Thrombotic Centre
Thrombotic Centre (TC) was already established in the General University Hospital in the year 2002. Now, TC has two ambulances equipped with an ultrasound diagnosis of deep venous thrombosis. Medical services are provided by the following experts: internists, hematologists, angiologists, pediatrician and clinical geneticist in the composition: 1 professor, 1 associate professor and 7 doctors with scientific degree PhD or MD.
An important research part of TC is also Research Laboratory of hereditary defects of hemostasis and vascular wall pathology. Routine and other specialized tests are performed in an accredited central laboratory oh Haematology (APTT, PT, TT, concentration of D-dimer, fibrinogen, concentration of clotting factors, particularly factor VIII and their inhibitors (antithrombin III, protein C, protein S), known thrombophilias mutations (FV Leiden mutation, prothrombin mutation FII, GP6), antiphospholipid antibodies, lupus anticoagulant, homocysteine and FXa inhibition during treatment with LMWH. Such investigations are performed selectively in patients with a history of venous thrombosis, pulmonary embolism or in persons with a proven family burden (incidence of thromboembolism or thrombophilia mutations in relatives), especially in women with thrombophilia risk before deploying combined hormonal contraceptives or estrogen replacement therapy.
In the TC are observed the thrombotic patients with inherited or acquired thrombophilia. These patients are afforded the full diagnostic, counseling and therapeutic outpatient care. Thrombotic consulting activities include regions: an area of Prague and several other regions, especially Central Bohemia. There is formed a register of pregnant women with thrombophilia monitored during pregnancy. Treatment and prophylaxis of venous thrombosis is carried out in accordance with the recommendations of the 9-ACCP conference on antithrombotic and thrombolytic therapy from y. 2012. This is called evidence based guidelines arising from the evaluation results of several clinical trials. According to these guidelines is done prevention of thromboembolism in patients with high-risk : surgery, trauma, prolonged immobilization, drive long distances, etc. TC has a register monitored thrombotic patients (n 8620) with previous venous thrombosis, or pulmonary embolism (n 2629), which are at the disposal of all the necessary data, both clinical and laboratory. TC provides preventive health care on the basis of their knowledge and experience.
The research also evaluated the effectiveness of prophylaxis with LMWH in pregnancy, including the monitoring of potential risks of bleeding.
The results of the TC were used for the text of national consensus of recommendations for the indication of molecular genetic tests for diagnosis of thrombophilic states in the venous system (Kvasnicka J.: "Hereditary thrombophilia - recommendations for the implementation of genetic testing in clinical practice." Journal of Czech Physicians 2010; 149: 468-471), which is accepted by six expert societies. TC also provides rapid screening polymorphism of CYP 2C 19 (* 1 / * 2 / * 3), necessary for patients with cardiovascular disease with clopidogrel therapy.
For research purposes, we implemented additional testing of thrombophilic mutations: CYP4V2 (rs13146272), SerpinC1 (rs2227589) and PEAR-1 (rs41299597, rs11264579, rs2768759) and LPA mutations (rs 3798220) and 9 chromosome (9 P 21.3; rs10757274), which occur in patients with atherosclerotic coronary disease. Increased demands on the examination assures molecular genetic laboratory in two LightCycler ® 480 Real - Time PCR. Currently, the evaluation of significance of these polymorphisms in relation to the infarction in people under 55 years, eventually. other complications after PCI, in cooperation with the 2-nd Department of Internal Medicine General Teaching Hospital (Prof. A. Linhart).
In cooperation with the Transplantation Centre of Institute of Clinical and Experimental Medicine (IKEM) are tested a protrombogenic mutations in patients in the waiting list for a kidney transplantation. One of the possible complications early period after kidney transplantation are currently thrombosis. Until now, it was examined in 1570 patients with renal failure, who are included in the transplantation program and 700 patients after successful transplantation. The positive persons with known hereditary thrombophilias (FVL or FII mutation) is performed after transplantation 1 month preventive prophylaxis with LMWH to prevent thrombotic complications in the perioperative phase and acute rejection. The research in the TC introduced the technique of flow cytometry to determine the qualitative and quantitative changes in protein composition of the membrane surface of activated / non-activated platelets (P-selectin) after activation with collagen and CRP-XL, which allows only platelet activation mediated collagen receptor GP VI .
