We measured plasma parameters of the prothrombotic state, namely thrombin-antithrombin III complex (TAT), fíbrinopeptide A (FPA). D-dimer (DD), von Willebrand factor (vWF), tissue-type plasminogen activator (tPA), β-thrombo-globulin (βTG), platelet factor 4 (PF4) and serotonin (5HT) in a series of 51 adult patients with chronic uremia: 22 were on maintenance hemodialysis (MHD) and 29 on conservative dietary treatment. Serum tumor necrosis factor α (TNF) was determined as well. Uremics presented significantly higher levels of TAT, FPA, DD, vWF, TNF, βTG and 5HT than normal controls. Patients on conservative treatment showed lower levels of TAT, DD, TNF and βTG than patients on MHD. Our results provide evidence that a prothrombotic state exists in chronic uremia and that MHD patients have a higher degree of hypercoagulation. Both hemodialysis procedure and uremia-related factors are likely to contribute to the hemostatic derangement.
Prophylaxis replacement therapy has been assessed for a period of 12 months in 10 patients with severe haemophilia B showing a high incidence of spontaneous bleeding episodes. Two different schedules of administration of a freeze‐dried factor IX concentrate were randomly evaluated: according to scheme A, 7.5 U/kg were administrated biweekly, whereas scheme B was based on the weekly infusion of 15 U/kg. On prophylaxis the frequency of bleeding episodes was significantly reduced (P < 0.005) when compared with that observed in the one‐year period preceding the trial.
Biweekly infusions were superior to weekly infusion (P < 0.01), and the benefit appeared to be related to the higher number of days in which measurable levels of factor IX were attained in plasma.
Range of motion, which was reduced at the start of the trial in 26 joints, was found to have improved in 23. Favourable changes of the joint radiological picture were observed in 6 cases. Hepatitis and factor IX inhibitors did not develop during the trial period. Side effects were rare and mild.
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