Kooperativer Bibliotheksverbund

In: BMC Cancer, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2019-12)

Type of Medium: Online Resource

ISSN: 1471-2407

URL: Article

DOI: 10.1186/s12885-019-5705-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2019

detail.hit.zdb_id: 2041352-X

In: Perfusion, SAGE Publications, Vol. 22, No. 5 ( 2007-09), p. 345-352

Abstract: Various strategies have been proposed to decrease allogeneic blood transfusion requirements after cardiac surgery. The aim of the study was to evaluate the efficacy of collected and re-infused autologous shed mediastinal blood on a patient's postoperative course. Ninety patients who underwent heart surgery with cardiopulmonary bypass (CPB) were studied. The patients were divided into two groups: Group 1 ( n = 41) received the centrifuged autologous shed mediastinal blood collected from the cardiotomy reservoir 4 hours after surgery; in Group 2 ( n = 49) all shed mediastinal blood was discarded (control group). Haemoglobin (Hb), haematocrit (Hct), C-reactive protein values, and leucocyte count were compared before surgery, at 4 h and 20 h after surgery, and on the fifth postoperative day. We have measured serum procalcitonin (PCT) concentration at 4 h and 20 h after CPB. We assessed drained blood loss within 20 postoperative hours. Leucocyte count, Hb, Hct values, C-reactive protein, and procalcitonin concentration did not differ between the groups before and at 4 h after surgery. Hb, Hct level, and leucocyte count were similar at 20 hours and on the fifth day after surgery. At 20 hours after surgery, an increase of serum PCT concentration ( 〉 0.5—2 ng/mL) was more frequent in Group 2 (58.3% vs. 33.3%; p = 0.03). On the fifth postoperative day, C-reactive protein concentration was lower in Group 1 (71.74 ± 15.23; p 〈 0.01) compared to Group 2 (93.53 ± 20.3). Postoperative blood loss did not differ between the groups. Requirement for allogeneic blood transfusion was significantly lower in Group 1 (14.6% vs. 38.8%; p 〈 0.02). Patients in Group 1 developed less infective complications compared with Group 2 (2.4% and 16.3%, respectively; p 〈 0.05). The length of postoperative in-hospital stay was shorter in Group 1 compared with Group 2 (9.32 ± 2.55 and 16.45 ± 6.5, respectively; p 〈 0.05). We conclude that postoperative re-infusion of autologous red blood cells processed from shed mediastinal blood did not increase bleeding tendency and systemic inflammatory response and was effective in reducing the requirement for allogeneic transfusion, the rate of infective complications and the length of postoperative in-hospital stay. Perfusion (2007) 22, 345—352.

Type of Medium: Online Resource

ISSN: 0267-6591 , 1477-111X

URL: Article

DOI: 10.1177/0267659107088450

Language: English

Publisher: SAGE Publications

Publication Date: 2007

detail.hit.zdb_id: 2029611-3

In: Pharmacogenomics, Future Medicine Ltd, Vol. 20, No. 7 ( 2019-05), p. 483-492

Abstract: Aim: The aim of this study was to determine the impact of genetic and nongenetic factors on treatment outcomes in patients receiving dual antiplatelet therapy after percutaneous coronary intervention and stent implantation. Materials &  methods: Patients (n = 628) used clopidogrel or ticagrelor for at least 1 week before platelet aggregation test. Results: Multivariate binary regression analysis demonstrated that aspirin use and CYP4F2 T allele significantly increased odds for bleeding in clopidogrel users (OR: 2.488, 95% CI: 1.452–4.265; p = 0.001 and OR: 1.573, 95% CI: 1.066–2.320; respectively; p = 0.022). CYP4F2 T allele significantly increased odds for bleeding in ticagrelor users (OR: 8.270, 95% CI: 3.917–17.462; p  〈  0.001). Conclusion: Aspirin use and CYP4F2 T allele were significantly associated with bleeding during dual antiplatelet therapy.

Type of Medium: Online Resource

ISSN: 1462-2416 , 1744-8042

URL: Article

DOI: 10.2217/pgs-2018-0178

Language: English

Publisher: Future Medicine Ltd

Publication Date: 2019

SSG: 15,3

In: Journal of Thrombosis and Thrombolysis, Springer Science and Business Media LLC, Vol. 37, No. 2 ( 2014-2), p. 177-185

Type of Medium: Online Resource

ISSN: 0929-5305 , 1573-742X

URL: Article

DOI: 10.1007/s11239-013-0940-x

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2014

detail.hit.zdb_id: 2017305-2

In: Medicina, MDPI AG, Vol. 47, No. 1 ( 2011-01-15), p. 4-

Abstract: A clinical effect of warfarin depends on highly polymorphic drug-metabolizing (CYP2C9) and drug-target (VKORC1) enzymes. The objective of this study was to investigate the impact of CYP2C9*2, CYP2C9*3, and VKORC1 (G-1639A) polymorphisms on the variability of warfarin dosage requirements in Lithuanian patients after heart valve replacement. Materials and Methods. The study included 83 patients with a mean age of 65.2 years (SD, 13.31) after heart valve replacement with an achieved stable international normalized ratio of 2–3.5. The restriction fragment length polymorphism method was used to identify polymorphisms of VKORC1 and CYP2C9. Results. Daily warfarin dosage significantly correlated with weight (r=0.4087) and height (r=0.3883) of the patients. Patients younger than 60 years required significantly higher daily warfarin dosages than older patients. Two-thirds (66.3%) of the patients had the wild-type (WT) CYP2C9* 1/*1 genotype; 38.6% and 54.2% of the patients had WT VKORC1 (G/G) and VKORC1 (G/A) genotypes, respectively. WT CYP2C9*1/*1 genotype was associated with a higher daily warfarin dosage (5.84 mg [SD, 2.84]) as compared to other CYP2C9 genotypes. Carriers of WT VKORC1 (G/G) required a higher warfarin dose as compared to (A/A) carriers (6.20±2.78 mg and 3.75±1.40 mg, respectively; P=0.04). Patients having CYP2C9*1/*1 or 1/*2 in combination with VKORC1 (G/G) or (G/A) genotypes required the highest daily warfarin dosage in comparison to other combinations of genotypes. Conclusions. The Lithuanian study sample is characterized by high a frequency (92.8%) of VKORC1 G/G and G/A genotypes that determines a higher warfarin-loading dose. Analysis of combined CYP2C9 and VKORC1 gene variants allows the prediction of warfarin dosage. These results can be used to individualize treatment with warfarin in the field of heart surgery in Lithuania.

Type of Medium: Online Resource

ISSN: 1648-9144

URL: Article

DOI: 10.3390/medicina47010004

Language: English

Publisher: MDPI AG

Publication Date: 2011

detail.hit.zdb_id: 2088820-X

In: Medicina, MDPI AG, Vol. 46, No. 8 ( 2010-08-11), p. 561-

Abstract: Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. There are evidence-based data about some risks related with transfusion of blood components: acute or delayed hemolytic, febrile, allergic reactions, transfusion-related acute lung injury, negative immunomodulative effect, transmission of infectious diseases, dissemination of cancer. This is why the indications for allogeneic blood transfusion are restricted, and new safer methods are being discovered to decrease the requirement for it. Red cell alloimmunization may develop in pregnancy; therefore, all pregnant women should pass screening for irregular antibodies. Antierythrocytic irregular antibodies may occur due to previous pregnancies or allogeneic red blood cell transfusions, and it is important for blood cross-matching in the future. Under certain circumstances, such as complicated maternal history, severe coagulation abnormalities, severe anemia, the preparation of cross-matched blood is necessary. There is evidence of very significant variation in the use of blood products (red cells, platelets, fresh frozen plasma, or cryoprecipitate) among clinicians in various medical institutions, and sometimes indications for transfusion are not correctly motivated. The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in order to improve the skills of doctors and to optimize therapeutic options in obstetric emergencies.

Type of Medium: Online Resource

ISSN: 1648-9144

URL: Article

DOI: 10.3390/medicina46080081

Language: English

Publisher: MDPI AG

Publication Date: 2010

detail.hit.zdb_id: 2088820-X

In: Perfusion, SAGE Publications, Vol. 21, No. 1 ( 2006-01), p. 61-66

Abstract: The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p 〈 0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p 〈 0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p 〈 0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p 〈 0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p 〈 0.05), 27.3% of patients in Group 2 ( p 〈 0.05) and in 35.7% of patients in Group 3 ( p 〈 0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p 〈 0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

Type of Medium: Online Resource

ISSN: 0267-6591 , 1477-111X

URL: Article

DOI: 10.1191/0267659106pf845oa

Language: English

Publisher: SAGE Publications

Publication Date: 2006

detail.hit.zdb_id: 2029611-3

In: Medicina, MDPI AG, Vol. 44, No. 6 ( 2008-06-17), p. 482-

Abstract: Recently the use of allogeneic (donor) blood transfusion is widely accepted in the clinical practice. Despite of good quality and safety of preparation of allogeneic blood, there are some risks related with transfusion: hemolytic, febrile, and allergic reactions, transfusion related acute lung injury, negative immunomodulatory effect, transmission of infections diseases, dissemination and recurrence of cancer. This is why the indications for donor blood transfusion are restricted, so new safer methods are discovered to avoid or to decrease the heed for allogeneic blood transfusion. Nowadays, there is an increased interest in autologous blood transfusion as the most acceptable alternative to allogeneic blood transfusion. Autologous transfusion is the collection and reinfusion of the patient’s own blood (donor and recipient is the same person). Several types of autologous transfusion can be used: preoperative autologous blood donation, acute normovolemic hemodilution, intraoperative blood salvage, postoperative blood salvage. Neverless, autologous transfusion does not protect from all risks, it still remains the safest type of blood transfusion and is important in the strategy of blood conservation.

Type of Medium: Online Resource

ISSN: 1648-9144

URL: Article

DOI: 10.3390/medicina44060063

Language: English

Publisher: MDPI AG

Publication Date: 2008

detail.hit.zdb_id: 2088820-X

In: Lietuvos chirurgija, Vilnius University Press, Vol. 5, No. 3 ( 2007-01-01), p. 0-0

Abstract: Audronė Veikutienė1, Rimantas Benetis1, Edmundas Širvinskas2, Pranas Grybauskas3, Judita Andrejaitienė2, Vincentas Veikutis2, Jonas Šurkus41 Kauno medicinos universiteto klinikų Širdies,krūtinės ir kraujagyslių chirurgijos klinika, Eivenių g. 2, LT-50009 Kaunas2 Kauno medicinos universiteto Biomedicininių tyrimų institutas, Eivenių g. 2, LT-50009 Kaunas3 Kauno medicinos universiteto Kardiologijos institutas, Eivenių g. 2, LT-50009 Kaunas4 Kauno medicinos universiteto klinikų Nefrologijos klinika, Eivenių g. 2, LT-50009 KaunasEl paštas: aveikutiene@gmail.com Įvadas / tikslas Įvairūs metodai yra siūlomi alogeninio kraujo poreikiui po širdies operacijų sumažinti. Šio darbo tikslas – nustatyti, ar tikslinga naudoti reinfuzijai autologinį kraują, ištekėjusį ankstyvuoju pooperaciniu laikotarpiu, atsižvelgiant į reinfuzijos įtaką ligos pooperacinei eigai. Ligoniai ir metodai Ištirta 90 ligonių, kuriems atliktos širdies operacijos naudojant dirbtinę kraujo apytaką. Tiriamieji suskirstyti į dvi grupes. Pirmą grupę (n = 41) sudarė ligoniai, kuriems po operacijos per 4 valandas į kardiotominį rezervuarą išsiskyręs kraujas buvo surenkamas į sterilius plastikinius maišelius, centrifuguojamas, o gauti autologiniai eritrocitai grąžinami ligoniui. Antros grupės (n = 49) ligoniams išsiskyręs autologinis kraujas nebuvo grąžinamas. Palyginome hemoglobino, hematokrito, leukocitų, C reaktyviojo baltymo vertes prieš operaciją, po operacijos praėjus 4 val., 20 val. ir penktą parą. Tyrėme prokalcitonino koncentraciją serume praėjus 4 val. ir 20 val. po operacijos. Įvertinome netekto kraujo kiekį per 20 val. laikotarpį. Rezultatai Grupių demografiniai, intraoperaciniai duomenys, kairiojo skilvelio išstūmimo frakcija, NYHA funkcinė klasė nesiskyrė. Prieš operaciją ir praėjus 4 val. po operacijos hemoglobino, hematokrito, leukocitų, C reaktyviojo baltymo, prokalcitonino vertės grupėse buvo panašios. Hemoglobino, hematokrito vertės, leukocitų skaičius tarp grupių reikšmingai nesiskyrė ir po 20 val. bei penktą parą. Praėjus 20 val. po operacijos, prokalcitonino koncentracijos padidėjimas ( 〉 0,5–2 ng/ml) dažniau pasitaikė II grupės ligoniams (58,3% / 33,3%). Penktą parą C reaktyviojo baltymo vertė buvo mažesnė I grupėje (70,63 ± 34,23), palyginti su II grupe (93,53 ± 45,48; p 〈 0,05). Pooperacinis kraujo netekimas per pirmąsias 20 val. tarp grupių reikšmingai nesiskyrė. Alogeninio kraujo transfuzijų poreikis buvo reikšmingai mažesnis I grupės ligoniams: 14,6% / 38,8% (p 〈 0,05). Infekcinės komplikacijos registruotos I grupės 2,4% ligonių ir II grupės 10,2% ligonių (p 〈 0,05) Pooperacinio hospitalizavimo trukmė 35,19% buvo trumpesnė I grupės tiriamųjų (p 〈 0,05). Išvada Ankstyva po širdies operacijos ištekėjusio autologinio, centrifuguoto kraujo reinfuzija nedidino kraujavimo bei sisteminio uždegiminio atsako. Autologinių eritrocitų ankstyvos reinfuzijos grupėje mažėjo alogeninio kraujo transfuzijų poreikis, infekcinių komplikacijų rizika, buvo trumpesnė pooperacinio hospitalizavimo trukmė. Pagrindiniai žodžiai: autologinis kraujas, alogeninis kraujas, dirbtinė kraujo apytaka Benefit of early reinfusion of autologous shed mediastinal blood after cardiac surgery Audronė Veikutienė1, Rimantas Benetis1, Edmundas Širvinskas2, Pranas Grybauskas3, Judita Andrejaitienė2, Vincentas Veikutis2, Jonas Šurkus41 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery,Eivenių str. 2, LT-50009 Kaunas, Lithuania2 Kaunas University of Medicine, Institute for Biomedical Research,Eivenių str. 2, LT-50009 Kaunas, Lithuania3 Kaunas University of Medicine, Institute of Cardiology,Eivenių str. 2, LT-50009 Kaunas, Lithuania4 Kaunas University of Medicine Hospital, Department of Nefrology,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: aveikutiene@gmail.com Background / objective Various strategies have been proposed to decrease allogeneic transfusion requirements after cardiac surgery. The aim of the study was to evaluate the efficacy of collected and reinfused autologous shed mediastinal blood on the postoperative cource. Patients and methods We investigated 90 patients who underwent cardiac surgery with cardiopulmonary bypass. The patients were divided into two groups: group I (n = 41) received the centrifuged autologous shed mediastinal blood collected from the cardiotomy reservoir following 4 hours after surgery; in group II (n = 49) all shed mediastinal blood was discarded (control group). Haemoglobin, haematocrit, C-reactive protein values, leucocyte count were compared before surgery, 4 h, 20 h after surgery and on the fifth postoperative day. We have measured serum procalcitonin concentration at 4 h and 20 h after cardiopulmonary bypass. We assessed drained blood loss within 20 postoperative hours. Results There were no significant differences in patients’ demographic, operative data, left ventricle ejection fraction, NYHA functional class between the two groups. C-reactive protein, procalcitonin concentration, haemoglobin, haematocrit values, leucocyte count did not differ between the groups before and at 4 hours after surgery. Haemoglobin, haematocrit level, leucocyte count were similar at 20 hours and on the fifth day after surgery. At 20 hours after surgery, an increase of serum procalcitonin concentration ( 〉 0.5–2 ng/ml) was more frequent in group II (58.3% vs 33.3%). On the fifth postoperative day, the C-reactive protein value was lower in group I (70.63 ± 34.23; p 〈 0.05), compared to group II (93.53 ± 45.48). Postoperative blood loss did not differ between the groups. Requirement for allogeneic transfusion was significantly lower in group I (14.6% vs 38.8%; p 〈 0.05). Patients in group I developed less infective complications as compared with the group II (2.4% and 10.2%, respectively; p 〈 0.05). The length of postoperative in-hospital stay was shorter by 35.19% in group I (p 〈 0.05) as compared with group II. Conclusions Reinfusion of centrifuged autologous shed mediastinal blood did not increase bleeding tendency and systemic inflammatory response. Requirement for allogeneic transfusion, the risk of postoperative infection and the length of postoperative in-hospital stay was lower in autotransfused patients (group I). The estimation of serum procalcitonin concentration is a usable and rather informative test for evaluating inflammatory response activity after cardiac surgery. Key words: autologous blood, allogeneic blood, cardiopulmonary bypass

Type of Medium: Online Resource

ISSN: 1648-9942 , 1392-0995

URL: Article

DOI: 10.15388/LietChirur.2007.3.2201

Language: Unknown

Publisher: Vilnius University Press

Publication Date: 2007

In: Personalized Medicine, Future Medicine Ltd, Vol. 13, No. 5 ( 2016-09), p. 423-428

Abstract: We present two clinical cases of acute and subacute coronary artery stent thrombosis in patients treated at the Department of Interventional Cardiology in Aktobe, Kazakhstan. Our results draw attention to the impact of CYP3A4*1B on the clinical effect of clopidogrel during dual antiplatelet therapy after PCI. The genotyping performed at the Laboratory of Molecular Cardiology of Institute of Cardiology of Lithuanian University of Health Sciences in Lithuania revealed that both patients were homozygous carriers of CYP3A4*1B*1B. They also were carriers of CYP2C19 loss-of-function *2 or *3 alleles (*1*2 and *1*3, respectively).

Type of Medium: Online Resource

ISSN: 1741-0541 , 1744-828X

URL: Article

DOI: 10.2217/pme-2016-0041

Language: English

Publisher: Future Medicine Ltd

Publication Date: 2016

SSG: 15,3