Paul M Ford

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Scholarly Contributions

Journals/Publications

• Nielsen, V. G., & Ford, P. M. (2018). The ratio of concentrations of aminocaproic acid and tranexamic acid that prevent plasmin activation of platelets does not provide equivalent inhibition of plasmatic fibrinolysis. Journal of thrombosis and thrombolysis.
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  Aminocaproic acid (EACA) availability has recently been decreased whereas tranexamic acid (TXA) is still available as an antifibrinolytic agent to decrease blood loss associated with procedures involving cardiopulmonary bypass (CPB) by inhibiting plasmin mediated platelet activation. Given that the clinical inclination is to substitute TXA for EACA, we sought to compare the antifibrinolytic efficacy of the two agents using the clinically accepted molar ratio of EACA:TXA (7.9:1) that prevents platelet activation in a viscoelastic based system under a variety of conditions in human plasma; 25-50% therapeutic concentration (EACA 32.5-65 µg/ml, TXA 5-10 µg/ml) in the presence of 1500-3000 IU tissue-type plasminogen activator, with 0-50% dilution of plasma with buffer. In all equipotent concentrations, TXA provided superior antifibrinolytic action compared to EACA. It is hoped that this work will serve as a rationale to further investigate these and other similar agents, especially now in a time of unpredictable unavailability of key medications needed to optimize patient care. It is also our wish that these data assist perfusionists, anesthesiologists and cardiothoracic surgeons with their consideration of using an antifibrinolytic agent when managing complex patients with hypercoagulable states (e.g., ventricular assist device explant, infective endocarditis) undergoing CPB.
• Nielsen, V. G., Ward, T. D., & Ford, P. M. (2018). Effects of cupric chloride on coagulation in human plasma: role of fibrinogen. Journal of thrombosis and thrombolysis.
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  Copper poisoning is associated with severe multiorgan injury and potentially death if chelation therapy is not administered. Of interest, while important gastrointestinal and urinary tract hemorrhage is associated with copper poisoning, very little is known concerning the nature of copper induced coagulopathy.
• Boyer, L. V., Redford, D. T., Ford, P. M., Redford, D. T., Nielsen, V. G., Ford, P. M., & Boyer, L. V. (2017). Thrombelastographic characterization of the thrombin-like activity of Crotalus simus and Bothrops asper venoms.. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 28(3), 211-217. doi:10.1097/mbc.0000000000000577
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  : Annually, thousands suffer venomous snake-bite from Crotalus simus and Bothrops asper vipers in central and South America. The goals of the present study were to generally characterize the thrombin-like effects of venom from these snakes in human plasma with viscoelastic methods. Human plasma was exposed to the venom of three different C. simus subspecies and venoms obtained from B. asper vipers located in three different locations in Mexico. To characterize the factor X-activating and thrombin-like activity of these venoms, plasma (normal or factor XIII deficient) was pretreated with a variety of additives (e.g., heparin) in the absence or presence of calcium prior to exposure to 2.0 μg/ml of each viper's venom. These profiles were compared with plasma without venom that had contact activation of coagulation. Coagulation kinetics were determined with thrombelastography. All venoms had thrombin-like activity, with C. s. simus creating a slow growing, weak clot that was likely mediated by metalloproteinases. In contrast, B. asper venoms had rapid onset of coagulation and a high velocity of thrombus growth. Further, B. asper venom activity was calcium-independent, activated prothrombin, activated factor XIII, and independently polymerized fibrinogen. The viscoelastic methods used were able to differentiate subspecies of C. simus and specimens of B. asper, and provide insight into the mechanisms by which the venoms acted on plasma. These methods may be useful in the profiling of similar venoms and perhaps can assist in the assessment of interventions designed to treat envenomation (e.g., antivenom).
• Nielsen, V. G., Boyer, L. V., Redford, D. T., & Ford, P. (2016). Thrombelastographic characterization of the thrombin-like activity of Crotalus simus and Bothrops asper venoms. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.
  More info

  Annually, thousands suffer venomous snake-bite from Crotalus simus and Bothrops asper vipers in central and South America. The goals of the present study were to generally characterize the thrombin-like effects of venom from these snakes in human plasma with viscoelastic methods. Human plasma was exposed to the venom of three different C. simus subspecies and venoms obtained from B. asper vipers located in three different locations in Mexico. To characterize the factor X-activating and thrombin-like activity of these venoms, plasma (normal or factor XIII deficient) was pretreated with a variety of additives (e.g., heparin) in the absence or presence of calcium prior to exposure to 2.0 μg/ml of each viper's venom. These profiles were compared with plasma without venom that had contact activation of coagulation. Coagulation kinetics were determined with thrombelastography. All venoms had thrombin-like activity, with C. s. simus creating a slow growing, weak clot that was likely mediated by metalloproteinases. In contrast, B. asper venoms had rapid onset of coagulation and a high velocity of thrombus growth. Further, B. asper venom activity was calcium-independent, activated prothrombin, activated factor XIII, and independently polymerized fibrinogen. The viscoelastic methods used were able to differentiate subspecies of C. simus and specimens of B. asper, and provide insight into the mechanisms by which the venoms acted on plasma. These methods may be useful in the profiling of similar venoms and perhaps can assist in the assessment of interventions designed to treat envenomation (e.g., antivenom).

Poster Presentations

• Ford, P. M. (2019, Spring). Acute Type A Aortic Dissection and Aortic Valve Replacement with Dissection Flap Minimizing Aortic Insufficiency. Arizona Society of Anesthesiology.
• Ford, P. M. (2019, Spring). Acute Type A Aortic Dissection and Aortic Valve Replacement with Dissection Flap Minimizing Aortic Insufficiency. Western Anesthesia Resident Conference. Denver.
• Farshad, K., & Ford, P. (2017, Fall). Tracheal Lesion with ECMO Standby. ASA. Boston, MA.
• Lightfoot, C., & Ford, P. (2017, Fall). Anterior Mediastinal Mass Reduction in a Patient with Epidermolysis Bullosa. ASA. Boston, MA.
• Tang, R., & Ford, P. (2017, Spring). Postoperative paraplegia in a patient who underwent extra anatomic thoracic aorta bypass. Western Anesthesia Resident's Conference. Portland, OR.
• Thornton, T., & Ford, P. (2015, May). Complete Heart Block During Central Line Placement. Western Anesthesia Resident's Conference. Seattle, WA.