Application value of combined coagulation function indicators in monitoring hypercoagulable state of patients with colorectal cancer after chemotherapy / 中国癌症杂志

Background and purpose:The plasma used for routine coagulation test(CCT)can only reflect a single component at a certain coagulation time point/segment,while thromboelastography(TEG)can depict the overall dynamic process curve of coagulation and fibrinolysis,which can more independently and completely reflect the true state of the blood and can serve as a supplement to coagulation function testing.This study aimed to evaluate the application value of combined coagulation function indexes in monitoring the hypercoagulable state of patients with colorectal cancer after chemotherapy,and to explore the risk factors of thrombosis in patients with colorectal cancer after chemotherapy,so as to provide reference for clinical monitoring of hypercoagulable state.Methods:A total of 160 patients with colorectal cancer from Fudan University Shanghai Cancer Center from June 2021 to June 2023 were selected as the experimental group,and 80 healthy subjects were selected as the control group.Then the experimental group was divided into a group without thrombosis(82 cases)and a group with thrombosis(78 cases)according to whether they had thrombosis or not.The determinations of thromboelastography(TEG)[coagulation reaction time(R),coagulation formation time(K),blood clot formation rate(α-Angle),maximum amplitude(MA)and coagulation index(CI)],conventional coagulation tests(CCT)[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(Fib),D-dimer(DD),fibrinogen degradation products(FDP)]and platelet count(PLT)were studied among three groups.With or without thrombosis as the criterion of hypercoagulable state,statistically significant indicators were selected to be included in the binary logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of single and combined detection of the coagulation function indicators for hypercoagulable state in patients with colorectal cancer after chemotherapy.Basic information,tumor stage and Autar score of deep vein thrombosis were collected in 160 patients with colorectal cancer.Logistic regression analysis was performed to explore the risk factors of thrombosis.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(number:050432-4-2108*).Results:Compared with the control group,the R,TT and PLT of the group with thrombosis were decreased(P＜0.05),while APTT,PT,DD and FDP were increased(P＜0.05).The differences in various indicators between the group with thrombosis and the control group were statistically significant(P＜0.05).Compared with the group without thrombosis,the K in the group with thrombosis decreased(P＜0.05),while Angle,MA,CI,FIB,DD and FDP all increased(P＜0.05).ROC curve analysis showed that in the assessment of hypercoagulable state in patients with colorectal cancer after chemotherapy,the area under curve(AUC)of TEG was 0.756,sensitivity was 67.5%,and specificity was 73.8%.The AUC of CCT was 0.691,sensitivity was 78.8%,and specificity was 56.2%.The combined detection AUC was 0.840,sensitivity was 80.0%,and specificity was 77.5%.In the analysis of risk factors,tumor stage,distant metastasis and Autar score were correlated with thrombus formation in patients with colorectal cancer after chemotherapy(P＜0.05),and the differences of the three risk factors in K,Angle,MA,CI,Fib,DD and FDP were statistically significant(P＜0.05).Conclusion:K,Angle,MA,CI,Fib,DD and FDP are the main indicators to reflect the hypercoagulable state,and the combined detection of TEG and CCT can better reflect the coagulation state of patients with colorectal cancer after chemotherapy.Tumor stage Ⅲ to Ⅳ,distant metastasis and high Autar score are risk factors for thrombosis.The incidence of thrombosis can be reduced by monitoring the relevant coagulation indicators in the high-risk population.

Comparative Analysis of Thromboelastogram and Coagulation Items in Mongolian Patients with Thrombosis / 中国实验血液学杂志

OBJECTIVE@#To investigate the age distribution of Mongolian patients with cerebral infarction caused by thrombosis and the correlation and consistency between thromboelastography (TEG) and four parameters of coagulation.@*METHODS@#The age distribution of 298 Mongolian patients with cerebral infarction treated in Affiliated Hospital of Inner Mongolia Minzu University from January 2020 to December 2021 and their TEG, four items of routin coagulation and platelet count were analyzed retrospectively. The correlation and consistency of above-mentioned two detection methods were statistically analyzed.@*RESULTS@#The onset age of 298 Mongolian patients with cerebral infarction was mainly 61-70 years old, accounting for 38.3%, followed by 51-60 years old, accounting for 26.8%. The R time detected by TEG was linearly correlated with PT and APTT（r=0.186，r=0.152）. K value, MA value and α-Angle measured by TEG was linearly correlated with Fib (r=-0.364，r=0.616，r=0.359), K value, MA value and α-Angle measured by TEG was linearly correlated with Plt (r=0.318，r=0.519，r=0.301). The R time detected by TEG was consistent with PT and APTT, and the Kappa values were 0.252 (P<0.001), 0.336 (P<0.001). K, MA, and α-Angle measured by TEG was consistent with Fib, the Kappa values were 0.265 (P<0.001), 0.289 (P<0.001) and 0.290 (P<0.001), respectively; K、MA and α-Angle measured by TEG was consistent with Plt, the Kappa values were 0.276 (P<0.001), 0.285 (P<0.001) and 0.302 (P<0.001), respectively.@*CONCLUSION@#The onset age of Mongolian patients with cerebral infarction caused by thrombosis is mainly 61-70 years old, followed by 51-60 years old. The onset age shows a younger trend. There is a significant correlation between TEG and coagulation, but the consistency is weak, therefore, the two methods can not be replaced each other.

Correlation betweenthromboelastography and routine coagulation tests in malignant tumor patients / 中国输血杂志

【Objective】 To investigate the correlation between preoperative thromboelastography (TEG) parameters and routine coagulation tests of malignant tumor patients. 【Methods】 A total of 79 patients with malignant tumors, receiving preoperative TEG tests and routine coagulation tests between January 2019 and June 2020, were included. The correlation and regression between coagulation indexes and TEG parameters were analyzed. 【Results】 In patients with malignant tumors, the coagulation time(K) was negatively correlated with Plt and fibrinogen (FIB), while Angle, Ma, and G were respectively positively correlated with Plt and FIB. 【Conclusion】 There is a correlation between preoperative TEG parameters and routine coagulation tests in patients with malignant tumors. There is complementarity but not reciprocal substitutability between these two tests.

Evaluation and comparison of thromboelastography and conventional coagulation tests for blood coagulation function in children with Kasabach-Merritt syndrome / 中国输血杂志

【Objective】 To evaluate the coagulation function of children with Kasabach-Merritt syndrome(KMS)by thromboelastography (TEG) and conventional coagulation tests (CCTs), and to explore the correlation and consistency of the 2 test methods. 【Methods】 A total of 49 children with KMS, submitted to our hospital from January 2016 to December 2020, were enrolled. The TEG, CCTs data and platelet count were analyzed to evaluate the coagulation function, and the superiority of the 2 test methods were compared by Spearman correlation and Kappa consistency analysis. 【Results】 TEG and CCTs showed that the coagulation reaction time(R) was normal, the counts and function of platelet and fibrinogen decreased, and the D-dimer increased. The coagulation complex index (CI) indicated that the whole coagulation function was low. There was no significant difference in coagulation by sex or age in KMS children. The correlation analysis of TEG and CCTs in the coagulation function of KMS children showed that R was correlated with prothrombin time (PT) and activated partial thromboplastin Time(APTT), respectively (P<0.01); Fib had weak correlation with clot formation time (k)(r2=0.33), but strongly correlated with α-angle and MA value(r2=0.7, 0.69), respectively (P<0.01). PLT was moderately correlated with MA(r2=0.49, P<0.05); D-dimer had no correlation with LY30. Comparision resu lts of the consistency of TEG and CCTs showed that FIB and MA had consistency ( kappa=1, P<0.01); None or weak consistency was noticed among other indicators, R with PT/APTT, the kappa was 0.18 and 0.19; Fib with K/α-Angle, the kappa was 0.28 and 0.34; D-dimer with LY30, the kappa was 0.01; PLT with MA, the kappa was 0.35. 【Conclusion】 The main manifestations in low coagulation function in children with KMS were mainly thrombocytopenia, lower fibrinogen, and increased fibrinogen degradation-products, and the coagulation factors were normal. Except for Fib and MA, the consistency of other indexes in the detection of coagulation function in children with KMS by TEG and CCT is weak. Some indexes are significantly correlated but others not. Therefore, the 2 test methods are irreplaceable and should be combined to reduce the risk of embolism and bleeding in children.

Correlation analysis of thromboelastogram and routine coagulation test in the detection of cerebrovascular diseases / 中国输血杂志

【Objective】 To explore the changes of parameters of thromboelastogram (TEG) detection in patients with cerebral infarction and cerebral hemorrhage, and their correlation with routine coagulation indicators, and compare the two methods in detecting coagulation function and status in patients with cerebrovascular disease. 【Methods】 The detection data of 34 cases of cerebral infarction and 102 cases of cerebral hemorrhage, who underwent TEG and routine coagulation test in parallel, in Department of Neurosurgery of our hospital from January 1, 2018 to March 26, 2019 were collected. Fifty healthy subjects, who underwent TEG and routine coagulation tests in the same period, served as the control. The results of TEG and routine coagulation test of the 3 groups were compared and analyzed. 【Results】 Compared with cerebral hemorrhage (group) and the control, R value of cerebral infarction group decreased significantly, while the Angle angle, MA distance, CI value, Fib and D-D levels increased significantly(P<0.05); the K value, Fib, TT, and D-D of cerebral hemorrhage group increased significantly while Angle angle and MA distance decreased significantly compared with other two groups(P<0.05). The R value, K time (min), TT (s), D-D (mg/L), Angle angle (°), MA distance, CI value, and Fib (mmg/L) of cerebral infarction and cerebral hemorrhage group were 5.06±1.71 vs 6.95±4.34, 1.19±0.68 vs 3.43±1.46, 13.89±1.05 vs 18.63±1.25, 1.93±0.25 vs 2.63±0.45, 69.34±10.37 vs 56.54±10.48, 68.34±9.37 vs 54.35±7.48, 2.20±0.31 vs 0.78±0.41, and 380±70.02 vs 354±71.56 (P<0.05). In cerebral infarction group, the R value, APTT, Angle angle, MA, and CI values were positively correlated with Fib (P<0.05); while K time was negatively correlated with Fib ; MA distance with PT/TT; CI value with PT/APTT(P<0.05). In the cerebral hemorrhage group, the R value was positively correlated with PT/APTT; K time with TT; Angle with Fib (P<0.05); R value/K time were negatively correlated with Fib; Angle with TT; CI value with PT (P<0.05). 【Conclusion】 For patients with cerebrovascular disease, there is no correlation between TEG indicators and the D-D level of routine coagulation tests; the Angle angle of patients with cerebrovascular disease is positively correlated with the elevated Fib; and MA distance is more useful for diagnosing cerebral infarction than cerebral hemorrhage. TEG is complementary to routine coagulation test, and can be used as a laboratory index for assessing the severity of cerebrovascular disease.

Influência do tempo de centrifugação em testes de coagulação: tempo de protrombina e tempo de tromboplastina parcial / Influence of the centrifuge time in coagulation tests: prothrombin time and partial thromboplastin time

Objetivo: Analisar os testes de coagulação: tempo de protrombina (TP) e tempo de tromboplastina parcial (TTP) em diferentes tempos de centrifugação da amostra da biológica, com relação ao protocolo padrão do Clinical Laboratory Standards Institute (CLSI). Métodos: As amostras foram divididas em cinco alíquotas de 1 mL. Foi realizada a centrifugação em 15, 10, 5, 2 e 1 minuto, com velocidade de 1500 g. O TP e TTP foram imediatamente analisados em aparelho automatizado. Os plasmas foram analisados para presença de elementos residuais: eritrócitos, leucócitos e plaquetas. Resultados: Observou-se alteração dos valores do TP nos tempos de centrifugação 10, 5, 2 e 1 minuto e do TTP em 5, 2 e 1 minuto, com relação ao protocolo padrão. Na interpretação de Bland Altman, observou-se um viés significativo do limite clínico aceitável para o TP e para o TTP em todos os tempos de centrifugação, com relação ao protocolo padrão. Apenas no tempo de centrifugação de 15 minutos não foram encontradas células residuais nas amostras analisadas. Conclusão: O tempo de centrifugação de 15 minutos é o ideal para remoção completa das células sanguíneas residuais e para garantia da confiabilidade dos resultados dos testes de coagulação TP e TTP.

Objective: To analyze the coagulation tests: prothrombin test (PT) and partial thromboplastin time (PTT) in different centrifugation times of the sample, in relation to the standard protocol of the Clinical Laboratory Standards Institute (CLSI). Methods: The selected samples were splitted up into five aliquots of 1 mL. Centrifugation of these aliquots was carried out at 15, 10, 5, 2 and 1 minute at 1500 g. The PT and PTT were analyzed in an automated apparatus. The plasmas were analyzed for presence of residual elements: erythrocytes, leukocytes and platelets. Results: The results showed a change in the values of PT at the 10, 5, 2 and 1 minute centrifugation times and the PTT at 5, 2 and 1 minutes, relative to the standard protocol. In the interpretation of Bland Altman, a significant bias of the acceptable clinical limit for TP and TTP at all centrifugation times was observed, relative to the standard protocol. Only in the 15 minute centrifugation time no residual cells were found in the analyzed samples. Conclusion: The present study demonstrated that the 15-minute centrifugation time is ideal for complete removal of residual blood cells and to ensure the reliability of the results of the PT and PTT coagulation

Improvement of preanalytical screening interference on coagulation tests by auto checking system / 中华检验医学杂志

Objective@#To investigate the potential improvement of sample quality by automatic pre-analysis sample checking system, comparing to visual inspection for coagulation tests routinely.@*Methods@#Thirty samples with hemolysis, Icteric and lipemia in different levels were prepared and issued to 13 technicians for visual check, to evaluate the consistency individually. 2 949 blood samples with order for coagulation test were collected in Beijing Chaoyang Hospital in April and May 2018, the quality of all samples was evaluated by both visual check and automatic sample quality checking system before analysis, performance of two measurements detecting hemolysis, lipid, icteric or clot was compared.@*Results@#Significant differences were found in visual check among operators. The Kappa coefficients in three randomly selected groups were 0.32, 0.26 and 0.38 respectively, indicating that the consistency of visual check was poor. Among all investigated samples, 3 samples with unacceptable interference were detected visually, including 2 samples with hemolysis and another one with lipemia. On the other hand, 19 unqualified samples were identified by automatic checking system. Five types of interference of unqualified samples were detected as icteric (26.32%,5/19), clot (21.05%,4/19) hemolysis (5.26%,1/19),lipemia (36.84%, 7/19), and hemolysis with lipemia (10.53%,2/19) respectively by automatic checking system. But one case of hemolysis sample rejected by visual check was not rejected by automatic sample quality checking system.7 samples were merely affected on D-dimer by lipemia, which level did not influence the results of prothrombin time(PT) and activated partial thromboplastin time (APTT). Notably, other two samples were interfered with not only tests of PT, APTT and fibrinogen by hemolysis, but also D-dimer by the considerable level of lipemia, which showed the superiority of test-specific quality checking features.@*Conclusions@#The automatic pre-analysis sample quality checking system can improve the detection rate of unqualified samples and improve the efficiency of routine, helping realization of total quality management.

Performance Evaluation and Local International Sensitivity Index Verification Using Automated Coagulation Analyzer Coapresta 2000

BACKGROUND: The Coapresta 2000 (CP2000; Seikisui, Japan) system is a fully-automated random-access multiparameter coagulation analyzer equipped with a photo-optical clot detection unit. It can perform clotting time assays as well as colorimetric assays. METHODS: We evaluated the analytical performance of CP2000 for several coagulation test parameters and compared its performance with that of the CA-7000 (Sysmex, Japan) system. Fresh and frozen plasma samples were used to evaluate the performance of CP2000 with respect to four routine coagulation test parameters: prothrombin time (PT), activated partial thromboplastin time, fibrinogen, and D-dimer. On-board stability of the liquid reagents was confirmed. Additionally, local international sensitivity index (ISI) verification was performed with four levels of calibrants and direct PT/international normalized ratio (INR) line. RESULTS: The intra- and inter-assay coefficients of variation were below 5% for every parameter in both normal and pathological ranges. Carryover was not detected. The results obtained using CP2000 showed good correlation (r 2 over 0.95) with those obtained by the CA-7000 analyzer. On-board stability in open-vial state, which was expected to be much longer than that of other reagents, was confirmed. Local verification of ISI showed an acceptable bias range of INR, compared with the values using calibrants. CONCLUSIONS: The high-throughput, CP2000 analyzer is a fast, user-friendly system with long on-board reagent stability. Its results were concordant with the CA-7000 analyzer, for analysis of the routine coagulation test parameters. Furthermore, this system would add greater confidence to the reporting of INR data.

Study on change rule of coagulation related indexes in patients with acute cerebral infarction / 国际检验医学杂志

Objective To research the change rule of indexes of thromboelastography (TEG) ,conventional coagulation test and platelet(PLT) count in the patients with acute cerebral infarction .Methods Eighty-two patients with acute cerebral infarction were selected as the disease group and divided into the mild group (35 cases) ,moderate group (30 cases ) and severe group (17 cases ) according to the disease severity .Other 42 healthy subjects undergoing the physical examination were collected as the control group .The TEG indexes (R ,K ,A ,MA) ,conventional coagulation test (PT ,APTT ,FIB) and PLT count were measured .Then the cor-relation analysis was performed .Results Compared with the control group ,R and K in the disease group , mild ,moderate and severe groups the different disease group were decreased ,while A ,MA and FIB were in-creased ,the differences were statistically significant (P<0 .05);K ,A and APTT had statistical difference be-tween the severe group and moderate group(P<0 .05);R was positively correlated with PT ,APTT and PLT (r=0 .606 ,0 .303 ,0 .179 ,P<0 .05);K was positively correlated with PT and negatively correlated with FIB (r=0 .217 ,-0 .212 ,P< 0 .05);A was negatively correlated with PT and positively correlated with FIB (r= -0 .259 ,0 .228 ,P<0 .05);MA was positively correlated with FIB and PLT (r=0 .297 ,0 .165 ,P<0 .05) . Conclusion The blood in the patients with acute cerebral infarction is in hypercoagulable state .Compared with the conventional coagulation test ,TEG can earlier reflect the body′s coagulation function abnormalities and has a certain help for judging the severity of the disease .TEG has a certain correlation with conventional coagulation test indexes and PLT .

Application of simplified adjustment formula for coagulation test in individuals with erythrocytosis / 临床检验杂志

Objective To explore a simplified method of coagulation test for the individuals with erythrocytosis. Methods The antico-agulants, blood volume and fixed blood collecting volume were adjusted by the formula: anticoagulants (mL)＝(100－HCT×100)× blood (mL)×0.001 85. A total of 124 blood samples for coagulation testing in which the calcium ( Ca2+) interval was designated and hematocrit (HCT) was more than 55% were tested with calibrated anticoagulants, adjusted blood volume and fixed blood collection vol-ume [anticoagulant(mL)/0.055 5]. The results of plasma prothrombin time (PT), international standardization ratio (INR) and acti-vated partial thromboplastin time (APTT) before and after adjustment were compared. The results of the samples from 3 groups after adjustment were also compared. The relationship of HCT with unadjusted PT and APTT were simultaneously observed. Results The unadjusted results of PT, INR and APTT were significantly higher than those after anticoagulants adjustment (27.52±16.37 vs 12.49± 1.35, 2.31±1.47 vs 0.99±0.11 and 50.09±13.32 vs 33.37±5.05) with statistically significant difference in paired comparison (P＜0.05). No statistical difference was found in the comparison of the results for PT, INR and APTT after adjustment within the 3 groups ( PT: 12.49±1.35 vs 12.84±1.54 vs 12.82±1.76, INR:0.99±0.11 vs 1.02±0.13 vs 1.02±0.15, APTT: 33.37±5.05 vs 33.49±5.09 vs 32.83±5.06) (P＞0.05). HCT values of the patients were positively correlated with unadjusted PT (r＝0.461, P＜0.05) and APTT (r＝0.571, P＜0.05). Conclusion The coagulation test of the individuals with erythrocytosis may use to adjust the blood volume and the fixed blood collection volume provided calcium concentration in reference interval.

Thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in acute ischemic stroke: an association study / 中华神经医学杂志

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

Thromboelastography and routine coagulation test in short -term prognosis of acute cerebral infarction / 中华神经医学杂志

Objective To investigate the differences of thromboelastography (TEG) and routine coagulation test in evaluating the coagulation function of patients with acute cerebral infarction before antithrombotic therapy, and to evaluate the short-term prognosis of these two methods and their application values in guiding clinical intervention treatment. Methods The clinical data of 99 patients with acute cerebral infarction, admitted to our hospital from October 2016 to March 2018, were retrospectively analyzed. At admission, patients were assessed by TEG and routine coagulation test. All patients were assessed by National Institutes of Health Stroke Scale (NIHSS) at admission and 7 d after antithrombotic therapy and modified Rankin scale (mRS) at discharge. According to NIHSS scores, the patients were divided into neurological function poor prognosis group (NIHSS scores being decreased by less than 18％ or being increased, n=49) and neurological function good prognosis group (NIHSS scores being decreased more than 18％, n=50). According to mRS scores, the patients were divided into living ability good prognosis group (mRS scores being less than/ equal to 2, n=68) and living ability poor prognosis group (mRS scores being more than 3, n=27). When grouping patients with the above two scoring scales, the differences of coagulation functions between TEG and routine coagulation test were compared. The risk factors and protective factors affecting the neurological function and living ability of patients were analyzed using binary Logistic regression analysis, and receiver-operator characteristic (ROC) curve of the subjects was plotted. Results (1) In TEG indexes, response time of coagulation (R), α angle, maximum amplitude (MA), and composite index (CI) were significantly different between the neurological function poor prognosis group and neurological function good prognosis group (P<0.05), while in conventional coagulation test, only thrombin time (TT) and fibrinogen (Fib) level were significantly different between the neurological function poor prognosis group and neurological function good prognosis group (P<0.05). In TEG indexes, coagulation time (K), α angle, MA, and CI were significantly different between the living ability poor prognosis group and living ability good prognosis group (P<0.05), while in conventional coagulation test, only antithrombase III (AT III) and Fib level were significantly different between the living ability poor prognosis group and living ability good prognosis group (P<0.05). (2) Binary Logistic regression analysis showed that Fib was an independent risk factor for living ability poor prognosis in patients with cerebral infarction (OR=0.080, 95％ CI: 0.009-0.693, P=0.022); AT III was a protective factor for living ability good prognosis (OR= 1.174, 95％ CI: 1.010-1.366, P=0.037); however, all parameters of routine coagulation test showed no signficant difference in Logistic regression analysis of prognosis of neurological function (P>0.05), and all parameters of TEG had no statistical significance in Logistic regression analysis of prognosis of neurological function and prognosis of life ability (P>0.05). (3)ROC curve analysis showed that TT=17.3 s was the best diagnostic threshold for good prognosis of neurological function and poor prognosis of neurological function (area under curve [ACU]=0.738, sensitivity=94.7％, specificity=52.4％) and AT III=72.1％ was the best diagnostic threshold for good prognosis of living ability and poor prognosis of living ability (ACU=0.740, sensitivity=95.8％, specificity= 61.5％); in ROC curve analysis of prognoses of neurological function and living ability, ACU of TEG indexes were all smaller than those of TT and AT III. Conclusion TEG is more sensitive and comprehensive than routine coagulation test in evaluating early changes of coagulation function and predicting short-term prognosis after antithrombotic therapy in patients with acute cerebral infarction, while routine coagulation test has higher application value in guiding clinical intervention treatment.

Generalidades del sistema de la coagulación y pruebas para su estudio / Overwiew of the Coagulation System and laboratory tests for its study

En la década de los años sesenta, se describió la cascada de la coagulación como una secuencia de eventos enzimáticos iniciada por dos vías, la intrínseca y la extrínseca, las cuales convergían en una vía común para generar una enzima multifuncional, denominada trombina. La principal función de esta enzima consistía en transformar el fibrinógeno, en fibrina, una proteína que se polimeriza espontáneamente para formar la base estructural del coágulo. Posteriormente, se propuso el Modelo Celular según el cual la coagulación no es la consecuencia de vías de activación enzimáticas secuenciales, sino de una red de interacciones entre proteínas plasmáticas y transmembranas, así como, varios tipos celulares, que permiten la formación de complejos enzimáticos altamente eficientes con la finalidad de generar trombina. Esta revisión explica en detalle ambos enfoques, además, aborda las diferentes funciones que cumple la trombina dentro de la hemostasia y los mecanismos de inhibición que regulan la coagulación. Finalmente, se describen diferentes pruebas empleadas en la actualidad para evaluar la funcionalidad del sistema de coagulación, como: el tiempo de tromboplastina parcial activado, el tiempo de protrombina, el tiempo de trombina, el tiempo de reptilasa, el tiempo de coagulación por ecarina y el uso de sustratos cromogénicos para evaluar cada factor de la coagulación. Finalmente, dado a que la generación de trombina es clave dentro de la coagulación y a que el potencial de generar trombina puede indicar propensión a desarrollar eventos trombóticos o hemorrágicos, en este trabajo se presentan los métodos existentes para determinar la generación de trombina.

In the sixties, the clotting cascade was proposed, which describes the coagulation process as a sequence of enzymatic events initiated by two different pathways, the intrinsic and the extrinsic pathways, converging on a common pathway, to generate a multifunctional enzyme, thrombin, whose main function is to convert fibrinogen into fibrin, a protein that polymerizes spontaneously to form the building block of a hemostatic clot. Later, it was proposed a cell-based model of the hemostasis according to that coagulation does not occur as a consequence of linear sequential enzyme activation pathways, but rather via a network of simultaneous interactions between plasmatic and transmembrane proteins, as well as several cellular types, that allow the formation of highly efficient enzymatic complexes that lead to thrombin generation. In this review, we summarize these two approaches highlighting the functions of thrombin within the hemostasis and the inhibition mechanisms that regulate the blood coagulation. Moreover, we described different tests that are used to assess the function of the coagulation system, such as: activated partial thromboplastin time, prothrombin time, thrombin time, reptilase time, ecarin clotting time, and the use of chromogenic substrates to evaluate individual coagulation factors. Finally, because of thrombin generation is a fundamental part of the blood coagulation and, an estimation of how well a particular individual can generate thrombin may correlate with either a risk of bleeding or thrombosis, we also include the existing methods to evaluate the potential of thrombin generation in an individual.

Influence of insufficient blood specimens volume on the detection results of coagulation tests in SD rats / 中国比较医学杂志

Objective To explore the best anticoagulant ratio in SD rats .To analyse the influence of insufficient blood specimens volume on coagulation tests .Methods 60 rats were divided into 2 groups.According to the method of vacuum blood, collect abdominal aortic blood after fasting 12 hours.The first group 20 rats were used only for routine blood test.Fully automatic hematology analyzer detected hematocrit and platelet .The second group 40 rats were used for coagulation test .Every rat was collected 2 blood specimens with different anticoagulant ratio [ the proportion of sodium citrate anticoagulation and the whole blood (vlume∶volume)]1∶9(the control group)and 1∶5( the experimental group),1∶8( the experimental group) and 1∶7( the experimental group).Get plasma without platelet through centrifugation.Fully automatic blood coagulation analyzer detected prothrombin time , activated partial thromboplatin time , thrombin time and Fibrinogen.Results HCT (%) and PLT (x 109/L) in SD rats were respectively 41.7 ±2.9 and 1114 ±173.As anticoagulant ratio was increased ,PT, APTT and TT were extended and FIB was decreased .Compared with the control group ,these PT,APTT,TT,FIB four results of 1∶8 group were not statistically different , of 1∶5 group were statistically different, these PT,APTT,FIB three results of 1∶7 group were not statistically different , TT of 1∶7 group was statistically different.Conclusions The detection of coagulation project coagulation test results were affected by the proportion of anticoagulant and blood .1∶9 was the best anticoagulant ratio in SD rats , 1∶8 can also.Rat had its unique physiological characteristics .The results could provide reference for the evaluation of rats .

Reduction of Perioperative Fresh Frozen Plasma Wastage and Transfusion by Quality Improvement Activity / 대한수혈학회지

BACKGROUND: Empirical use of fresh frozen plasma (FFP) in perioperative blood transfusion leads to high wastage of FFP. However, coordination of many related clinical departments is difficult. Therefore, quality improvement (QI) activities for establishment of appropriate use of FFP are needed. METHODS: Departments of surgery (all surgery departments except ophthalmology) and the departments of anesthesiology, clinical pathology, and nurses met each month from March, 2011 to October, 2011. Each department investigated the number of FFP usages, wastage, and coagulation tests. Primary measured variables and objectives were decrease of 50% of FFP wastage rate compared with the previous year and 50% increase of coagulation testing before using FFP. Secondary measured variables were total amount of FFP usage and report time for coagulation tests. RESULTS: After the QI activities (March, 2011~October, 2011), FFP wastage decreased, from 71.5 units during the second half of 2010 to 37.8 units during the second half of 2011 (-47.1%). Rate of coagulation testing before using FFP more than doubled during the second half of 2011 (57%) compared with the second half of 2010 (25%). The rate of less than 30 minutes report time for coagulation testing increased from 60% to 75%. FFP transfusion per 1,000 surgical cases decreased to from 190 units to 118 units. CONCLUSION: Rate of FFP wastage and transfusion decreased and rate of performance of the blood coagulation test was enhanced through education and training on transfusion and QI activities.

Extraction and anticoagulant activity of sulfated polysaccharides from Caulerpa cupressoides var lycopodium (Vahl) C Agardh (Chlorophyceae) / Extração e atividade anticoagulante dos polissacarídeos sulfatados da clorofícea Caulerpa cupressoides var lycopodium (Vahl) C Agardh

The reportedly low standard quality of heparin (HEP) for use in cardiac surgeries has led to concern in the Brazilian and international markets. Sulfated polysaccharides (SPs) from seaweeds have been regarded as promising substitutes for HEP. The aim of this study was to sequentially extract total SPs (TSPs) from Caulerpa cupressoides (Chlorophyceae) with papain in 100 mM sodium acetate buffer (pH 5.0) containing 5 mM cysteine and 5 mM EDTA, followed by fractionation by ion-exchange chromatography (DEAE-cellulose), and then evaluate the anticoagulant potential of SP fractions by activated partial thromboplastin time (APTT) using normal human plasma and compare it to standard HEP (193 IU mg-1). The obtained fractions were chemically characterized by chemical composition and agarose gel electrophoresis. The yield was 4.61%, and three fractions of SP (F I, F II and F III) eluted with 0.50, 0.75 and 1.00 M of NaCl, respectively, were observed on chromatography profiles; however, differences in charge densities patterns and degree of resolution among them were revealed by electrophoresis. SPs were capable of modifying APTT only in fractions eluted with 0.75 M of NaCl, whose activities were 23.37 and 25.76 IU mg-1, respectively, and the charge density was prerequisite to activity. Therefore, C. cupressoides is a source of SPs possessing low anticoagulant potential compared to HEP.

O baixo padrão de qualidade outrora declarado da heparina (HEP) para o uso em cirurgias cardíacas tem levado preocupação nos mercados nacional e internacional. Os polissacarídeos sulfatados (PSs) de algas marinhas têm sido considerados como promissores substitutos para HEP. Objetivou-se a extrair sequencialmente PSs totais (PSTs) da clorofícea Caulerpa cupressoides com papaína em tampão acetato de sódio 100 mM (pH 5,0) contendo cisteína 5 mM e EDTA 5 mM, fracionar por cromatografia de troca iônica (DEAE-celulose) e avaliar o potencial anticoagulante das frações de PS por meio do tempo de tromboplastina parcial ativada (TTPA), utilizando plasma humano normal e comparando-se à HEP padrão (193 IU mg-1). As frações obtidas foram caracterizadas quimicamente em composição química e por eletroforese em gel de agarose. O rendimento de PSTs foi 4,61% e os perfis cromatográficos, em DEAE-celulose, indicaram a separação de três frações de PS (F I; F II e F III) eluídas nas concentrações 0,50; 0,75 e 1,00 M de NaCl, respectivamente, revelando, por eletroforese, diferenças em termos de densidade de cargas e grau de resolução. Os PSs foram capazes de modificar o TTPA somente nas frações eluídas com 0,75 M de NaCl, cujas atividades foram 23,37 e 25,76 IU mg-1, respectivamente, quando a densidade de cargas foi pré-requisito para atividade. Portanto, C. cupressoides é uma fonte de PSs com baixos potenciais anticoagulantes comparados à HEP.

Extraction and anticoagulant activity of sulfated polysaccharides from Caulerpa cupressoides var. lycopodium (Vahl) C. Agardh (Chlorophyceae) - doi: 10.4025/actascibiolsci.v33i2.6243 / Extraction and anticoagulant activity of sulfated polysaccharides from Caulerpa cupressoides var. lycopodium (Vahl) C. Agardh (Chlorophyceae) - doi: 10.4025/actascibiolsci.v33i2.6243

The reportedly low standard quality of heparin (HEP) for use in cardiac surgeries has led to concern in the Brazilian and international markets. Sulfated polysaccharides (SPs) from seaweeds have been regarded as promising substitutes for HEP. The aim of this study was to sequentially extract total SPs (TSPs) from Caulerpa cupressoides (Chlorophyceae) with papain in 100 mM sodium acetate buffer (pH 5.0) containing 5 mM cysteine and 5 mM EDTA, followed by fractionation by ion-exchange chromatography (DEAE-cellulose), and then evaluate the anticoagulant potential of SP fractions by activated partial thromboplastin time (APTT) using normal human plasma and compare it to standard HEP (193 IU mg-1). The obtained fractions were chemically characterized by chemical composition and agarose gel electrophoresis. The yield was 4.61%, and three fractions of SP (F I, F II and F III) eluted with 0.50, 0.75 and 1.00 M of NaCl, respectively, were observed on chromatography profiles; however, differences in charge densities patterns and degree of resolution among them were revealed by electrophoresis. SPs were capable of modifying APTT only in fractions eluted with 0.75 M of NaCl, whose activities were 23.37 and 25.76 IU mg-1, respectively, and the charge density was prerequisite to activity. Therefore, C. cupressoides is a source of SPs possessing low anticoagulant potential compared to HEP.

The reportedly low standard quality of heparin (HEP) for use in cardiac surgeries has led to concern in the Brazilian and international markets. Sulfated polysaccharides (SPs) from seaweeds have been regarded as promising substitutes for HEP. The aim of this study was to sequentially extract total SPs (TSPs) from Caulerpa cupressoides (Chlorophyceae) with papain in 100 mM sodium acetate buffer (pH 5.0) containing 5 mM cysteine and 5 mM EDTA, followed by fractionation by ion-exchange chromatography (DEAE-cellulose), and then evaluate the anticoagulant potential of SP fractions by activated partial thromboplastin time (APTT) using normal human plasma and compare it to standard HEP (193 IU mg-1). The obtained fractions were chemically characterized by chemical composition and agarose gel electrophoresis. The yield was 4.61%, and three fractions of SP (F I, F II and F III) eluted with 0.50, 0.75 and 1.00 M of NaCl, respectively, were observed on chromatography profiles; however, differences in charge densities patterns and degree of resolution among them were revealed by electrophoresis. SPs were capable of modifying APTT only in fractions eluted with 0.75 M of NaCl, whose activities were 23.37 and 25.76 IU mg-1, respectively, and the charge density was prerequisite to activity. Therefore, C. cupressoides is a source of SPs possessing low anticoagulant potential compared to HEP.

Clinical Significance of Coagulation Screening Tests and Platelet Counts in Children Undergoing Endoscopy / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to assess the benefits of routine pre-endoscopy coagulation screening tests and platelet counts in Korean children. METHODS: Between March 2004 and December 2009, children who underwent gastrointestinal endoscopy for the evaluation of various gastrointestinal symptoms were included. All of the subjects included in the study also underwent routine coagulation screening and platelet count determinations prior to endoscopy and biopsy. The clinical records and laboratory tests were retrospectively reviewed in all patients. RESULTS: One hundred sixty-two of 1,476 (11%) patients who underwent endoscopy had abnormal results on pre-screening coagulation tests. Fourteen patients underwent coagulation factor assays due to abnormal clotting results in consecutive tests or due to clinical evidence of a bleeding tendency. Seven patients were diagnosed with factor XII deficiency, one patient was diagnosed with von Willebrand disease, one patient had von Willebrand disease and factor XII deficiency, and one patient was presumed to have mild hemophilia. The remaining 4 patients had normal results with the factor assays. The results of platelet counts were normal with the exception of 1 patient. No patient had significant bleeding during the endoscopic procedures, despite abnormal pre-endoscopic coagulation tests. CONCLUSION: Routine coagulation screening tests and platelet counts revealed abnormal results in some patients. Most of the patients with abnormal clotting were shown to have a factor XII deficiency, which had no significant associated bleeding tendencies; the other patients were diagnosed with hemophilia or von Willebrand disease. Therefore, although abnormal pre-endoscopic coagulation is not always related to significant bleeding complications, pre-endoscopic coagulation screening may be useful in some children in predicting the risk of bleeding tendency during endoscopic procedures.

The Value of Preoperative Coagulation Screening in Children Undergoing Surgery

BACKGROUND: To evaluate the usefulness of preoperative screening for coagulation disorders in children who have undergone surgery. METHODS: From January 2003 to December 2005, we prospectively evaluated laboratory and bleeding histories in 1,911 children between the ages of one year and 15 years. All of the patients had preoperative coagulation screening with a measurement of complete blood count, prothrombin time and activated partial thromboplastin time. The sensitivity, specificity and positive and negative predictive values following a preoperative coagulation-screening test were evaluated by a comparison of the type of surgery and bleeding complications that occurred during and after surgery. RESULTS: There were no patients with previously proven coagulopathies or suspicious medical histories. Among the 1,911 cases, a subset of 22 patients had persistent abnormalities detected after laboratory testing. In two of the 22 patients, lupus anticoagulant was detected and in one of the 22 patients, a factor VIII deficiency was discovered. There were 46 patients that had postoperative bleeding and required hospitalization extension or readmission for stanching. Among the 46 patients, 44 patients demonstrated normal coagulation after testing and two patients demonstrated abnormal coagulation after testing. Following a preoperative coagulation-screening test, a low sensitivity (0.04) and positive predictive value (0.09) were determined. CONCLUSION: For the prediction of perioperative bleeding, the use of a coagulation-screeningtest showed a very low positive predictive value. Many false positive laboratory tests coupled with the relative rarity of inherited and acquired coagulopathies raises doubt about the overall value of routine preoperative coagulation screening in children.

Coagulopathy Detected with a Thrombelastography during ANH after Induction of General Anesthesia: A case report / 대한마취과학회지

Thrombelastography (TEG) performed by an anesthesiologist provides a rapid assessment of coagulation at the bedside. TEG analyzing coagulation status of native whole blood is a more accurate test with a relatively good sensitivity and specificity than PT and aPTT. We experienced an unexpected coagulopathy during the perioperative period. The case was a 47-year-old male patient with blood type O who underwent elective spine surgery. Perioperative coagulation tests (PT, aPTT, BT, CT, etc.) were within normal limits. Anesthesia was induced with propofol 90 mg, vecuronium 8 mg and alfentanil 0.5 mg and maintained with 1.0 1.5 vol% enflurane and 50% N2O in O2. Then we performed acute normovolemic hemodilution (ANH) with monitoring pre- and post-hemodilutional TEG. Hemostasis was revealed as abnormal by a pre-hemodilution TEG (CI = -11.06) and post-hemodilution TEG (CI = -13.06). We managed this coagulopathy with blood components and drugs on the basis of a follow-up TEG so that abnormal hemostasis and TEG findings improved (CI = -4.35). We report a case where undetected coagulopathy was revealed and treated successfuly with TEG.