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We conduct clinical research in collaboration with various clinical departments, including the Departments of Orthopedics, Cardiology and Hematology as well as the Intensive Care and Gastrointestinal Surgery units.
We have collaborated with the Department of Cardiology and regional hospitals on the issue of resistance to antiplatelet drugs. Aspirin, also known as acetylsalicylic acid exerts antiplatelet effects by irreversibly inhibiting platelet cyclooxygenase (COX-1). Aspirin has the longest history of any antiplatelet drug, and it is very widely used. Aspirin resistance (inability of aspirin to reduce platelet production of thromboxane A2) has become a hot topic, because it can increase the risk of cardiovascular events.
We reported that this pharmacological effect is observed in all patients taking low dose aspirin (Ohmori T, et al, J Thromb and Haemost，2006).
In addition, based on the results obtained from measuring coagulation ability and platelet aggregation in patients who underwent coronary angioplasty, we concluded that the hypercoagulable state that results from sleep apnea and obesity is not suppressed by antiplatelet therapy alone. It is expected that comprehensive treatment with antiplatelet therapy is important (Yano et al, Eur Heart J，2008).
DIC is a serious complication of sepsis that is associated with a high incidence of mortality.
Consequently, early diagnosis and treatment of DIC is crucial. We have a database collected from patients with coagulation disorders, including DIC. Using that database, we found out that PAI-1 (a fibrinolysis inhibitor) levels are related to the prognosis of DIC patients (Madoiwa et al, Int J Hematol, 2006).
To identify DIC patients earlier, we have now proposed an algorithm that makes use of a combination of clinical findings of platelet reduction and abnormal levels of molecular markers of coagulation and fibrinolysis (Koyama et al, J Crit Care, 2014).
There are some cases in which ADAMTS13 (VWF cleaving enzyme) activity is reduced in DIC patients, as in thrombocytopenic purpura patients. This reduction in ADAMTS13 activity induces the emergence of a huge multimeric form of VWF that may exacerbate thrombus formation (Mimuro J, et al, Blood 2006).
To improve the prognosis of DIC patients, our research will continue doing research to improve diagnostic procedures.
In collaboration with the Orthopedics Department, we are now endeavoring to identify the risk factors associated with post-operative bleeding.
We also examined risk factors for post operative-DVT, and reported the efficacy of various molecular markers (Watanabe et al, J Arthropathy 2014; Watanabe et al, Thromb Res 2011).
Our research, along with regional hospitals, is now establishing a monitoring system with which we can perform efficient anticoagulation therapy using new oral anticoagulants (NOAC) in the perioperative period.
Many liver transplants have been performed in the Division of Surgery, Jichi Medical University. We have analyzed in detail the fluctuation in coagulation and fibrinolysis markers after liver transplantation, and found that PAI-1 elevations are associated with rejection (Mimuro et al, Periatr Transplant 2010).