Effect on coagulation

Unknown regimen for 2 mos Female/7 8 Coronary artery bypass and progressive dementia Warfarin for 5 yrs None mentioned Intracerebral hemorrhage Additive effect on coagulation mechanisms... 

When HES is infused, the smaller molecules are excreted by the kidneys, while the larger molecules are metabolised by o-amylase, and taken up by the reticuloendothelial system (RES) and the skin. Even though HES molecules disappear from the blood within 10-72 hours, dependent on their molecular weight, they can be detected in the RES for at least one month. Anaphylactic reactions to HES are lower than with other colloids and they have minimal effects on coagulation. Controversy exists regarding the use of HES in patients with renal insufficiency, and dose recommendations are based on the risk of renal tubular overload and the influence on haemostasis (possible decrease in factor Vll/von Willebrand factor). The risk is greater with the higher MW solutions, and appears to be lower with the new HES 130/0.4. 

Kluft C, de Maat MP, Heinemann LA, Spannagl M, Schramm W. Importance of levonorgestrel dose in oral contraceptives for effects on coagulation. Lancet 1999 354(9181) 832-3. 

Fibrates should be avoided in gallbladder disease or any form of obstructive jaundice because of the risk of stone formation. The extended therapeutic effect of gemfibrozil, which is due to enterohepatic recycling, may be reduced in obstructive jaundice. Fibrates may have an adverse effect on coagulation if used, the INR/PT should be monitored... 

Heparin binds to antithrombin (a protease inhibitor that inactivates factors Ha, IXa, Xa and XIa) and markedly accelerates its inhibitory effect on coagulation. In addition, heparin inhibits platelet function, The newer low-molecular-weight heparins augment antithrombin activity preferentially against factor Xa and do not prolong the APTT like standard (unfractionated) heparin does. 

Human albumin solution has proved extremely reliable, especially when used in conjunction with crystalloid infusions. (Synthetic iso-oncotic colloids should be avoided as far as possible because of their negative effects on coagulation and kidney function.)... 

Sallah, S., Bobzlen, W. Bleeding problems in patients with liver disease. Ways to manage the many hepatic effects on coagulation. Postgrad. Med. 1999 106 187-195... 

Leese, P.T. Noveck, R.J. Shorr, J.S. Woods, C.M. Flaim, K.E. Keipert, P.F. Randomized safety studies of intravenous perflubron emulsion I. Effects on coagulation function in healthy volunteers. Anesth. Analg. 2000, 91, 804-811. 

Some authors have concluded that etherified starches and albumin do not differ with respect to efficacy and adverse effects on coagulation and renal function (3), but etherified starches clearly do have a distinct adverse reactions profile. Some of the problems that they cause, such as anaphylaxis, volume overload, cerebral hemorrhage, and acute renal insufficiency, are sufficient reason to avoid hetastarch when benefit is doubtful, such as ischemic brain infarction (4). 

Small M, Lowe GD, Douglas JT, Forbes CD, Prentice CR, Factor IX thrombogenicity in vivo effects on coagulation activation and a case report of disseminated intravascular coagulation. Thromb Haemost 1982 48(l) 76-7. 

With this formulation, chemical effects on coagulation are included in a and physical effects in Particle contacts are usually considered to be caused by three mechanisms differential sedimentation, shear (laminar and turbulent), and Brownian motion. Differential sedimentation contact occurs when two particles fall through the water at different rates and the faster particle overtakes the slower one. Shear contact occurs when different parts of the fluid environment move at different speeds relative to each other, and thus a particle that is moving with one fluid patch overtakes and collides with a particle in a slower fluid patch. Brownian motion contact occurs when two particles move randomly through their fluid in Brownian motion and collide... 

Antithrombin is a complex protein with multiple biologically important activities. It is the most critical modulator of coagulation, and has potent anti-inflammatory properties independent of its effects on coagulation [35, 70-73]. Several in vitro and in vivo animal studies, some of which used hpAT as a direct comparator, were undertaken to evaluate the potency of rhAT. 

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