Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 186
Filtrar
1.
Ann Biol Clin (Paris) ; 78(5): 574-580, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716002

RESUMO

Laboratories need to set up effective overall management of their internal quality control (IQC) and external quality assessment (EQA) results as key elements in statistical process control. Quality targets need to be defined, with methods to ensure durable control with respect to the relevant specifications. The hemostasis laboratory of the Lyon Hospitals Board (HCL, Lyon, France) uses model 3 from the Milan consensus conference, which is the state of the art in terms of quality targets, and uses a common EQA provider supplying as many real patient samples as possible. Giving priority to adopted methods, the lab optimizes the use of manufacturers' prior data: maximum acceptable inter assay coefficient of variation (CV) and prior IQC target values. Bayesian inference brings the method under control with respect to the manufacturers' prior data without the need for a preliminary phase. It links the IQC and EQA plans by the maximum acceptable CVs defined by the manufacturer.


Assuntos
Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/normas , Laboratórios Hospitalares/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Teorema de Bayes , Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Testes de Coagulação Sanguínea/estatística & dados numéricos , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , França/epidemiologia , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Hemostasia/fisiologia , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Ensaio de Proficiência Laboratorial/organização & administração , Ensaio de Proficiência Laboratorial/normas , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Controle de Qualidade , Estudos Retrospectivos
2.
Anaesthesia ; 75(11): 1476-1481, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32500569

RESUMO

Bleeding and blood transfusion are common after scoliosis surgery. Fibrinogen is essential for blood clot formation and depletes quickly during haemorrhage. We randomly allocated 102 children 12-18 years old having surgery for idiopathic scoliosis, 51 to intra-operative fibrinogen concentrate 30 mg.kg-1 (maximum 2 g) and 51 to saline placebo. Fibrinogen reduced peri-operative blood loss by a median (95%CI) volume of 155 (5-320) ml, from a median (IQR [range]) of 1035 (818-1420 [400-3030]) ml to 885 (755-1155 [270-2645]) ml, p = 0.04. Seven and four children received allogeneic red blood cell transfusion after fibrinogen and placebo, respectively, p = 0.34. There were no side-effects.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Fibrinogênio/uso terapêutico , Hemostáticos/uso terapêutico , Cuidados Intraoperatórios/métodos , Hemorragia Pós-Operatória/prevenção & controle , Escoliose/cirurgia , Adolescente , Testes de Coagulação Sanguínea/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino
3.
Am J Emerg Med ; 38(6): 1226-1232, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029342

RESUMO

BACKGROUND: Coagulation panels are ordered for a variety of conditions in the emergency department (ED). OBJECTIVE: This narrative review evaluates specific conditions for which a coagulation panel is commonly ordered but has limited utility in medical decision-making. DISCUSSION: Coagulation panels consist of partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR). These tests evaluate the coagulation pathway which leads to formation of a fibrin clot. The coagulation panel can monitor warfarin and heparin therapy, evaluate for vitamin K deficiency, evaluate for malnutrition or severe systemic disease, and assess hemostatic function in the setting of bleeding. The utility of coagulation testing in chest pain evaluation, routine perioperative assessment, prior to initiation of anticoagulation, and as screening for admitted patients is low, with little to no change in patient management based on results of these panels. Coagulation testing should be considered in systemically ill patients, those with a prior history of bleeding or family history of bleeding, patients on anticoagulation, or patients with active hemorrhage and signs of bleeding. Thromboelastography and rotational thromboelastometry offer more reliable measures of coagulation function. CONCLUSIONS: Little utility for coagulation assessment is present for the evaluation of chest pain, routine perioperative assessment, initiation of anticoagulation, and screening for admitted patients. However, coagulation panel assessment should be considered in patients with hemorrhage, patients on anticoagulation, and personal history or family history of bleeding.


Assuntos
Anticoagulantes/análise , Testes de Coagulação Sanguínea/normas , Medicina de Emergência/métodos , Anticoagulantes/uso terapêutico , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Dor no Peito/sangue , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Heparina/análise , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/normas , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/diagnóstico , Tempo de Tromboplastina Parcial/métodos , Tempo de Tromboplastina Parcial/normas , Tempo de Protrombina/métodos , Tempo de Protrombina/normas , Varfarina/análise , Varfarina/uso terapêutico
4.
Am J Clin Pathol ; 153(2): 181-189, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31602457

RESUMO

OBJECTIVES: The naming convention in coagulation may cause confusion in electronic ordering systems, leading to inappropriate test orders. We implemented test utilization efforts and studied utilization before and after interventions for two specialty coagulation assays. METHODS: Two interventions were implemented: test names were changed from factor assay to activity, and residents reviewed all factor V and X requests. A retrospective review of factor V and X activity orders was performed for the period 1 year before and after interventions. RESULTS: After interventions, factor V and X activity orders decreased by approximately 40%. Resulted tests decreased by 53.8% and 47.8%, corresponding to reductions of $2,493.05 and $1,867.80 per year in laboratory charges for factor V and factor X activity, respectively. Abnormal factor V activity results increased from 45% to 59%. Factor V activity orders from outpatient clinics decreased by 21.6%. CONCLUSIONS: Simple interventions can reduce inappropriate specialty coagulation test orders and unnecessary costs.


Assuntos
Testes de Coagulação Sanguínea/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Fator V/análise , Fator X/análise , Testes de Coagulação Sanguínea/economia , Técnicas de Laboratório Clínico/economia , Fator V/genética , Inibidores do Fator Xa/sangue , Humanos , Mutação , Estudos Retrospectivos , Procedimentos Desnecessários
5.
Int J Clin Pract ; 74(1): e13420, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532052

RESUMO

OBJECTIVE: Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC). METHOD: We included individuals over 75 years old, affiliated to Mutualité Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the type of prescribing physician and laboratory monitoring for novel prescriptions (initial) and prescription refills (≥ 3 months). RESULTS: Of the 19 798 included patients, 1518 (7.7%) were prescribed DAOCs and 18 280 (92.3%) were not. Mean and median age was 85 years in the 2 groups (DOACG and noDOACG). In the DOACG, there were more men (50% vs 40.2%), more RCD (88.9% vs 68.7%) and more drugs per prescription (6 ± 2.8 vs 5 ± 2.9) (All P < .01). The DOACG also took more antihypertensive drugs. The most commonly prescribed DOACs were apixaban (42.9%) followed by rivaroxaban (38.4%) and dabigatran (18.6%). Complete blood count, serum creatinine and coagulation function tests were requested for 69.4%, 75% and 22.2%, respectively, of patients prescribed DAOCs. CONCLUSIONS: The DOACG had more RCD and drugs per prescription than the noDOACG; routine laboratory monitoring was insufficient. What's known Platelet aggregation inhibitors (low-dose) are recommended for secondary prevention of cardiovascular events in patients suffering from symptomatic atherosclerosis. The main risk of this treatment is bleeding. What's new A prescription for platelet aggregation inhibitors was found in 34% of geriatric inpatients in this prospective study. Compliance to guidelines was better for symptomatic peripheral artery disease than for primary prevention in accordance with recent publications. Geriatric comorbidities had no impact on the prescription of platelet aggregation inhibitors. Underuse of platelet aggregation inhibitors was observed in 11.3% of cases and overuse in 13.7% of cases.


Assuntos
Anticoagulantes/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Contagem de Células Sanguíneas/estatística & dados numéricos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Doença Crônica/epidemiologia , Creatinina/sangue , Dabigatrana/uso terapêutico , Feminino , França/epidemiologia , Humanos , Testes de Função Renal/estatística & dados numéricos , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana/uso terapêutico
6.
Eur J Clin Pharmacol ; 75(8): 1069-1075, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31139866

RESUMO

BACKGROUND: Routine laboratory monitoring of rivaroxaban and dose adjustment relating to exposure is currently not recommended. However, in certain clinical situations, assessment of rivaroxaban levels is desirable. OBJECTIVES: To examine inter- and intra-subject plasma rivaroxaban variability in patients with atrial fibrillation (AF) and to correlate these results to clinical outcomes. PATIENTS/METHODS: We included 60 patients with AF treated with rivaroxaban: half on 20 mg daily (R20) and half on 15 mg daily (R15). Three trough and peak blood samples were collected with an interval of 6-8 weeks apart. Plasma rivaroxaban concentration was measured directly by liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and indirectly by anti-Xa for rivaroxaban, prothrombin time (PT), and activated partial thromboplastin time (APTT). RESULTS: Patients on R15 were older (76 ± 6 vs 71 ± 6 years), had lower creatinine clearance (60 ± 26 vs 99 ± 32 mL/min), higher CHADS2 (2.5 ± 1.2 vs 1.8 ± 1.3), all p < 0.01, but had similar rivaroxaban concentrations in trough samples to patients on R20. There was no significant intra-individual variability for trough or peak rivaroxaban concentration assessed by LC-MS/MS, anti-Xa, or PT. Trough rivaroxaban levels determined by LC-MS/MS (48 ± 30 vs 34 ± 26, p = 0.02) and anti-Xa, but not with PT and APTT, were higher in patients with bleeding than in patients without it. CONCLUSIONS: There is a pronounced inter-, but not intra-individual variability in the rivaroxaban trough levels in patients with AF. Assessment of trough rivaroxaban concentration with LC-MS/MS or anti-Xa, but not with APTT or PT, may help to identify patients at increased risk of bleeding.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Variação Biológica Individual , Variação Biológica da População , Inibidores do Fator Xa/farmacologia , Hemorragia/epidemiologia , Rivaroxabana/farmacologia , Idoso , Idoso de 80 Anos ou mais , Testes de Coagulação Sanguínea/estatística & dados numéricos , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/estatística & dados numéricos , Inibidores do Fator Xa/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Medição de Risco , Rivaroxabana/uso terapêutico
7.
Medicine (Baltimore) ; 98(21): e15648, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124944

RESUMO

This study explored the predictive value of coagulation and fibrinolysis markers with acute pancreatitis (AP)-related mortality and organ failure.We retrospectively reviewed and analyzed coagulation and fibrinolysis markers and clinical outcomes of the patients with AP.A total of 273 patients with AP were enrolled, 7 patients died and 28 patients suffered from organ failure. Uni- and multivariate logistic regression identified the differences of all of the coagulation and fibrinolysis markers as risk factors for AP-related mortality. The differences of APTT value, TT value, D-dimmer level, FDP level, and AT III level were risk factors for organ failure. Furthermore, the OR of the differences of platelet, PT, APTT, TT, fibrinogen, D-dimmer, FDP, and AT III was substantially improved by grouping with intervals of 10 × 10/L, 2 seconds, 5 seconds, 3 seconds, 0.5 g/L, 3 mg/L FEU, 5 mg/L and 10%, respectively. The risk of mortality can increase up to 1.62, 5.17, and 5.60 fold for every 10 × 10/L, 2 seconds and 5 seconds of increase in platelet, PT and APTT, respectively. There is approximate 2-fold increase in risk of organ failure for every 2 seconds of TT increase. In receiver operating characteristic analysis, there is no difference in the predictive power of bedside index for severity in acute pancreatitis (BISAP) with them in mortality or organ failure.In patients with AP, the dynamic changes of coagulation and fibrinolysis markers are good predictors for AP-related mortality and organ failure, especially platelet, PT and APTT in mortality and TT in organ failure.


Assuntos
Escores de Disfunção Orgânica , Pancreatite/sangue , Pancreatite/mortalidade , Índice de Gravidade de Doença , Doença Aguda , Adulto , Antitrombina III/análise , Biomarcadores/sangue , Testes de Coagulação Sanguínea/estatística & dados numéricos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Contagem de Plaquetas/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco
8.
PLoS One ; 14(4): e0214874, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970034

RESUMO

BACKGROUND: The standard treatment of acute ischemic stroke patients is thrombolytic therapy within 60 minutes of a patient's arrival in stroke center hospitals. Based on the policy of the Lampang Referral System Committee, blood samples of suspected stroke patients need to be collected before transfer to the stroke center (Lampang Hospital). It was still questionable as to whether these blood samples are valid for clinical use and the present study aimed to confirm or deny their validity. METHODS: A diagnostic study was conducted from June 2015 to May 2016. After exclusion, 340 patients were deemed eligible for analysis. Blood samples were collected just before normal saline infusion at referring hospitals and stored in blood collecting tube boxes set during transportation. At the stroke center, informed consents was requested, blood samples were re-collected to serve as a 'gold standard'. Prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, hemoglobin (Hb), hematocrit (Hct), blood urea nitrogen (BUN), and creatinine (Cr) were compared using paired t-tests. Binary regression was used to analyze for accuracy (%) to adjust for extraneous influences and was presented by modified Bland-Altman plots. RESULTS: The laboratory results of referring hospitals vs. the stroke center were: PT, 12.4±3.2 vs. 12.5±3.0 sec; INR: 1.0±0.3 vs. 1.0±0.3; and platelet count: 239.8±77.1 vs. 239.8±74.8 (x103/µL). The adjusted accuracy of the PT, INR, and platelet counts were 96.8%, 96.8%, and 95.3% respectively. CONCLUSION: Laboratory tests from referring hospital were determined to be valid. Blood samples should thus be collected at referring hospitals in order to avoid unnecessary blood collection at the stroke center.


Assuntos
Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Análise Química do Sangue/estatística & dados numéricos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Coleta de Amostras Sanguíneas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico , Centros de Atenção Terciária , Tailândia , Terapia Trombolítica
9.
J Thromb Haemost ; 17(6): 878-884, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30887647

RESUMO

Essentials Hemolytic influence on the (pro)carboxypeptidase U ((pro)CPU) system is not known. In the current manuscript, this was assessed by spiking pooled normal plasma with hemolysate. CPU activity, proCPU levels, and clot lysis times showed a dose-dependent hemolytic bias. The observed bias in the several CPU related parameters is due to inhibition of CPU activity. INTRODUCTION: Spurious hemolysis of samples is the leading cause of interference in coagulation testing and was described to interfere in fibrinolysis assays. The influence of hemolysis on the procarboxypeptidase U (proCPU) system is not known. METHODS: By means of spiking of hemolysate in pooled normal plasma, the effect of hemolysis on CPU, proCPU, and functional clot lysis assays was assessed. The influence of hemolysis on CPU generation during in vitro clot lysis was also evaluated. Cutoffs corresponding to maximal acceptable bias were determined. RESULTS AND DISCUSSION: When active CPU was added to pooled plasma, a severe decrease in activity - up to 97.2% inhibition - was seen with increasing plasma concentrations of oxyhemoglobin (oxyHb) and the 10% cutoff value was found to be 0.3 g/L oxyHb. Using an activity-based assay, proCPU levels appeared to decrease gradually with increased hemolysis (maximal reduction of 19.5%) with a 10% cutoff value of 4.2 g/L oxyHb. The relative clot lysis time (CLT) showed a maximal negative bias of 68.5%. The reduction in CLT paralleled a significant reduction of the first CPU activity peak during clot lysis. The cutoff value for the CLT was 0.4 g/L oxyHb. In presence of thrombomodulin (TM), CLT+TM was not affected up to 8.0 g/L oxyHb. CONCLUSION: These data indicate a clear inhibition of the CPU system because of hemolysis resulting in an increase of lysis in functional fibrinolysis assays. We were able to quantify the inhibitory effect and to propose cutoff values for every parameter.


Assuntos
Testes de Coagulação Sanguínea/métodos , Carboxipeptidase B2/antagonistas & inibidores , Carboxipeptidase B2/sangue , Hemólise/fisiologia , Testes de Coagulação Sanguínea/estatística & dados numéricos , Tempo de Lise do Coágulo de Fibrina/métodos , Tempo de Lise do Coágulo de Fibrina/estatística & dados numéricos , Fibrinólise/fisiologia , Voluntários Saudáveis , Humanos , Técnicas In Vitro
10.
Arch Orthop Trauma Surg ; 139(2): 167-171, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30298379

RESUMO

PURPOSE: Our prospective study evaluated the incidence and location of deep vein thrombosis (DVT), the risk factors for PE and the natural history of DVT after TKA in patients who have received only mechanical compression device without having any chemical thromboprophylaxis or therapeutic treatment. METHODS: We studied 408 consecutive patients (691 knees) who underwent primary TKA; 283 patients had one-stage bilateral TKAs and 125 had unilateral TKAs. Coagulation assays, the full blood count and blood typing tests, and serum chemical profiles were undertaken in all patients on three separate occasions. Molecular genetic testing was performed preoperatively to detect the genetic traits involving DVT. Bilateral simultaneous or unilateral venograms were carried out at 6 or 7 days after operation. Perfusion lung scanning was undertaken before and at 7 or 8 days after operation. RESULTS: In the 691 venograms in 408 patients, only 4 knees (0.6%) were positive for fresh thrombi. In the 4 knees with DVT, thrombi were located in the calf veins. We observed factor V Leiden mutation, antithrombin-III level, and prothrombin promoter G20210A mutation were absent in all patients. We saw no relationship between DVT and coagulation or thrombophilic data. No pulmonary embolism (PE) occurred as shown by negative perfusion lung scan and absence of symptoms. CONCLUSION: We concluded that the combinations of absent thrombophilic polymorphisms with low clinical prothrombotic risk factors led to low prevalence of DVT and virtually absent PE after TKA in the current series of patients, who had received mechanical compression device only without chemical thromboprophylaxis.


Assuntos
Artroplastia do Joelho/efeitos adversos , Testes de Coagulação Sanguínea , Bandagens Compressivas , Embolia Pulmonar , Trombose Venosa , Adulto , Idoso , Artroplastia do Joelho/métodos , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Feminino , Testes Genéticos/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Flebografia/métodos , Prevalência , Estudos Prospectivos , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , República da Coreia/epidemiologia , Fatores de Risco , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
11.
Transfus Clin Biol ; 26(1): 18-26, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29936040

RESUMO

OBJECTIVES: The European trauma guidelines were developed to assist clinicians in the early phase of trauma management to diagnose and treat coagulopathy and bleeding. This study aimed to determine compliance with these European trauma guidelines in a French referral trauma centre. METHODS: Medical charts of trauma patients with an injury severity score≥16 admitted between January 2013 and December 2014 were reviewed. Compliance with 21 recommendations in the first 24-hours of patient management was assessed. RESULTS: There were 145 patients with median ISS of 34 [IQR 25-41]. A good level of compliance (i.e. applied in≥80% of patients) was identified for nine recommendations, inconsistent compliance (i.e. applied in 50 to 79% of patients) for six recommendations, including fibrinogen levels at hospital admission and achievement of a target mean arterial blood pressure (MAP)>80mmHg in patients with major bleeding and TBI (55.5%), and poor compliance (i.e. applied in<50% of patients) for another six recommendations. Poorly applied recommendations included early measurement of lactate or base deficit (32%), early administration of tranexamic acid (18%), and achievement of normocapnia in patients with TBI undergoing invasive ventilation (3%). CONCLUSIONS: In a referral trauma centre, nine of the 21 evaluable recommendations in the European trauma guidelines were applied in≥80% of patients. Early diagnosis and treatment of trauma-related coagulopathy was identified as an area for significant practice improvement. In patients with TBI, efforts should be made to achieve the targeted MAP and to maintain normocapnia.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Testes de Coagulação Sanguínea/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Transtornos da Coagulação Sanguínea/terapia , Feminino , França , Hemodinâmica , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/complicações
12.
Medicine (Baltimore) ; 97(22): e10929, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851830

RESUMO

Revision total hip arthroplasty (THA) may cause intra- and postoperative massive bleeding. This prospective observational study evaluated if the maximum clot firmness of FIBTEM (MCFFIB) could act as a predictor of perioperative massive bleeding in revision THA.Fifty-eight adult patients undergoing revision THA were included. Pre- and postoperative MCFFIB, hematological and hemostatic laboratory data, as well as the amount of intra- and postoperative blood loss (IBL and PBL) were obtained.The change rate (MCFFIB-C) between the pre- and postoperative MCFFIB had a significant correlation with IBL (ρ = 0.431, P = .001). Moreover, PBL had a significant correlation with MCFFIB-C (ρ = 0.292, P = .026). The MCFFIB-C cut-off value of ≥ 29% showed the highest sensitivity and specificity for predicting IBL ≥ 1000 mL or PBL ≥500 mL. The incidence of red blood cell transfusion in the postoperative period was higher in patients showing MCFFIB-C ≥ 29% (34% vs 8%, P = .015).The change rate between pre- and postoperative MCFFIB values was correlated well with the amount of IBL or PBL. Moreover, particular change rate of MCFFIB could predict massive bleeding in revision THA.


Assuntos
Artroplastia de Quadril/efeitos adversos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Perda Sanguínea Cirúrgica/fisiopatologia , Hemorragia Pós-Operatória/etiologia , Reoperação/efeitos adversos , Idoso , Artroplastia de Quadril/métodos , Elasticidade , Feminino , Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Reoperação/métodos
13.
BMC Anesthesiol ; 18(1): 56, 2018 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-29793426

RESUMO

BACKGROUND: Previous studies have shown that sugammadex resulted in the prolongation of prothrombin time and activated partial thromboplastin time. In this study, we aimed to investigate the in vitro effects of exogenous sugammadex on the coagulation variables of whole blood in healthy patients who underwent orthopedic surgery. METHODS: The effects of sugammadex on coagulations were assessed using thromboelastography (TEG) in kaolin-activated citrated blood samples taken from 14 healthy patients who underwent orthopedic surgery. The in vitro effects of three different concentrations of sugammadex (42, 193, and 301 µg mL- 1) on the TEG profiles were compared with those of the control (0 µg mL- 1). Previous studies indicated that these exogenous concentrations correspond to the approximate maximum plasma concentrations achieved after the administration of 4, 16, and 32 mg kg- 1 sugammadex to healthy subjects. RESULTS: Increased sugammadex concentrations were significantly associated with reduced coagulation, as evidenced by increases in reaction time (r), coagulation time, and time to maximum rate of thrombus generation (TMRTG), and decreases in the angle, maximum amplitude, and maximum rate of thrombus generation. Compared with the control, the median percentage change (interquartile range) in the TEG values of the samples treated with the highest exogenous sugammadex concentration was the greatest for r, 53% (26, 67.3%), and TMRTG, 48% (26, 59%). CONCLUSIONS: This in vitro study suggests that supratherapeutic doses of exogenous sugammadex might be associated with moderate hypocoagulation in the whole blood of healthy subjects. TRIAL REGISTRATION: identifier:  UMIN000029081 , registered 11 September 2017.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Procedimentos Ortopédicos , Sugammadex/farmacologia , Adulto , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Eur J Anaesthesiol ; 35(8): 621-626, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29474346

RESUMO

BACKGROUND: Procedures requiring optimisation of the coagulation status of patients using vitamin K antagonists are frequently postponed due to the late availability of laboratory international normalised ratio (INR) test results. A point-of-care (POC) alternative may facilitate early decision-making in peri-operative patients. OBJECTIVES: To assess the level of agreement between the POC-INR and the laboratory INR in patients who continue or stop vitamin K antagonists to determine whether the POC test may be a good alternative to the laboratory INR. DESIGN: Study of diagnostic accuracy. SETTING: Single-centre study at Zaans Medical Centre, The Netherlands. PATIENTS: Included patients were scheduled for cardioversion (these continued taking vitamin K antagonists), or a surgical procedure (these stopped taking vitamin K antagonists). MAIN OUTCOME MEASURES: The level of agreement and clinical acceptability of the laboratory and POC-INR results, evaluated by Bland-Altman analysis and error grid analysis. RESULTS: The surgical and cardioversion groups consisted of 47 and 46 patients, respectively. The bias in the INR in the surgical group was -0.12 ±â€Š0.09 with limits of agreement of -0.29 to 0.05, whereas the cardioversion group showed a bias in the INR of -0.22 ±â€Š0.36 with limits of agreement from -0.93 to 0.48. The percentage errors between methods in the surgical and cardioversion groups were 16 and 21%, respectively. Error grid analysis showed that the diagnostic accuracy of the POC prothrombin time is clinically acceptable as the difference did not lead to a different clinical decision in the surgical group with INR values less than 1.8. CONCLUSION: The current study shows a good level of agreement and clinical accuracy between the laboratory and POC-INR in patients who stopped anticoagulation intake for surgery. However, in patients who continued their anticoagulation therapy, the agreement between the two methods was less accurate.


Assuntos
Acenocumarol/administração & dosagem , Anticoagulantes/administração & dosagem , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Tempo de Protrombina/métodos , Tempo de Protrombina/estatística & dados numéricos , Idoso , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Feminino , Humanos , Masculino , Países Baixos , Reprodutibilidade dos Testes
15.
Clin Biochem ; 52: 26-32, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29056494

RESUMO

BACKGROUND: There is increasing emphasis on understanding the rate, and avoidable costs, of inappropriate laboratory testing in hospitals, especially associated with duplication of tests following transfer of patients from one hospital to another. While studies of inappropriate testing have been reported previously, there are no published data relevant to Ireland. AIMS: To determine the baseline rate of inappropriate testing for a subset of clinical parameters, specifically, full blood counts (FBC), biochemistry profiles (Bio) and coagulation (Coag) screens for geriatric patients transferring to and from University Hospital Limerick (UHL). Prospective pilot-scale implementation of five clustered interventions, and assessment of their effect. METHODS: Baseline testing levels were determined between October 2013 and January 2014. A patient survey was conducted to evaluate patient awareness of the blood tests they underwent. Five interventions were trialed sequentially each month between January and May 2014. These included: educational poster, intern training, presentations and communication to consultants; automated prompt in the Lab Information Technology system; highlighting of patient survey results to medical staff; inclusion of laboratory test details on patient transfer document; patient booklet promoting empowerment. Impact was assessed by determining rates of inappropriate laboratory testing monthly, and associated actual cost reductions were calculated. RESULTS: Approximately two-thirds of geriatric inpatients were unaware of why they underwent blood tests. Baseline numbers of inappropriate duplicate FBCs, Bio profiles and Coag tests were 758, 749 and 268 respectively for patients transferring to and from UHL. Following the interventions, these numbers dropped to 85, 84 and 0, respectively. CONCLUSION: The interventions resulted in sustained reduction in rates of inappropriate testing by May 2014. Extrapolated cost reductions exceed two million Euro annually. The most effective intervention involved staff education.


Assuntos
Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Contagem de Células Sanguíneas/estatística & dados numéricos , Contagem de Células Sanguíneas/tendências , Testes de Coagulação Sanguínea/estatística & dados numéricos , Testes de Coagulação Sanguínea/tendências , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/tendências , Hospitais , Humanos , Irlanda , Transferência de Pacientes , Estudos Prospectivos , Centros de Cuidados de Saúde Secundários , Centros de Atenção Terciária
16.
J Perinat Med ; 46(3): 251-260, 2018 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-28599392

RESUMO

INTRODUCTION: The incidence of venous thromboembolism (VTE) after cesarean section is up to 0.6%, and the widespread use of cesarean section draws attention to this group. The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient's risk can be low. Laboratory hemostasis assays are expected to solve this problem. The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period. MATERIALS AND METHODS: We conducted an observational study on 97 women undergoing cesarean section. Standard coagulation tests (Fg, APTT, prothrombin, D-dimer), an anti-Xa assay, rotation thromboelastometry and thrombodynamics/thrombodynamics-4D were performed. Coagulation assay parameters were compared in groups formed in the presence or absence of LMWH to estimate the laboratory assays' sensitivity to anticoagulation. RESULTS: Coagulation assays revealed hypercoagulation after delivery and a tendency toward normalization of coagulation during early postpartum. The thromboprophylaxis results revealed a higher percentage of coagulation parameters within the normal range in the LMWH group. CONCLUSION: This research is potentially beneficial for the application of thrombodynamics and thrombodynamics-4D in monitoring coagulation among patients with high VTE risk who receive thromboprophylaxis with heparin.


Assuntos
Testes de Coagulação Sanguínea/estatística & dados numéricos , Cesárea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Parto/sangue , Tromboembolia Venosa/prevenção & controle , Adulto , Anticoagulantes/uso terapêutico , Procedimentos Cirúrgicos Eletivos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Gravidez , Tromboembolia Venosa/etiologia , Adulto Jovem
17.
Rev. med. interna Guatem ; 22(1): 8-18, 2018 ene.mar. tab
Artigo em Espanhol | LILACS, LIGCSA | ID: biblio-1052597

RESUMO

La coagulopatía es el denominador común en la amplia gama de procesos hepático crónicos, efecto principal de la deficiencia de vitamina K. A pesar de la falta de evidencia que sostiene su eficacia, su administración representa una parte del manejo de muchos pacientes con coagulopatía. Por tanto, el objetivo primario de este estudio fue comparar los tiempos de coagulación tras la administración de vitamina K en pacientes con enfermedad hepática crónica y trastornos de coagulación. Se postularon como secundarios la caracterización del paciente hepatópata según grupo nosológico por edad y sexo, así como las diferencias existentes entre las pruebas de coagulación basales con respecto a cada grupo. 72 pacientes fueron reclutados en 4 grupos, grupo 1: hepatitis B inactiva (n=6), grupo 2: hepatitis B crónica-hepatitis C (n=14), grupo 3: cirrosis (n=35) y grupo 4: hepatocarcinoma (n=17), se administraron 3 dosis de vitamina K de 10 mg cada una a intervalos de 24 horas, se midieron tiempo de protrombina (TP), radio normalizado internacional (INR) y tiempo de tromboplastina parcial activado (TPT) basales y cada 24 horas después de cada dosis. Se logró establecer una diferencia estadísticamente significativa en la corrección del tiempo de protrombina (31.04±9.62 a 21.69±8.48 P˂0.0001) así como del INR (2.81±1.013 a 1.92±0.81, P˂0.0001), hubo diferencia en cuanto a grupo diagnóstico y edad de presentación, así como en cuanto a tiempos de coagulación basales según diagnóstico. Por tanto, se demostró la efectividad de la vitamina K en la corrección del TP e INR.(AU)


Coagulopathy is the common denominator in the wide range of chronic liver processes, the main effect of vitamin K deficiency. Despite the lack of evidence supporting its efficacy, its administration represents a part of the management of many patients with coagulopathy. Therefore, the primary objective of this study was to compare clotting times after vitamin K administration in patients with chronic liver disease and coagulation disorders. The characterization of the liver disease patient according to nosological group by age and sex, as well as the differences between the baseline coagulation tests with respect to each group, were postulated as secondary. 72 patients were recruited into 4 groups, group 1: inactive hepatitis B (n = 6), group 2: chronic hepatitis B-hepatitis C (n = 14), group 3: cirrhosis (n = 35) and group 4: hepatocarcinoma ( n = 17), 3 doses of vitamin K of 10 mg each were administered at 24-hour intervals, prothrombin time (TP), international normalized radius (INR) and baseline activated partial thromboplastin time (TPT) were measured and each 24 hours after each dose. It was possible to establish a statistically significant difference in the correction of prothrombin time (31.04 ± 9.62 to 21.69 ± 8.48 P˂0.0001) as well as the INR (2.81 ± 1.013 to 1.92 ± 0.81, P˂0.0001), there was a difference in terms of group Diagnosis and age of presentation, as well as baseline clotting times according to diagnosis. Therefore, the effectiveness of vitamin K in the correction of TP and INR was demonstrated


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Vitamina K/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Hepatopatias/terapia , Tempo de Protrombina , Testes de Coagulação Sanguínea/estatística & dados numéricos , Hepatite B Crônica/tratamento farmacológico
18.
Br J Anaesth ; 119(6): 1186-1193, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29136093

RESUMO

Background: Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences. Methods: Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings. Results: Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12-0.31% for tonsillectomy and 0.01-0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32-45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02-0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000). Conclusions: Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed.


Assuntos
Testes de Coagulação Sanguínea/estatística & dados numéricos , Tipagem e Reações Cruzadas Sanguíneas/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Adulto , Testes de Coagulação Sanguínea/economia , Tipagem e Reações Cruzadas Sanguíneas/economia , Criança , Pré-Escolar , Feminino , França , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Cuidados Pré-Operatórios/economia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Procedimentos Desnecessários/economia , Adulto Jovem
19.
J Thromb Haemost ; 15(12): 2377-2387, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28976630

RESUMO

Essentials Routine monitoring is unnecessary but measuring dabigatran levels is helpful in certain situations. We compared ecarin chromogenic assay (STA-ECA-II) and dilute thrombin time (dTT) in patient samples. Both tests provided accurate measurements over a wide range of dabigatran concentrations. Adoption of STA-ECA-II and dTT into routine clinical practice will improve patient care. SUMMARY: Background Although routine coagulation monitoring is unnecessary, measuring plasma dabigatran concentrations can be useful for detecting drug accumulation in renal failure or overdose, assessing the contribution of dabigatran to serious bleeding, planning the timing of urgent surgery or intervention, or determining the suitability for thrombolytic therapy for acute ischemic stroke. Dabigatran concentrations can be quantified using chromogenic or clot-based tests, such as the ecarin chromogenic assay (ECA) and the diluted thrombin time (dTT), respectively. Objective The purpose of this study was to compare the results of these assays with dabigatran concentrations measured by the reference standard of mass spectrometry in samples from 50 dabigatran-treated patients collected at peak and trough after at least 4 months of drug intake. Methods Drug levels measured with either the STA Ecarin Chromogenic Assay-II (STA-ECA-II) or dTT were linearly correlated with those determined by mass spectrometry over a wide range of concentrations. Results and Conclusions For detection of levels below 50 ng mL-1 both tests have specificities of at least 96%, suggesting that they accurately detect even low levels of drug. Therefore, regardless of whether a chromogenic or clot-based platform is preferred, the STA-ECA-II and dTT are useful tests for measuring dabigatran concentrations. Unfortunately, neither test is licensed by the United States Food and Drug Administration. Although approved in other jurisdictions, the dTT and STA-ECA-II are not widely or rapidly available in most hospitals. Therefore, cooperation between regulators and hospitals is urgently needed to render these tests readily available to inform patient care.


Assuntos
Análise Química do Sangue/métodos , Testes de Coagulação Sanguínea/métodos , Dabigatrana/sangue , Tempo de Trombina/métodos , Anticoagulantes/sangue , Anticoagulantes/normas , Anticoagulantes/uso terapêutico , Fibrilação Atrial/sangue , Fibrilação Atrial/tratamento farmacológico , Análise Química do Sangue/estatística & dados numéricos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Cromatografia Líquida de Alta Pressão , Compostos Cromogênicos , Dabigatrana/normas , Dabigatrana/uso terapêutico , Endopeptidases , Humanos , Espectrometria de Massas em Tandem , Tempo de Trombina/estatística & dados numéricos
20.
J Hosp Med ; 12(9): 705-709, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28914273

RESUMO

BACKGROUND: Clinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event. OBJECTIVE: To determine appropriateness of thrombophilia testing in a teaching hospital. DESIGN: Retrospective cohort study. SETTING: One academic medical center in Utah. PARTICIPANTS: All patients who received thrombophilia testing between July 1, 2014, and December 31, 2014. MAIN MEASUREMENTS: Proportion of thrombophilia tests occurring in situations associated with minimal clinical utility, defined as tests meeting at least 1 of the following criteria: discharged before results available; test type not recommended; testing in situations associated with decreased accuracy; duplicate testing; and testing following a provoked thrombotic event. RESULTS: Overall, 163 patients received a total of 1451 thrombophilia tests for stroke (50% of tests; 35% of patients), venous thromboembolism (21% of tests; 21% of patients), and pregnancy-related conditions (15% of tests; 25% of patients). Of the 39 different test types performed, the most common were cardiolipin IgG and IgM antibodies (9% each), lupus anticoagulant (9%), and ß2-glycoprotein 1 IgG and IgM antibodies (8% each). In total, 911 tests (63%) were performed in situations associated with minimal clinical utility, with 126 patients (77%) receiving at least one such test. Only 2 patients (1%) had clear documentation of being offered genetic consultation. CONCLUSIONS: Thrombophilia testing in this single-center study was often associated with minimal clinical utility. Strategies to improve testing practices (eg, hematology specialty consult prior to inpatient testing, improved order panels) might help minimize inappropriate testing and promote value-driven care.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Testes de Coagulação Sanguínea/estatística & dados numéricos , Programas de Rastreamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboembolia Venosa/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA