RESUMEN
BACKGROUND: A factor XIII (FXIII) level >30% is considered necessary to prevent spontaneous bleeding. Bleeding is also a risk in patients with acquired FXIII deficiency, but the hemostatic level of FXIII in this context remains to be determined. METHODS: We retrospectively analyzed all patients diagnosed with acquired FXIII deficiency at a large hospital over 3 years (study ID NCT04416594, http://www.clinicaltrials.gov) and assessed clinical data to identify the best cut-off point for FXIII activity to distinguish between low and high risk of major bleeding in a mixed medical and surgical population. RESULTS: Of the 97 patients who experienced bleeding despite a normal coagulation test, 43.2% had FXIII activity <70%. FXIII activity was significantly lower in surgical patients and patients admitted to the intensive care unit (ICU). Low FXIII activity was significantly associated with long ICU stays and a high incidence of major bleeding. CONCLUSION: Acquired FXIII deficiency is associated with high morbidity. The hemostatic level of FXIII in the setting of acquired FXIII deficiency might be above 30%.
Asunto(s)
Deficiencia del Factor XIII/complicaciones , Morbilidad/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Deficiencia del Factor XIII/epidemiología , Femenino , Hemostáticos/análisis , Hemostáticos/sangre , Hemostáticos/clasificación , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We describe seven critically ill and seven noncritically ill patients with coronavirus disease 2019 infection. Two viscoelastic assays were performed with ClotPro technology, activated by extrinsic system test and recombinant tissue plasminogen activator challenge test. Coagulation profile presents a marked hypercoagulability with increased resistance to fibrinolysis, reflected by tissue plasminogen activator test. Our pathological observations show that the hypercoagulative status described in these patients is, at least partially, secondary to fibrinolysis shutdown.
Asunto(s)
COVID-19/sangre , Fibrinólisis , SARS-CoV-2 , Trombofilia/etiología , Adulto , Anciano , Recuento de Células Sanguíneas , Pruebas de Coagulación Sanguínea , COVID-19/complicaciones , Comorbilidad , Enfermedad Crítica , Progresión de la Enfermedad , Femenino , Hemorragia/epidemiología , Hemorragia/etiología , Mortalidad Hospitalaria , Hospitales Urbanos , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Habitaciones de Pacientes , Proteínas Recombinantes , España/epidemiología , Tromboembolia/epidemiología , Tromboembolia/etiología , Trombofilia/sangre , Activador de Tejido PlasminógenoRESUMEN
It is well known that surgery provokes an inflammatory response. However, the induced inflammatory response to laparoscopic compared with open surgery under combined anesthesia has never been compared following colorectal cancer surgery. We hypothesize that laparoscopic technique under general anesthesia results in a decreased proinflammatory state. We compared cytokines plasma secretion after laparoscopic technique under general anesthesia (LG), open surgery under combined anesthesia (thoracic epidural and general anesthesia) (OGE), and open surgery under general anesthesia as the control group (OG). Proinflammatory cytokines measured postoperatively were significantly increased in the OG group (n=19), compared with the LG (n=18) and OGE (n=20) groups. Post hoc analysis showed that CCL2 levels were significantly lower in LG at all times postoperatively (P<0.01), while interleukin-4, an anti-inflammatory cytokine, was increased in the OGE group (P<0.01). Laparoscopic technique blunts the postoperative proinflammatory response from the very early stages of the inflammatory cascade, whereas combined anesthesia is a more anti-inflammatory approach.
