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Hemostaza – temat zawsze aktualny

100%
Pleban E.
Pediatria i Medycyna Rodzinna
|
2015
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vol. 11
|
issue 2
166-176
EN
Haemostasis is a set of processes with the aim to maintain blood in the liquid state in the vascular bed, and in the case of damage to the vessel – to prevent extravasation by clot formation (initially a platelet clot and then a fibrin clot). The main components of haemostasis include: platelets, vessel wall, plasma coagulation system, endogenous inhibitors of coagulation and fibrinolytic system. The stream of blood is also an important factor. Haemostasis is divided into two main phases: coagulation and fibrinolysis. These two phases take place simultaneously and remain in equilibrium. The prevalence of any of these processes is the result of the advantage of enzyme complex activity over the complex of the other process. In everyday practice, every physician encounters drugs that affect haemostasis. At the end of the article, the most commonly used anticoagulants and antiplatelet agents available in Poland are described with the mechanisms of their action. The effect of oral anticoagulants results from the inhibition of the transformation of vitamin K1 which is essential for the production of coagulation factors II, VII, IX and X. Acenocoumarol and warfarin are currently available in Poland. The group of new oral anticoagulants includes direct inhibitors of activated factor X: rivaroxaban, apixaban and dabigatran – a potent, competitive and reversible direct thrombin inhibitor. Anticoagulants which are used parenterally include unfractionated heparin, low molecular weight heparins and fondaparinux. Antiplatelet drugs can be divided into two groups based on the mechanism of action – drugs acting through the metabolism of arachidonic acid (aspirin) and acting on the platelet membrane receptors (ticlopidine, clopidogrel and prasugrel).
PL
Hemostaza to zespół procesów mających na celu utrzymanie krwi w stanie płynnym w łożysku naczyniowym, a w przypadku uszkodzenia naczynia – zapobieganie wynaczynieniu poprzez utworzenie skrzepu (początkowo płytkowego, następnie fibrynowego). Spośród głównych elementów hemostazy należy wymienić płytki krwi, ścianę naczyń krwionośnych, osoczowy układ krzepnięcia, endogenne inhibitory krzepnięcia i układ fibrynolizy. Istotnym czynnikiem jest także strumień przepływającej krwi. Najczęściej hemostazę dzieli się na dwa główne etapy: krzepnięcie i fibrynolizę. Oba te procesy zachodzą jednocześnie i pozostają w równowadze. Dominacja któregoś z nich to rezultat przewagi aktywności kompleksu enzymatycznego nad aktywnością kompleksu drugiego procesu. W codziennej praktyce każdy lekarz spotyka się z lekami wpływającymi na hemostazę – na końcu artykułu omówiono więc najpowszechniej stosowane leki przeciwkrzepliwe i przeciwpłytkowe dostępne w Polsce oraz mechanizmy ich działania. Działanie doustnych leków przeciwkrzepliwych wynika z hamowania przemiany witaminy K1, niezbędnej do wytwarzania w organizmie człowieka czynników krzepnięcia: II, VII, IX i X. Obecnie dostępne są acenokumarol i warfaryna. W grupie nowych doustnych antykoagulantów znalazły się bezpośrednie inhibitory aktywnego czynnika X: rywaroksaban, apiksaban i dabigatran, który jest silnym, kompetycyjnym, odwracalnym, bezpośrednim inhibitorem trombiny. Antykoagulanty stosowane parenteralnie to heparyna niefrakcjonowana, heparyny drobnocząsteczkowe i fondaparynuks. Ze względu na mechanizm działania leki przeciwpłytkowe można podzielić na dwie grupy: leki działające przez metabolizm kwasu arachidonowego (kwas acetylosalicylowy) i działające na receptory błonowe płytek krwi (tiklopidyna, klopidogrel, prasugrel).
2
Content available remote

Extracranial Carotid Aneurysms

63%
Pleban E., Szopiński P.
Polish Journal of Surgery
|
2008
|
vol. 80
|
issue 3
163-171
3
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Endovascular Treatment of Upper Gastrointestinal Bleeding Detected with the Use of CT Angiography

51%
Szopiński P., Terlecki M., Pleban E.
Polish Journal of Surgery
|
2009
|
vol. 81
|
issue 3
156-158
EN
The authors present a case of a patient with a history of open repair of abdominal aortic aneurysm with a tube graft three years previously presenting with gastrointestinal bleeding as a sign of aortoduodenal fistula. The diagnosis of the fistula was established on the basis of computed tomography angiography, with no source of bleeding found in endoscopy. Endovascular treatment was undertaken due to high operative risk (ASA class IV). A tube stentgraft was implanted covering both anastomoses of the previously implanted prosthesis. In 2-year observation no recurrent gastrointestinal bleeding was noticed.
4
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The Use of Liposomal Heparin Spray-Gel in the Treatment of Superficial Thrombophlebitis: A Multicenter Clinical Investigation Analysis

39%
Pleban E., Szopiński P., Górski G., Michalak J., Noszczyk B., Ciostek P.
Polish Journal of Surgery
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2008
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vol. 80
|
issue 2
81-55
EN
The aim of the study was to evaluate the efficacy and safety of liposomal heparin spray-gel in the treatment of superficial thrombophlebitis.Material and methods. The presented study is an analysis of two clinical investigations performed during the period between March 1999 and May 2002, which evaluate the efficacy and safety of liposomal heparin spray-gel (Lipohep) in the treatment of superficial thrombophlebitis, as well as a comparison with results obtained following subcutaneous enoxaparin injections. The study group comprised 88 patients, including 43 on Lipohep treatment and 45 on low molecular weight heparin.Results. Two patients withdrew from the investigation before the control visit. After seven days, therapy was stopped in the case of 16 Lipohep patients and 18 low molecular weight heparin patients. After 14 days, therapy was stopped in 21 and 25 patients, respectively. One low molecular weight heparin and five Lipohep patients did not finish the investigation. This was connected with a lack of clinical improvement and development of side-effects. A statistically significant reduction of pain and the appearance of erythema was observed in both patient groups during the initial seven days of treatment. One patient on low molecular weight heparin was diagnosed with superficial thrombophlebitis recurrence. Ten patients developed complications, with deep venous thrombosis being most significant (two patients were treated with Lipohep and one with enoxaparin). One patient on Lipohep treatment developed superficial thrombophlebitis of the upper extremity.Conclusions. Liposomal heparin spray-gel is safe and effective in the treatment of local superficial thrombophlebitis symptoms. The initial results considering the use of Lipohep are promising and should be confirmed in a larger group of patients.
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