Effect of rivaroxaban on blood coagulation using the viscoelastic coagulation test ROTEM™.

This study investigated the influence of the oral direct inhibitor of factor Xa rivaroxaban on blood coagulation measured by rotation thrombelastometry ROTEM™. Blood was obtained from 11 healthy male volunteers before and 2.5 h after oral administration of 10 mg rivaroxaban. In addition to standard coagulation tests clot formation was measured by ROTEM™ analyzing extrinsic (Extem) and intrinsic thrombelastometry (Intem). Significant differences to the baseline values were found in the Extem clotting time (Extem-CT, 58 ± 9 s and 87 ± 17 s, p < 0.01), Intem-CT (194 ± 26 s and 239 ± 43 s; p = 0.02), prothrombin time (PT, 86 ± 9% and 67 ± 7%; p < 0.01) and activated partial thromboplastin time (aPTT, 28 ± 1 s and 35 ± 2 s; p < 0.01). There was a low correlation between Extem-CT and PT as well as between Intem-CT and aPTT before and after rivaroxaban intake. The receiver operating characteristic curve (ROC) analysis determined aPTT to be the most appropriate parameter for the prediction of rivaroxaban-induced anticoagulation, Intem-CT and Extem-CT proved to be moderate tests and PT had no significance in the prediction of rivaroxaban-induced anticoagulation. Of utmost clinical importance was the fact that rivaroxaban treated patients could still show normal ROTEM™ values. Thus, ROTEM™ cannot be a suitable test method to exclude inhibition of blood coagulation by rivaroxaban.

[From financial to scientific fraud : methods to detect discrepancies in the medical literature]. / Vom Finanz- zum Wissenschaftsbetrug : Methode, den Irrungen in der medizinischen Literatur beizukommen.

Fraud is as old as Mankind. There are an enormous number of historical documents which show the interaction between truth and untruth; therefore it is not really surprising that the prevalence of publication discrepancies is increasing. More surprising is that new cases especially in the medical field generate such a huge astonishment. In financial mathematics a statistical tool for detection of fraud is known which uses the knowledge of Newcomb and Benford regarding the distribution of natural numbers. This distribution is not equal and lower numbers are more likely to be detected compared to higher ones. In this investigation all numbers contained in the blinded abstracts of the 2009 annual meeting of the Swiss Society of Anesthesia and Resuscitation (SGAR) were recorded and analyzed regarding the distribution. A manipulated abstract was also included in the investigation. The χ(2)-test was used to determine statistical differences between expected and observed counts of numbers. There was also a faked abstract integrated in the investigation. A p<0.05 was considered significant. The distribution of the 1,800 numbers in the 77 submitted abstracts followed Benford's law. The manipulated abstract was detected by statistical means (difference in expected versus observed p<0.05). Statistics cannot prove whether the content is true or not but can give some serious hints to look into the details in such conspicuous material. These are the first results of a test for the distribution of numbers presented in medical research.

Effects on coagulation of balanced (130/0.42) and non-balanced (130/0.4) hydroxyethyl starch or gelatin compared with balanced Ringer's solution: an in vitro study using two different viscoelastic coagulation tests ROTEMTM and SONOCLOTTM.

BACKGROUND: Hydroxyethyl starch (HES) solutions compromise blood coagulation. Low molecular weight, low-substituted HES products, and electrolyte-balanced solutions might reduce this effect. We compared the effects of in vitro haemodilution on blood coagulation with a balanced 6% HES 130/0.42 solution (HES(BAL)), a saline-based 6% HES 130/0.4 solution (HES(SAL)), a balanced lactated Ringer's solution (RL) and a saline-based 4% gelatin solution (GEL). METHODS: Blood was obtained from 10 healthy male volunteers and diluted with the test solutions by 33% and 66%. Quality of clot formation was measured using two viscoelastic coagulation tests: SONOCLOT and activated rotation thromboelastometry ROTEM. RESULTS: Of 16 parameters measured by the viscoelastic devices, we found three statistically significant differences compared with baseline for RL, but 11 for GEL, 10 for HES(SAL), and 11 for HES(BAL) in the 33% haemodilution group (P=0.01). Comparing the different solutions, we observed a significant difference between crystalloids and colloids but none between GEL and HES. In the 66% dilution group, effects on blood coagulation were increased when compared with the 33% dilution group. We found no differences in coagulation impairment between balanced and non-balanced HES products and no differences in the detection of impaired blood coagulation due to haemodilution between the two viscoelastic coagulation tests. CONCLUSIONS: Both ROTEM and SONOCLOT are sensitive tests for the detection of impaired blood coagulation due to haemodilution. There are fewer effects on blood coagulation using crystalloids compared with colloids. The effects of GEL and HES are similar. There is no difference between balanced HES 130/0.42 and non-balanced HES 130/0.4.

Isolated reduction of haematocrit does not compromise in vitro blood coagulation.

Low haematocrit values are generally well tolerated in terms of oxygen transport but a low haematocrit might interfere with blood coagulation. We thus sampled 60 ml of blood in 30 healthy volunteers. The blood was centrifuged for 30 min at 2000 g and separated into plasma, which contained the platelet fraction, and packed red blood cells. The blood was subsequently reconstituted by combining the entire plasma fraction with a mixture of packed red blood cells, 0.9% saline, so that the final haematocrit was either 40, 30, 20, or 10%. Blood coagulation was assessed by computerized Thrombelastograph analysis. Data were compared using repeated measures analysis of variance and post-hoc paired t-tests with Bonferroni correction. Decreasing the haematocrit from 40 to 10% resulted in a shortening of reaction time (r) and coagulation time (k), and an increase in angle alpha, maximum amplitude (MA) and clot strength (G) (all P<0.02). This pattern represents acceleration of blood coagulation with low haematocrit values. The isolated reduction in haematocrit, therefore, does not compromise in vitro blood coagulation.

Fatty acid composition, cooking loss and texture of beef patties from meat of bulls fed different fats.

The effect of fatty acid composition on the properties of patties standardised to contain 15% fat was studied. Patties were made of beef from 36 Brown Swiss bulls fed on six different diets with five of them containing additional fats to achieve a high variability in body lipid composition. When the feed contained fullfat oilseeds (rapeseed, sunflower seed, linseed), the proportions of some nutritionally favourable fatty acids were increased in the patties. Patties made from the meat of bulls fed linseed and coconut oil could be distinguished in a sensory triangle test from most other groups. Cooking loss and instrumental texture properties showed no relation to fatty acid composition of patties. Cooking only slightly decreased the proportion of saturated fatty acids in favour of polyunsaturated fatty acids. In conclusion, widely differing dietary fats can be fed to bulls without risking major effects on texture of beef patties.

Comparative evaluation of rumen-protected fat, coconut oil and various oilseeds supplemented to fattening bulls. 1. Effects on growth, carcass and meat quality.

Growth performance, carcass and meat quality were determined in 36 fattening Brown Swiss bulls fed with maize silage-hay-concentrate based rations supplemented with fats and various oilseeds. The concentrate diet in the control group contained only barley and soybean meal, while the treated groups included, as partial replacement of the concentrate, rumen-protected crystalline fat, coconut oil, whole crushed rapeseed, sunflower seed or linseed, providing additional 3% fat of total ration dry matter. Animals were housed in groups of six with one representative of each treatment in a monofactorial design and feed was offered using transponder controlled equipment. Daily gains were similar for control, protected fat, rapeseed and linseed treatments (1240 g/d on average), but were lower (P < 0.05) with sunflower seed (1135 g/d) and coconut oil (1038 g/d). Corresponding differences (P < 0.05) in carcass weights were observed. All fat supplemented groups had reduced rumen fluid protozoa counts (P < 0.05). Carcasses tended to be leaner with the fat supplements. Mostly no significant effects on other carcass quality (dressing percentage, conformation score) and meat quality traits (final pH, cooking loss, shear forces) as well as composition (dry matter, fat, collagen) occurred. Consequently, rumen protected fat and some oilseeds can be recommended to be fed to growing cattle as energy sources.

Comparative evaluation of rumen-protected fat, coconut oil and various oilseeds supplemented to fattening bulls. 2. Effects on composition and oxidative stability of adipose tissues.

The effects of five different dietary fat supplements on fatty acid composition and oxidative stability of subcutaneous and kidney fat were evaluated in 36 Brown Swiss bulls and compared to a low fat diet in a monofactorial design. The following fat supplements were provided as additional fat at 30 g per kg feed dry matter: crystalline rumen-protected fat, coconut oil, and three types of crushed whole oilseeds (rapeseed, sunflower seed and linseed). Adipose tissues reflected differences (P < 0.05) in dietary fatty acid composition although to a lower extent. Using protected fat, which contained elevated levels of trans fatty acids, and sunflower seed, containing a high proportion of linoleic acid, significantly increased C18:1 trans fatty acid proportion in the adipose tissues. The use of sunflower seed increased conjugated linoleic acid. The oilseeds resulted in lower amounts of C16:0 in favour of C18:0. Except for linseed, all fat supplemented groups improved oxidative stability of adipose tissues as compared with control. This was explained by lower proportions of unsaturated fatty acids in adipose tissue (protected fat), by elevated alpha-tocopherol contents (rapeseed, sunflower seed) or by a combination of both (coconut oil). Fat colour remained unaffected by treatments. Compared to other fat supplements oilseeds, especially sunflower seed and rapeseed, can therefore be recommended to be fed to bulls in order to increase the proportions of C18 unsaturated fatty acids in adipose tissues and to maintain or improve oxidative stability.

Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption.

OBJECTIVE: To determine factors influencing the individual effects of blood transfusions regarding oxygen delivery and consumption. DESIGN: Chart review. SETTING: A university hospital cardiosurgical intensive care unit. PATIENTS: Sixty-seven patients with 170 transfusion events evaluated. INTERVENTIONS: Blood transfusion. MEASUREMENTS AND MAIN RESULTS: Measurements were performed before and after a blood transfusion, separated by 302 +/- 13 mins (mean +/- SEM). The individual increase in cardiac index resulting from a blood transfusion was inversely related to cardiac index before transfusion (p < .001), oxygen delivery index before transfusion (p < .001), and oxygen consumption index before transfusion (p < .001). The individual increase in oxygen delivery index was inversely related to oxygen consumption index before transfusion (p < .001). The individual increase in oxygen consumption index was inversely related to oxygen consumption index before transfusion (p < .001). Individual changes in cardiac index, oxygen delivery index, and oxygen consumption index were not significantly related to preoperative ejection fraction (25%-87%), age (32-81 yrs), and pretransfusion hemoglobin concentration (5.0-11.8 g/dL). CONCLUSION: In adult patients after cardiovascular surgery, oxygen delivery- and oxygen consumption-related variables predict the individual response to blood transfusions better than do patient characteristics such as preoperative ejection fraction, age, and pretransfusion hemoglobin concentration. Including oxygen delivery and oxygen consumption, variables into the transfusion decision, thus, may enable a more individual use of allogeneic blood in specific situations.