Direct thrombin inhibitors have proven efficacious in prevention of venous thromboembolism. Bleeding complications are rare, but in case of acute serious bleeding, an effective and instant haemostatic intervention may be required. In the present study it was demonstrated that the direct thrombin inhibitor melagatran induces dose-dependent abnormalities in whole blood (WB) clotting profiles as recorded by a recently described modified thrombelastographic model, and that rFVIIa or APCC are capable of improving the haemostatic capacity. Experiments were performed using WB from 30 healthy males. In-vitro titration experiments (n = 10) with addition of melagatran to WB corresponding to plasma concentrations ranging from 0 to 5.0 microM (12 steps) showed a dose-dependent prolongation of the clot initiation and characteristic decrease of the maximum rate of clot propagation. In-vitro intervention studies (n = 20) were completed with four different concentrations of melagatran as well as addition of four different levels of rFVIIa or APCC. At all tested concentrations of melagatran, rFVIIa significantly shortened the melagatran-induced prolonged clot initiation but induced only minor improvements of the reduced clot propagation. In contrast, APCC significantly and dose-dependently shortened the clot initiation and accelerated the clot propagation. In conclusion, our thrombelastographic model appears useful for evaluating the effect of direct thrombin inhibitors on dynamicWB clot formation and rFVIIa, but especially APCC significantly improved theWB clot formation. The pronounced stabilizing effect of APCC may be caused by its content of prothrombin and activated coagulation factors.

译文

直接凝血酶抑制剂已被证明对预防静脉血栓栓塞有效。出血并发症很少见,但在急性严重出血的情况下,可能需要有效且即时的止血干预。在本研究中,证明了直接凝血酶抑制剂melagatran诱导全血 (WB) 凝血谱的剂量依赖性异常,如最近描述的改良血栓弹力图模型所记录,并且rFVIIa或APCC能够改善止血能力。使用来自30名健康男性的WB进行了实验。将melagatran添加到WB中的体外滴定实验 (n = 10),对应于血浆浓度范围为0至5.0微米 (12步),结果显示凝块起始的剂量依赖性延长和最大凝块传播速率的特征性降低。用四种不同浓度的美拉加群以及添加四种不同水平的rFVIIa或APCC完成了体外干预研究 (n = 20)。在所有测试的melagatran浓度下,rFVIIa均显着缩短了melagatran诱导的长时间凝块起始,但仅诱导了减少的凝块繁殖的微小改善。相反,APCC显着且剂量依赖性地缩短了凝块的起始并加速了凝块的传播。总之,我们的血栓弹力图模型似乎可用于评估直接凝血酶抑制剂对动态wb凝块形成和rFVIIa的影响,但尤其是APCC显着改善了wb凝块形成。APCC的明显稳定作用可能是由其凝血酶原和活化的凝血因子的含量引起的。

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