Assuntos
Coagulação Intravascular Disseminada , Fibrinólise , Hemostasia , Humanos , Fibrinólise/fisiologia , Fibrinólise/efeitos dos fármacos , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/fisiopatologia , Hemostasia/fisiologiaRESUMO
INTRODUCTION: Peripheral blood stem cell (PBSC) collection via apheresis requires the administration of granulocyte colony-stimulating factor (filgrastim) to stem cell donors. Several reports have shown that filgrastim administration and apheresis procedure induce a hypercoagulable state across PBSC collection, which might predispose certain donors to thrombotic complications. METHODS: We evaluated the hemostatic functions of healthy allogeneic stem cell donors by rotational thromboelastometry (ROTEM). Blood samples from healthy donors (n = 30) were collected at defined time points: before filgrastim (baseline), on the day of apheresis before and after the procedure, and 1 week after apheresis. RESULTS: The results indicated that hemostatic changes are temporary since all parameters in both EXTEM and INTEM assays are restored to their initial values 1 week after the apheresis. CONCLUSION: We concluded that stem cell apheresis does not induce a hypercoagulable state in healthy donors. This is the first study evaluating the hemostatic functions of stem cell donors by ROTEM.
Assuntos
Remoção de Componentes Sanguíneos , Tromboelastografia , Humanos , Tromboelastografia/métodos , Remoção de Componentes Sanguíneos/métodos , Masculino , Feminino , Adulto , Filgrastim/farmacologia , Pessoa de Meia-Idade , Hemostasia/fisiologia , Transplante Homólogo/métodos , Doadores de Tecidos , Adulto JovemRESUMO
Measurement of a single marker of coagulation may not provide a complete picture of hemostasis activation and fibrinolysis in patients with chronic cardiovascular diseases. We assessed retrospective orders of a panel which included prothrombin fragment 1.2 (PF1.2), thrombin: antithrombin complexes, fibrin monomers, and D-dimers in patients with heart assist devices, cardiomyopathies, atrial fibrillation and intracardiac thrombosis (based on ordering ICD-10 codes). During 1 year there were 117 panels from 81 patients. Fifty-six (69%) patients had heart assist devices, cardiomyopathy was present in 17 patients (21%) and 29 patients (36%) had more than 1 condition. PF1.2 was most frequently elevated in patients with cardiomyopathy (61.1%) compared to those with cardiac assist devices (15.7%; P = 0.0002). D-dimer elevation was more frequent in patients with cardiac assist devices (98.8%) compared to those patients with cardiomyopathy (83.3%; P = 0.014). Patients with cardiomyopathy show increases of PF1.2 suggesting thrombin generation. In contrast, elevations of D-dimers without increase in other coagulation markers in patients with cardiac assist devices likely reflect the presence of the intravascular device and not necessarily evidence of hemostatic activation.
Assuntos
Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/sangue , Doenças Cardiovasculares/sangue , Hemostasia/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/farmacologia , Doenças Cardiovasculares/patologia , Doença Crônica , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Fontan-associated liver disease is accompanied by a hypercoagulable state. While hepatic dysfunction in Fontan patients is common, its relationship with haemostatic changes and clinical outcomes in this patient population remains unclear. OBJECTIVE: To correlate liver dysfunction and haemostatic profiles with clinical outcomes in the Fontan population. PATIENTS/METHODS: Patients were enrolled in a multicentre, cross-sectional study in Australia and New Zealand. Hepatic structure and function were assessed using serum-based calculations (Fibrotest and model for end-stage liver disease excluding international normalised ratio scores). Haemostatic profiles were assessed by Thrombin Generation. Platelet function was assessed via Platelet Factor 4 (PF4) and P-selectin (P-SEL). Clinical outcomes were obtained from the Australian and New Zealand Fontan Registry. RESULTS: Seventy-three patients participated in the study (mean age 18.9±8.5 years with a mean of 13.5±6.9 years post-Fontan). The Endogenous Thrombin Potential (ETP) for patients who suffered thrombotic events (TE) (1366.4±66.2 nM/min) was higher compared with patients with major bleeding events (1011.1±138.4 nM/min) (p=0.03). Except for a negative correlation between Fibrotest-score and PF4 (p=0.045), PF4 and P-SEL concentrations did not correlate with markers of hepatic dysfunction or structural abnormality. CONCLUSIONS: Increased ETP is associated with TE during clinical follow-up after Fontan. This study reinforces that hepatic dysfunction may contribute to the derangement of coagulation factors, impacting the individual risk of haemostatic complications for the Fontan population.
Assuntos
Doença Hepática Terminal/sangue , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Hemostasia/fisiologia , Adolescente , Adulto , Austrália/epidemiologia , Testes de Coagulação Sanguínea , Criança , Estudos Transversais , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Complicações Pós-Operatórias , Índice de Gravidade de Doença , Adulto JovemRESUMO
Platelet biology owes to intravital studies not only a better understanding of platelets' role in primary hemostasis but also findings that platelets are important factors in inflammation and atherosclerosis. Researchers who enter the field of intravital platelet studies may be confused by the heterogeneity of experimental protocols utilized. On the one hand, there are a variety of stimuli used to activate platelet response, and on the other hand there are several approaches to measure the outcome of the activation. A number of possible combinations of activation factors with measurement approaches result in the aforementioned heterogeneity. The aim of this review is to present the most often used protocols in a systematic way depending on the stimulus used to activate platelets. By providing examples of studies performed with each of the protocols, we attempt to explain why a particular combination of stimuli and measurement method was applied to study a given aspect of platelet biology.
Assuntos
Plaquetas/fisiologia , Ativação Plaquetária/fisiologia , Testes de Função Plaquetária/métodos , Animais , Aterosclerose/sangue , Hemostasia/fisiologia , Humanos , Inflamação/sangue , Agregação Plaquetária/fisiologia , Testes de Função Plaquetária/tendências , Trombose/sangueAssuntos
Testes de Função Plaquetária/métodos , Tromboelastografia/métodos , Grânulos Citoplasmáticos/fisiologia , Elasticidade , Hemostasia/fisiologia , Humanos , Ativação Plaquetária/efeitos dos fármacos , Ativação Plaquetária/fisiologia , Testes de Função Plaquetária/instrumentação , Glicoproteínas da Membrana de Plaquetas/fisiologia , Sistemas Automatizados de Assistência Junto ao Leito , Resistência ao Cisalhamento , Tromboelastografia/instrumentação , Ultrassonografia/instrumentação , Ultrassonografia/métodos , ViscosidadeRESUMO
BACKGROUND: Hemostasis of patients suffering from liver cirrhosis is challenging due to both, pro- and anticoagulatory disorders leading to hemostatic alterations with distinct abnormalities of coagulation. Pathological changes in conventional coagulation analysis and platelet count are common manifestations of decreased liver synthesis of coagulation factors and reduced platelet count in these patients. However, conventional coagulation analysis and platelet count do not reflect in-vivo coagulation status or platelet function. The purpose of this present observational study was therefore to assess the haemostatic profile including plasmatic coagulation using thrombelastometry and impedance aggregometry for platelet function in patients suffering from liver cirrhosis. AIM: To assess the hemostatic profile of cirrhotic patients according to model for end-stage liver disease (MELD) score. METHODS: Our study included both in- and outpatients suffering from liver cirrhosis attending the out- and inpatient care of the department of hepatology. Demographic and biochemical data as well as medical history including cause of liver cirrhosis, end stage kidney failure and medication with anticoagulants were recorded. To assess the hemostatic profile, platelet function was analyzed by multiple electrode aggregometry (MEA) using Multiplate® (ADP-, ASPI- and TRAP-test) and thrombelastometry using ROTEM® (EXTEM, INTEM, FIBTEM). Data were compared using Mann-Whitney U- or χ 2-test. Spearman correlation was performed to analyze the association between MELD Score and results of thrombelastometry and MEA. RESULTS: A total of 68 patients attending the out- and inpatient care suffering from liver cirrhosis were screened. Of these, 50 patients were included and assigned to groups according to MELD score 6 to 11 (n = 25) or ≥ 17 (n = 25). Baseline patient characteristics revealed significant differences for MELD score (8 vs 22, P < 0.0001) and underlying laboratory parameters (international normalized ratio, bilirubine, creatinine) as well as fibrinogen level (275 mg/dL vs 209 mg/dL, P = 0.006) and aPTT (30 s vs 35 s, P = 0.047). MEA showed a moderately impaired platelet function (medians: AUCADP = 43U, AUCASPI = 71U, AUCTRAP = 92U) but no significant differences between both groups. Thrombelastometry using ROTEM® (EXTEM, INTEM, FIBTEM) revealed values within normal range in both groups. No significant correlation was observed between MELD score and results of MEA/thrombelastometry. CONCLUSION: Our data demonstrate a partially impaired hemostatic profile in liver cirrhosis patients unrelated to MELD score. An individual assessment of a potential coagulopathy should therefore be considered.
Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Plaquetas/fisiologia , Doença Hepática Terminal/diagnóstico , Hemostasia/fisiologia , Cirrose Hepática/sangue , Idoso , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Doença Hepática Terminal/sangue , Doença Hepática Terminal/patologia , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Tromboelastografia/estatística & dados numéricosRESUMO
Horses with clinical signs of unprovoked or excessive hemorrhage should be evaluated for underlying platelet defects or coagulopathies. This article provides an overview of preliminary screening and definitive tests to assess coagulation and identify hemostatic defects in horses, as well as a review of the hemostatic disorders most frequently encountered in clinical practice.
Assuntos
Transtornos da Coagulação Sanguínea/veterinária , Doenças dos Cavalos/sangue , Cavalos/sangue , Animais , Coagulação Sanguínea , Transtornos da Coagulação Sanguínea/sangue , Fibrinólise/fisiologia , Hemorragia/sangue , Hemorragia/veterinária , Hemostasia/fisiologia , Doenças dos Cavalos/diagnósticoAssuntos
Hemostasia/fisiologia , Doenças de von Willebrand/tratamento farmacológico , Fator de von Willebrand/uso terapêutico , Idoso , Angiodisplasia/complicações , Angiodisplasia/fisiopatologia , Desamino Arginina Vasopressina/uso terapêutico , Fator VIII/metabolismo , Feminino , Hemostáticos/uso terapêutico , Humanos , Infusões Intravenosas/métodos , Pessoa de Meia-Idade , Testes de Função Plaquetária/métodos , Resultado do Tratamento , Doenças de von Willebrand/complicações , Doenças de von Willebrand/genética , Doenças de von Willebrand/fisiopatologia , Fator de von Willebrand/administração & dosagem , Fator de von Willebrand/metabolismoRESUMO
BACKGROUND: Rapid assessment of hemostasis during postpartum hemorrhage (PPH) is essential to allow characterization of coagulopathy, to estimate bleeding severity, and to improve outcome. Point of care (POC) coagulation monitors could be of great interest for early diagnosis and treatment of coagulation disorders in PPH. METHODS: Women with ongoing PPH >500 mL who clinically required an assessment of coagulation with thromboelastography (TEG) were included. The primary aim of this retrospective observational cohort study was to assess the predictive accuracy of TEG parameters for the diagnosis of coagulation disorders (hypofibrinogenemia ≤2 g/L, thrombocytopenia ≤80,000/mm, prothrombin ratio ≤50%, or activated partial thromboplastin time ratio ≥1.5) during PPH. The analyzed TEG parameters were Kaolin-maximum amplitude (K-MA), Kaolin-maximum rate of thrombus generation using G (K-MRTGG), functional fibrinogen-maximum amplitude (FF-MA), and functional fibrinogen-maximum rate of thrombus generation using G (FF-MRTGG). Secondary aims of this study were (1) comparison of the time delay between classical parameters and velocity curve-derived parameters (K-MA versus K-MRTGG and FF-MA versus FF-MRTGG) and (2) evaluation of the accuracy of TEG parameters to predict severe hemorrhage estimated by calculated blood losses. RESULTS: Ninety-eight patients were included with 98 simultaneous TEG analyses and laboratory assays. All parameters had an excellent predictive performance. For the Kaolin assay, no significant difference was evidenced between K-MA and K-MRTGG for the predictive performance for hypofibrinogenemia ≤2 g/L and/or thrombocytopenia ≤80,000/mm (respective area under the curve [AUC], 0.970 vs 0.981). For the functional fibrinogen assay, no significant difference was evidenced between FF-MA and FF-MRTGG for the predictive performance for hypofibrinogenemia ≤2 g/L (respective AUC, 0.988 vs 0.974). For both assays, the time to obtain results was shorter for the velocity parameters (K-MRTGG: 7.7 minutes [2.4 minutes] versus K-MA: 24.7 minutes [4.2 minutes], P < .001; FF-MRTGG: 2.7 minutes [2.7 minutes] versus FF-MA: 14.0 minutes [4.3 minutes], P < .001). All TEG parameters derived from the Kaolin and functional fibrinogen assays and Clauss fibrinogen were significantly predictive of severe PPH >2500 mL. CONCLUSIONS: During PPH, when coagulation assessment is indicated, TEG provides a rapid and reliable detection of hypofibrinogenemia ≤2 g/L and/or thrombocytopenia ≤80,000/mm. No difference in performance was evidenced between the velocity-derived parameters (K-MRTGG and FF-MRTGG) and the classical parameters (K-MA and FF-MA). However, velocity-derived parameters offer the advantage of a shorter time to obtain results: FF-MRTGG parameter is available within ≤5 minutes. POC assessment of hemostasis during PPH management may help physicians to diagnose clotting disorders and to provide appropriate hemostatic support.
Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Coagulação Sanguínea/fisiologia , Hemorragia Pós-Parto/diagnóstico , Tromboelastografia/métodos , Adulto , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/fisiopatologia , Estudos de Coortes , Feminino , Hemostasia/fisiologia , Humanos , Hemorragia Pós-Parto/sangue , Hemorragia Pós-Parto/fisiopatologia , Gravidez , Estudos Retrospectivos , Tromboelastografia/normasRESUMO
BACKGROUND: TEG6S® and TEG5000® (Haemonetics Corp, USA) are haemostasis analysers that measure viscoelasticity properties of whole blood. Both use different mechanisms to assess similar components of the coagulation process. The aim of this study was to assess agreement and interchangeability between the TEG6S and TEG5000 analysers. METHODS: 3.5 mL whole blood was collected from 25 adult patients in a tertiary intensive care unit (ICU). Analysis was performed using TEG6S and TEG5000 haemostatic platforms. Agreement between platforms was measured using Lin's concordance coefficient (Lin's CC), further validated using intraclass correlation coefficients and reduced major axis regression (RMAR). RESULTS: Sixteen (64%) patients were male; mean (range) age: 59yo (23-86). TEG6S and TEG5000 systems were broadly interchangeable. The majority of TEG variables demonstrated almost perfect or substantial agreement and minimal proportional bias (maximum amplitude demonstrated a fixed bias). LY30%, however, demonstrated poor agreement and a proportional bias. Lin's CC coefficients (95% CI, RMAR slope, intercept) between TEG6S and TEG5000 variables were: R time: 0.78 (0.64-0.92, 0.76, 0.92); K time: 0.82 (0.69-0.94, 1.30, - 0.93); alpha angle: 0.79 (0.64-0.95, 1.04, - 1.43); maximum amplitude (MA): 0.90 (0.83-0.96, 0.99, - 5.0); LY30%: 0.34 (0.1-0.58, 0.43, 0.04). CONCLUSIONS: Adult patients with critical illness demonstrate almost perfect agreement in the R time and MA, substantial agreement in K time and alpha angle, but poor agreement in LY30%, as measured by the TEG6S and TEG5000 analysers. With the exception of LY30%, the TEG6S and TEG5000 platforms appear interchangeable. This has important implications for use in clinical practice and multi-site research programs. TRIAL REGISTRATION: ANZCRT number: 12617000062325 , registered 12/Jan17. Retrospectively registered.
Assuntos
Coagulação Sanguínea/fisiologia , Estado Terminal/terapia , Hemostasia/fisiologia , Tromboelastografia/métodos , Tromboelastografia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Risk analysis consists in identification, scoring and ranking of risks in order to manage the major risks. The aim of the study is to determine the risk analysis of the pre-analytical step of routine hemostasis in Hematological laboratory of CHU Ibn Rochd-Casablanca, Morocco. MATERIAL AND METHODS: The identification of pre-analytical activities of routine hemostasis was extensively realized according to a "by-proccess" methodology. According to "5M" analysis, we identified the risks associated with these activities. Therefore, the scoring of each risk was realized according to «AMDEC¼ methodology, by the staff of hematological laboratory. Risks were classified according to their severity and the major were identified using "Pareto diagram". RESULTS: Forty eight risks were identified in 15 activities. Identity monitoring (13.7%), pre-analytical storage of samples (13.4%), pre-analytical treatment, including centrifugation (12.9%) and transport to the laboratory (11.3%) represented the activities that exhibited the highest level of risk. Using "Pareto diagram", we retained 19 major risks, related to medical prescription, identity monitoring, transport to the laboratory, pre-analytical treatment of samples and IT processing. DISCUSSION AND CONCLUSION: Risk analysis allowed the identification of 19 major risks out of 48 identified risks, related to the pre-analytical step of routine hemostasis. These 19 major risks needed a plan to reduce their criticity.
Assuntos
Testes Diagnósticos de Rotina , Testes Hematológicos , Hemostasia/fisiologia , Fase Pré-Analítica , Gestão de Riscos , Estudos Transversais , Erros de Diagnóstico/estatística & dados numéricos , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Testes Hematológicos/métodos , Testes Hematológicos/normas , Testes Hematológicos/estatística & dados numéricos , Humanos , Laboratórios/normas , Marrocos/epidemiologia , Fase Pré-Analítica/métodos , Fase Pré-Analítica/normas , Fase Pré-Analítica/estatística & dados numéricos , Fatores de Risco , Gestão de Riscos/métodos , Gestão de Riscos/normas , Gestão de Riscos/estatística & dados numéricosRESUMO
BACKGROUND: Risk factors for bleeding complications after percutaneous kidney biopsy (PKB) and the role of primary hemostasis screening are not well established. OBJECTIVES: To determine the role of primary hemostasis screening and complication outcomes among individuals who underwent PKB. METHODS: We reviewed data of 456 patients who underwent PKB from 2010 to 2016 in a large university hospital. In 2015, bleeding time (BT) testing was replaced by light transmission aggregometry (LTA) as a pre-PKB screening test. RESULTS: Of the 370 patients who underwent pre-PKB hemostasis screening by BT testing, prolonged BT was observed in 42 (11.3%). Of the 86 who underwent LTA, an abnormal response was observed in 14 (16.3%). Overall, 155 (34.0%) patients experienced bleeding: 145 (31.8%) had minor events (hemoglobin fall of 1-2 g/dl, macroscopic hematuria, perinephric hematoma without the need for transfusion or intervention) and 17 (3.7%) had major events (hemoglobin fall > 2 g/dl, blood transfusion or further intervention). Abnormal LTA response did not correlate with bleeding (P = 0.80). In multivariate analysis, only prolonged BT (P = 0.0001) and larger needle size (P = 0.005) were identified as independent predictors of bleeding. CONCLUSIONS: Bleeding complications following PKB were common and mostly minor, and the risk of major bleeding was low. Larger needle size and prolonged BT were associated with a higher bleeding risk. Due to the relatively low risk of major bleeding and lack of benefit of prophylactic intervention, the use of pre-PKB hemostasis screening remains unestablished.
Assuntos
Biópsia/efeitos adversos , Testes de Coagulação Sanguínea/métodos , Rim/patologia , Programas de Rastreamento/métodos , Hemorragia Pós-Operatória/epidemiologia , Medição de Risco/métodos , Adulto , Feminino , Hemostasia/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de RiscoAssuntos
Estenose da Valva Aórtica/fisiopatologia , Hemostasia/fisiologia , Agregação Plaquetária/fisiologia , Fator de von Willebrand/fisiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Hemorreologia/fisiologia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Conformação Proteica , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Fator de von Willebrand/químicaRESUMO
: Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of 'pass' or 'fail' is made. EQA provider members of the international organization, external quality assurance in thrombosis and hemostasis, took part in a study to compare outcome of performance analysis using the same data set of laboratory results. Eleven EQA organizations using eight different analytical approaches participated. Data for a normal and prolonged activated partial thromboplastin time (aPTT) and a normal and reduced factor VIII (FVIII) from 218 laboratories were sent to the EQA providers who analyzed the data set using their method of evaluation for aPTT and FVIII, determining the performance for each laboratory record in the data set. Providers also summarized their statistical approach to assignment of target values and laboratory performance. Each laboratory record in the data set was graded pass/fail by all EQA providers for each of the four analytes. There was a lack of agreement of pass/fail grading among EQA programs. Discordance in the grading was 17.9 and 11% of normal and prolonged aPTT results, respectively, and 20.2 and 17.4% of normal and reduced FVIII results, respectively. All EQA programs in this study employed statistical methods compliant with the International Standardization Organization (ISO), ISO 13528, yet the evaluation of laboratory results for all four analytes showed remarkable grading discordance.
Assuntos
Hemostasia/fisiologia , Laboratórios/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Humanos , Controle de QualidadeRESUMO
BACKGROUND: Bariatric surgery is associated with increased thromboembolic risk, which may extend well beyond hospital stay. The hemostatic mechanisms implicated in this risk are not well established. OBJECTIVES: We aimed to determine the dynamics of hemostatic changes and procoagulant potential among patients undergoing laparoscopic sleeve gastrectomy, during both the early and late postoperative periods. SETTING: A university hospital. METHODS: Patients who underwent laparoscopic sleeve gastrectomy were recruited consecutively to this study. Blood samples were taken preoperatively, before discharge (postoperative day [POD] 3), and at the first follow-up visit (POD10). All samples were tested for complete blood count, C-reactive protein, von Willebrand factor, factor VIII, fibrinogen, and thrombin generation. RESULTS: The median preoperative body mass index of the 26 participants was 41.3 (38.7-43.3) kg/m2. Compared with preoperative evaluation, fibrinogen, von Willebrand factor antigen and activity, and factor VIII levels were significantly higher at POD3 and POD10 (P<.0001 for all comparisons). Peak thrombin levels and endogenous thrombin potential (ETP) were higher at POD3 (P = .005 for both comparisons) and POD10 (P = .0009 and<.0001) compared with baseline. ETP and peak thrombin, as well as fibrinogen, von Willebrand factor, and factor VIII levels, were comparable between POD3 and POD10. Multivariate analysis showed that the only predictor of postoperative ETP was the preoperative ETP level (ß = .55, P = .007). CONCLUSIONS: As determined by thrombin generation, laparoscopic sleeve gastrectomy was associated with hypercoagulability, which persisted during POD10. This finding suggests a possible benefit of extended thromboprophylaxis. Nevertheless, our results should be interpreted with caution due to the lack of a control group.
Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Tromboembolia Venosa/prevenção & controle , Adulto , Contagem de Células Sanguíneas , Fatores de Coagulação Sanguínea/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Estudos Transversais , Feminino , Hemostasia/fisiologia , Humanos , Dispositivos de Compressão Pneumática Intermitente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Duração da Cirurgia , Trombina/biossíntese , Trombofilia/diagnóstico , Tromboembolia Venosa/enzimologiaRESUMO
BACKGROUND: Rotational elastometry (ROTEM) has been shown useful to monitor coagulation in trauma patients and in major elective surgery. In this study, we aimed to evaluate the utility of ROTEM to identify hemostatic disturbances and to predict the need for transfusion, compared with standard coagulation tests (SCTs) in patients undergoing emergent neurosurgery. METHODS: Over a four-year period, adult patients who met criteria for emergent neurosurgery lasting more than 90 min were included in the study. Blood was collected preoperatively and analyzed with SCTs (international normalized ratio [INR], fibrinogen concentration, prothrombin time [PT or Quick], partial thromboplastine time [PTT], fibrinogen concentration and platelet count), and ROTEM assays. Correlations between SCTs and ROTEM parameters as well as receiver operating characteristic curves were performed to detect a coagulopathic pattern based on standard criteria and the need for transfusing at least 3 units of packed red blood cells (PRBCs). RESULTS: In a cohort of 92 patients, 39 (42%) required ≥3 PRBCs and a coagulopathic pattern was identified in 32 patients based on SCTs and in 19 based on ROTEM. There was a strong correlation between PTT and INTEM coagulation time (R = 0.76) as well as between fibrinogen concentrations and FIBTEM maximal clot firmess (R = 0.70). The need for transfusion (≥ 3 PRBCs) was best predicted by the maximal clot firmess of EXTEM and FIBTEM (AUC of 0.72 and 0.71, respectively) and by fibrinogen concentration (AUC of 0.70). CONCLUSIONS: In patients undergoing emergent neurosurgery, ROTEM analysis provides valid markers of early coagulopathy and predictors of blood transfusion requirements.
Assuntos
Hemostasia/fisiologia , Procedimentos Neurocirúrgicos/métodos , Cuidados Pré-Operatórios/métodos , Rotação , Tromboelastografia/métodos , Adulto , Idoso , Testes de Coagulação Sanguínea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Haemostasis is of fundamental significance in neurosurgery, and insufficient control of bleeding is associated with morbidity and mortality. Topical haemostatic agents play an important role, as the characteristics of neuronal tissue limit the use of classical surgical haemostasis techniques. Appropriate choice of agent depends on the location and type of bleeding, but also on knowledge of the products' mechanisms of action, indications, price and accessibility. Biological products are superior to the mechanical in efficacy but require more preparation and are significantly more cost-intensive.
Assuntos
Hemostasia , Hemostáticos , Procedimentos Neurocirúrgicos/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Celulose Oxidada/administração & dosagem , Celulose Oxidada/economia , Celulose Oxidada/uso terapêutico , Colágeno/administração & dosagem , Colágeno/economia , Colágeno/uso terapêutico , Fibrina/administração & dosagem , Fibrina/economia , Fibrina/uso terapêutico , Hemostasia/efeitos dos fármacos , Hemostasia/fisiologia , Hemostáticos/administração & dosagem , Hemostáticos/economia , Hemostáticos/farmacocinética , Hemostáticos/uso terapêutico , Humanos , Peróxido de Hidrogênio/administração & dosagem , Peróxido de Hidrogênio/economia , Peróxido de Hidrogênio/uso terapêutico , Procedimentos Neurocirúrgicos/economia , Palmitatos/administração & dosagem , Palmitatos/economia , Palmitatos/uso terapêutico , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/economia , Cloreto de Sódio/uso terapêutico , Tampões de Gaze Cirúrgicos/economia , Trombina/administração & dosagem , Trombina/economia , Trombina/uso terapêutico , Ceras/economia , Ceras/uso terapêuticoRESUMO
On activation at sites of vascular injury, platelets undergo morphological alterations essential to hemostasis via cytoskeletal reorganizations driven by the Rho GTPases Rac1, Cdc42, and RhoA. Here we investigate roles for Rho-specific guanine nucleotide dissociation inhibitor proteins (RhoGDIs) in platelet function. We find that platelets express two RhoGDI family members, RhoGDI and Ly-GDI. Whereas RhoGDI localizes throughout platelets in a granule-like manner, Ly-GDI shows an asymmetric, polarized localization that largely overlaps with Rac1 and Cdc42 as well as microtubules and protein kinase C (PKC) in platelets adherent to fibrinogen. Antibody interference and platelet spreading experiments suggest a specific role for Ly-GDI in platelet function. Intracellular signaling studies based on interactome and pathways analyses also support a regulatory role for Ly-GDI, which is phosphorylated at PKC substrate motifs in a PKC-dependent manner in response to the platelet collagen receptor glycoprotein (GP) VI-specific agonist collagen-related peptide. Additionally, PKC inhibition diffuses the polarized organization of Ly-GDI in spread platelets relative to its colocalization with Rac1 and Cdc42. Together, our results suggest a role for Ly-GDI in the localized regulation of Rho GTPases in platelets and hypothesize a link between the PKC and Rho GTPase signaling systems in platelet function.