coronary disease. The direct thrombin inhibitors appear to be the tion has improved in recent years, with heparin–platelet factor 4 most promising alternatives to heparin, when continued use of complex as the culprit antigen in most patients. New sensitive heparin is contraindicated, and the results of several multicenter laboratory assays for the pathogenic antibody are now available trials evaluating their application in patients with HIT are and should permit an earlier, more reliable diagnosis, but their awaited. optimal application remains to be defined. For patients in whom (J Am Coll Cardiol 1998;31:1449–59) HIT is diagnosed, immediate discontinuation of heparin infusions ©1998 by the American College of Cardiology Since it was first used to prevent venous thrombosis in surgical Frequency of Thrombocytopenia patients in 1937, heparin has been the anticoagulant therapy of Approximately 10% to 20% of patients will develop a choice for the prevention and early management of arterial transient mild thrombocytopenia after 1 to 4 days of heparin and venous thromboembolic disease (1).
    [Show full text]
  • Some Side Effects of Heparin, Heparinoids, and Their Antagonists
    Some side effects of heparin, heparinoids, and their antagonists Effects of heparin, heparinoids, and their antagonists, other than actions on blood coagulation and lipemia clearing, are described. Many, if not all, of these properties are probably related to the unusual structure and high-charge density of these macromolecules. Some may have therapeutic utility. William W. Coon, M.D., and Park W. Willis, III, M.D. Ann Arbor, Mich. Departments of Surgery and Medicine, University of Michigan Since its discovery fifty years ago, and Astrup56 demonstrated that these salts heparin has been extensively used as an partially dissociate according to mass law anticoagulant and, in recent years, as an as long as the product remains in solution; agent to facilitate more rapid clearing of this has been confirmed by Jaques.100 Com­ lipemic plasma. These functions of heparin plexing with heparin has been observed have been adequately reviewed in the re­ not only with proteins and peptides (silk cent past. This monograph lists some of peptone, gelatin, clupein, salmine, his tones the side effects of heparin which are not from thymus and blood, hemoglobin, egg so well known. Some may ultimately be albumin, casein, serum proteins, liver pro­ shown to be directly related to the anti­ teins, thromboplastins, enzymes, and so coagulant effect of heparin but, if so, this forth) but also with organic bases (benzi­ association has not yet been proved. dine, quinine, brucine, and piperidine) and Several of these effects have been observed basic dyes (thionine, toluidine blue, and only in vitro, and to our knowledge studies others). Although optimal combination of to document whether or not they persist in heparin with protein occurs near the iso­ vivo have not yet been carried out.
    [Show full text]
  • Influence of Heparinoid from Paeonia Lactiflora on Hemostatic System Within Conditions of Prethrombosis
    RESEA RCH ARTICLE ISSN 2307-9266 e-ISSN 2413-2241 INFLUENCE OF HEPARINOID FROM PAEONIA LACTIFLORA ON HEMOSTATIC SYSTEM WITHIN CONDITIONS OF PRETHROMBOSIS M.G. Lyapina, M.S. Uspenkaya, E.S. Maistrenko, M.D. Kalugina Lomonosov Moscow State University, Block 12, 1, Leninskie Gory, Moscow, Russia, 119234 Е-mail: [email protected] Received 23 May 2019 Review (1) 4 July 2019 Review (2) 2 August 2019 Accepted: 15 August 2019 The search and development of direct and rapid anticoagulants used per os, is an urgent problem in physiological and medical science. A number of plants contain heparin-like components with a positive effect on the hemostatic system, both within normal and in some pathological conditions of the body. The aim of the work was to study the complex effect of fibrin, a heparin-like substance (heparinoid) from the roots of Paeonia lactiflora, on fibrinolytic, anticoagulant systems of the body and polymerization processes, when it is administered per os in animals within normal conditions and when modeling the state of prethrombosis. Materials and methods. To carry out the research, the roots of Paeonia lactiflora growing in the Botanical Garden of Moscow State University, and laboratory animals – male Wistar rats – were used. To study the antithrombotic effects of the extract from roots containing heparinoid, the state of prethrombosis was modeled in rats. The determined parameters of hemostasis were: anticoagulant activity according to the tests of activated partial thromboplastin time and thrombin time, fibrinolytic activity according to the test of total fibrinolytic activity, fibrin polymerization according to the test of fibrindepolymerization activity of blood plasma.
    [Show full text]