Plasmatic Plasminogen Activator Inhibitor Activity in Patients with Primary Breast Cancer

Blood rheology during chemotherapy in patients with ovarian cancer.

The use of platinum based chemotherapy in ovarian malignancy and other cancer types is known to be associated with deep vein thrombosis. In a prospective study of 47 patients with ovarian cancer of International Federation of Gynecology and Obstetrics stage Ib-IV, serial rheological parameters were determined (plasma viscosity, red blood cell aggregation under conditions of stasis and low shear) in addition to hemoglobin, hematocrit, leukocytes, platelets, and fibrinogen. At the same time the incidence of deep vein thrombosis was recorded before, during six cycles of first line cisplatinum/epirubicin/cyclophosphamide chemotherapy, and 2 months thereafter (two-months check-up). Only six pati…

Antiphospholipid syndrome in obstetrics.

Antiphospholipid syndrome (APLS) in pregnancy is characterized by the presence of autoantibodies in association with recurrent fetal loss and severe complications such as preeclampsia, fetal growth retardation, or placental insufficiency. The most clinically important serologic markers are lupus anticoagulant, anticardiolipin antibodies, and recently anti-beta-2-glycoprotein 1 antibodies. At present, standardization does not exist and a definitive association between specific clinical manifestation and antibody level is not yet known. Experimental data gave evidence that passive transfer of antiphospholipid antibodies result in clinical manifestation of APLS, that is, fetal loss and thromb…

Hyperviscosity syndrome in patients with ovarian carcinoma

BACKGROUND In patients with ovarian carcinoma, an hematocrit-independent hyperviscosity syndrome is often present. The syndrome is characterized by normal or low hematocrit and hemoglobin concentration, an elevated platelet count, and an increase in clotting factor turnover. Because deep vein thrombosis (DVT) often complicates the course of ovarian carcinoma, the aim of this study was to investigate the possible association of hyperviscosity syndrome with the development of DVT. METHODS Rheologic estimations of the blood included red blood cell (RBC) aggregation (stasis and low shear), plasma viscosity (pv), blood cell count, and fibrinogen, which were performed before primary surgery and t…

State-of-the-Art Review : Chemotherapy and Thrombosis in Gynecologic Malignancy

Thromboembolism is a severe and frequent problem in gynecologic malignancy. The average DVT incidence during chemotherapy of 5% might represent the lower range of incidence because < 55% of thrombotic complication manifest clinical signs. However, it seems likely that in addition to chemotherapy other risk factors such as menopausal status, BMI of patients, or type of preceding surgery must coincide before thrombosis manifests. While monitoring of patients using sophisticated coagulation tests did not identify patients' risk for DVT during chemotherapy, an evaluation of the coagulation status before initiating chemotherapy is recommended. Patients with a venous access device (e.g., indwelli…

Successful treatment of life-threatening bleeding after cesarean section with recombinant activated factor VII.

Hemorrhagic shock developed in a 29-year-old nullipara without coagulopathy after emergency caesarean section. Treatment with uterotonic drugs, prostaglandins, and conservative procedures with transfusion of packed red cells and fresh-frozen plasma failed to control the diffuse vaginal and uterine bleeding. Finally an intravenous bolus injection of 90 μg/kg recombinant activated factor VII (rFVIIa, NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark), was given and showed success within 20 minutes after administration, without any side effects.

Incidence of the Factor V Leiden-mutation, Coagulation Inhibitor Deficiency, and Elevated Antiphospholipid-antibodies in Patients with Preeclampsia or HELLP–Syndrome

LETTER TO THE EDITORS-IN-CHIEF Incidence of the Factor V Leiden-mutation, Coagulation Inhibitor Deficiency, and Elevated Antiphospholipid-antibodies in Patients with Preeclampsia or HELLP–Syndrome Georg–Friedrich von Tempelhoff1, Lothar Heilmann1, Eberhard Spanuth1, Erich Kunzmann1 and Gerhard Hommel2 1Department of Obstetrics and Gynecology, City Hospital of Ruesselsheim and 2Institute for Medical Statistic and Documentation, University of Mainz, Germany.

ProC® Global Assay in the Evaluation of Women with History of Severe Preeclampsia or HELLP Syndrome

Preeclampsia/HELLP syndrome has been associated with a high incidence of defects in the protein C pathway and increased anticardiolipin-antibodies/lupus anticoagulants. It is also apparent that thrombophilia is responsible for other pregnancy complications, such as recurrent spontaneous abortion, fetal growth restriction, intrauterine fetal death, and abruptio placentae. ProC® Global is a new global clotting assay designed to evaluate the abnormalities in the protein C anticoagulant pathway. It is based on the ability of endogenous activated protein C, generated by activation of protein C by Protac®, to prolong an activated partial thromboplastin time. A total of 61 patients with a history…

Comparison of Unfractionated Versus Low Molecular Weight Heparin for Deep Vein Thrombosis Prophylaxis During Breast and Pelvic Cancer Surgery: Efficacy, Safety, and Follow-up

In a prospective, double-blind randomized trial the efficacy and safety of low molecular weight heparin and un fractionated heparin were compared for the prevention of post operative deep vein thrombosis in patients undergoing major surgery for breast and pelvic cancer. Three hundred fifty-eight patients were randomly allocated to the two treatment groups. Thirty-four of these were excluded from the study. Of the re maining 324 patients, 164 received 5000 IU unfractionated heparin three times daily and 160 received 3000 anti-Xa units of low molecular weight heparin once daily. Treatment was started 2 to 5 hours preoperatively and continued for 7 days. The occurrence of deep vein thrombosis…