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1.
J Extra Corpor Technol ; 53(1): 50-56, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33814606

RESUMO

Modified ultrafiltration (MUF) is still used after pediatric cardiopulmonary bypass (CPB) in some pediatric cardiac surgery centers to decrease transfusion requirements. Other potential benefits of MUF include clearance of inflammatory markers and improvement in myocardial function. Our hypothesis is that MUF will hemoconcentrate coagulation factors and improve thromboelastography (TEG) parameters after pediatric CPB. Patients younger than 6 months were prospectively enrolled over a year. TEG was carried out before MUF, after MUF, and after protamine administration. Paired t tests were conducted to compare values pre-MUF and post-MUF as well as post-MUF and post-protamine administration. Thirty patients were enrolled in the study, with 20 (67%) neonates in the cohort. Seven arterial switch operations and nine Norwood procedures were found to be performed among the cohort. Reaction time (R), angle (α), and maximum amplitude (MA) were significantly worse post-MUF compared with pre-MUF (p < .001). They improved significantly after protamine administration compared with post-MUF (p < .001). The amount of fluid removal was significantly associated with a worse post-MUF R, angle, and MA and worse post-protamine administration, angle, and MA but with no effect on post-protamine R. MUF caused worsening of TEG parameters that is reversed by protamine administration.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tromboelastografia , Ponte Cardiopulmonar , Criança , Humanos , Recém-Nascido , Estudos Prospectivos , Ultrafiltração
3.
Zhonghua Yi Xue Za Zhi ; 101(8): 586-590, 2021 Mar 02.
Artigo em Chinês | MEDLINE | ID: mdl-33663190

RESUMO

Objective: To analyze the effects of hemocoagulase agkistrodon (HCA) on the coagulation status of healthy people and traumatic brain injury (TBI) patients in vitro. Methods: A total of 10 TBI patients were enrolled from December 2018 to June 2019,and 24 age and sex matched healthy controls were also enrolled. Clinical and pathological data, blood samples of all subjects were collected. Different gradient concentrations of HCA were added to the blood samples which were detected by thromboelastography, and the R value, K value, α angle and MA value of thromboelastography parameters between the two groups were analyzed to explore the effect of HCA on the coagulation status of patients with TBI. Results: With the increase of HCA concentration in blood samples, the R and K values gradually increased, and the α angles and MA values gradually decreased in both TBI patients group which included 7 males and 3 females, with an median age of 33 (28-39) years old and healthy control group which included 11 males and 13 females, with an median age of 33 (23-49) years old. The differences in the R values, K values, α angles, and MA values of different concentration gradients were statistically significant in both healthy control group and TBI patients group (χ2 were 109.80, 131.28, 185.47, 165.97 and 54.92, 75.60, 80.12, 59.25, respectively, all P<0.001). The differences between R values after adding HCA of 0-0.105 U/ml in the healthy group were statistically significant (P=0.025), but K values, α angles and MA values were not statistically significant (P values were 0.275, 0.206 and 0.330, respectively); the R values of the TBI patients group were not statistically significant after adding HCA of 0 to 0.105 U/ml (P=0.976), and the K values, α angles, and MA values were statistically significant (P values were 0.047, 0.041, and 0.034, respectively).The R values of the healthy control group, the TBI patients group, and the overall data were significantly positively correlated with the HCA dose (r values were 0.552、0.700、0.420, respectively, P<0.001), the K values were significantly positively correlated with the HCA dose (r values were 0.726、0.861、0.750, respectively, P<0.001), the α angles were significantly negatively correlated with the HCA dose (r values were -0.815、-0.876、-0.807, respectively, P<0.001) and the MA values were significantly negatively correlated with the HCA dose (r values were -0.757、-0.710、-0.729, respectively, P<0.001). Conclusions: HCA does not aggravate the procoagulant state of blood in healthy people and TBI patients, and with the increase of HCA concentration in blood, the blood samples of both groups show a tendency to decrease the coagulation ability.


Assuntos
Agkistrodon , Lesões Encefálicas Traumáticas , Adulto , Animais , Batroxobina , Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboelastografia
4.
ASAIO J ; 67(3): 254-262, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33627598

RESUMO

Viscoelastic coagulation monitor (VCM) is a portable device developed to evaluate the viscoelastic properties of whole blood activated by contact with glass. In this study, VCM was employed to analyze the viscoelastic profiles of 36 COVID-19 intensive care patients. Full anticoagulant dose heparin (unfractionated [UFH]; low molecular weight [LMWH]) was administrated to all patients. The association between VCM and laboratory parameters was retrospectively analyzed. The administration of UFH-influenced VCM parameters prolonging clotting time (CT) and clot formation time (CFT) and reducing angle (alpha) and amplitudes of the VCM tracings (A10, A20, and maximum clot firmness [MCF]) compared with LMWH therapy. A tendency toward hypercoagulation was observed by short CT and CFT in patients receiving LMWH. Clotting time was correlated with UFH dose (Spearman's rho = 0.48, p ≤ 0.001), and no correlation was found between CT and LMWH. All VCM tracings failed to show lysis at 30 and 45 minutes, indicating the absence of fibrinolysis. A10, A20, and MCF exhibited very-good to good diagnostic accuracy for detecting platelet count and fibrinogen above the upper reference limit of the laboratory. In conclusion, VCM provided reliable results in COVID-19 patients and was easy to perform with minimal training at the bedside.


Assuntos
/sangue , Monitorização Fisiológica/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Tromboelastografia/instrumentação , Adulto , Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Estudos Retrospectivos , Tromboelastografia/métodos , Trombose/diagnóstico , Trombose/virologia
5.
Clin Appl Thromb Hemost ; 27: 1076029620983902, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523711

RESUMO

A rapid and reliable assessment of the dabigatran effect is desirable in dabigatran treated patients with uncontrolled bleeding or before acute surgery. The aim of this study was to study the anticoagulant effects of dabigatran in patients with atrial fibrillation (AF) as assessed by the whole blood assays ROTEM, and how data from these methods correlate to plasma dabigatran concentrations measured by Hemoclot. ROTEM was performed with ROTEM Gamma (Pentapharm GmbH, Munich, Germany). The assays used in our study were Ex-tem and In-tem assay. Plasma dabigatran concentrations were determined by hemoclot thrombin inhibitor assay (Hyphen BioMed, France) at trough and post-dose in 27 patients on dabigatran 150 mg BID. Median plasma dabigatran concentrations at trough were 74 ng/mL (11.2-250) and post-dose (2 h after ingestion) 120 ng/mL (31-282). The ROTEM clotting time (CT) and maximum clot firmnes (MCF) correlated strongly with dabigatran concentrations when activated with the reagents Ex-tem (p < 0.0001) and In-tem (p < 0.0001). In summary, in our study, we have found that the ROTEM variable CT and MCF, when activated with triggers Ex-tem and In-tem, has a strong and highly significant correlation with the plasma dabigatran concentration in a real-life population of AF-patients and could thereby be an alternative to estimate dabigatran concentration in emergency situations. However, additional studies are needed to further validate these findings.


Assuntos
Antitrombinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Dabigatrana/uso terapêutico , Monitoramento de Medicamentos , Testes Imediatos , Tromboelastografia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/sangue , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Dabigatrana/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Resultado do Tratamento
6.
Aust Crit Care ; 34(2): 160-166, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33509706

RESUMO

BACKGROUND: A high number of thrombotic complications have been reported in critically ill patients with coronavirus disease 2019 (COVID-19) and appear to be related to a hypercoagulable state. Evidence regarding detection, management, and monitoring of COVID-19-associated coagulopathy is still missing. We propose to describe the thrombus viscoelastic properties to investigate the mechanisms of hypercoagulability in patients with COVID-19. METHODS: Thromboelastography (TEG) was performed in 24 consecutive patients admitted to a single intensive care unit for COVID-19 pneumonia, and 10 had a second TEG before being discharged alive from the intensive care unit. RESULTS: Compared with a group of 20 healthy participants, patients with COVID-19 had significantly decreased values of reaction time, coagulation time, and lysis index and increased values of α angle, maximum amplitude, clot strength, and coagulation index. Velocity curves were consistent with increased generation of thrombin. These values persisted in surviving patients despite their good clinical course. DISCUSSION: In patients with COVID-19, TEG demonstrates a complex and prolonged hypercoagulable state including fast initiation of coagulation and clot reinforcement, low fibrinolysis, high potential of thrombin generation, and high fibrinogen and platelet contribution. The antithrombotic strategy in patients with COVID-19 during intensive care hospitalisation and after discharge should be investigated in further studies.


Assuntos
/sangue , Pneumonia Viral/sangue , Tromboelastografia , Trombofilia/diagnóstico , Trombofilia/virologia , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia
8.
Anesthesiology ; 134(3): 457-467, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417674

RESUMO

BACKGROUND: The hemostatic balance in patients with coronavirus disease 2019 (COVID-19) seems to be shifted toward a hypercoagulable state. The aim of the current study was to assess the associated coagulation alterations by point-of-care-diagnostics, focusing on details of clot formation and lysis in these severely affected patients. METHODS: The authors' prospective monocentric observational study included critically ill patients diagnosed with COVID-19. Demographics and biochemical data were recorded. To assess the comprehensive hemostatic profile of this patient population, aggregometric (Multiplate) and viscoelastometric (CloPro) measures were performed in the intensive care unit of a university hospital at a single occasion. Coagulation analysis and assessment of coagulation factors were performed. Data were compared to healthy controls. RESULTS: In total, 27 patients (21 male; mean age, 60 yr) were included. Impedance aggregometry displayed no greater platelet aggregability in COVID-19 in comparison with healthy controls (area under the curve [AUC] in adenosine diphosphate test, 68 ± 37 U vs. 91 ± 29 U [-27 (Hodges-Lehmann 95% CI, -48 to -1); P = 0.043]; AUC in arachidonic acid test, 102 ± 54 U vs. 115 ± 26 U [-21 (Hodges-Lehmann 95% CI, -51 to 21); P = 0.374]; AUC in thrombin receptor activating peptide 6 test, 114 ± 61 U vs. 144 ± 31 U [-31 (Hodges-Lehmann 95% CI, -69 to -7); P = 0.113]). Comparing the thromboelastometric results of COVID-19 patients to healthy controls, the authors observed significant differences in maximum clot firmness in fibrin contribution to maximum clot firmness assay (37 ± 11 mm vs. 15 ± 4 mm [21 (Hodges-Lehmann 95% CI, 17 to 26); P < 0.001]) and lysis time in extrinsic activation and activation of fibrinolysis by tissue plasminogen activator assay (530 ± 327 s vs. 211 ± 80 s [238 (Hodges-Lehmann 95% CI, 160 to 326); P < 0.001]). CONCLUSIONS: Thromboelastometry in COVID-19 patients revealed greater fibrinolysis resistance. The authors did not find a greater platelet aggregability based on impedance aggregometric tests. These findings may contribute to our understanding of the hypercoagulable state of critically ill patients with COVID-19.


Assuntos
Fibrinólise , Estado Terminal , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária , Estudos Prospectivos , Tromboelastografia , Ativador de Plasminogênio Tecidual
9.
Medicine (Baltimore) ; 100(2): e23784, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466128

RESUMO

BACKGROUND: CO2 artificial pneumothorax creates a sufficient operative field for thoracoscopic esophagectomy. However, it has potential complications and continuous CO2 insufflation may impede coagulation and fibrinolysis. We sought to compare the effects of CO2 artificial pneumothorax on perioperative coagulation and fibrinolysis during thoracoscopic esophagectomy. METHODS: We investigated patients who underwent thoracoscopic esophagectomy with (group P, n = 24) or without CO2 artificial pneumothorax (group N, n = 24). The following parameters of coagulation-fibrinolysis function: intraoperative bleeding volume; serum levels of tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thromboelastogram (TEG), D-Dimer; and arterial blood gas levels were compared with two groups. RESULTS: Group P showed higher levels of PaCO2, reaction time (R) value and kinetics (K) value, but significantly lower pH value, alpha (α) angle and Maximum Amplitude (MA) value at 60 minutes after the initiation of CO2 artificial pneumothorax than group N ((P < .05, all). The t-PA level after CO2 insufflation for 60 minutes was significantly higher in group P than in group N (P < .05), but preoperative levels were gradually restored on cessation of CO2 insufflation for 30 min (P > .05). There was no significant difference in D-dimer. CONCLUSION: CO2 artificial pneumothorax during thoracoscopic esophagectomy had a substantial impact on coagulation and fibrinolysis, inducing significant derangements in pH and PaCO2. TRIAL REGISTRATION: The study was registered at the Chinese clinical trial registry (ChiCTR1800019004).


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Dióxido de Carbono/administração & dosagem , Esofagectomia/métodos , Fibrinólise/efeitos dos fármacos , Pneumotórax Artificial/métodos , Toracoscopia/métodos , Idoso , Gasometria , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/efeitos dos fármacos , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/efeitos dos fármacos , Pneumotórax Artificial/efeitos adversos , Tromboelastografia , Ativador de Plasminogênio Tecidual/efeitos dos fármacos
10.
Phytomedicine ; 81: 153419, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33360345

RESUMO

BACKGROUND: Salvia Miltiorrhiza Depside Salt (SMDS) was extracted from Salvia miltiorrhiza with high-quality control of active principles. In 2005, China's FDA approved the use of SMDS for stable angina pectoris (SAP), but the evidence of SMDS combined with aspirin remains unclear. PURPOSE: The aim of this study was to assess the clinical effectiveness and safety of SMDS combined with aspirin in patients with SAP. METHODS: A multicenter, pragmatic, three-armed parallel group and an individually randomized controlled superiority trial was designed. Participants aged 35 to 75 years old with SAP were recruited from four "Class Ⅲ Grade A" hospitals in China. Participants who were randomized into the SMDS group were treated with SMDS by intravenous drip. Participants in the control group received aspirin enteric-coated tablets (aspirin). Participants who were randomly assigned to the combination group received SMDS combined with aspirin. All participants received standard care from clinicians, without any restrictions. The primary outcome measure was thromboelastography (TEG). Secondary outcome measures included symptom score of the Seattle Angina Questionnaire (SAQ), visual analogue scale (VAS) score of traditional Chinese medicine (TCM) symptoms, platelet aggregation measured by light transmittance aggregometry (LTA), and fasting blood glucose. Effectiveness evaluation data were collected at baseline and ten days after treatment. Researchers followed up with participants for one month after treatment to determine whether adverse events (AEs) or adverse drug reactions (ADRs) such as bleeding tendency occurred. All statistical calculations were carried out with R 3.5.3 statistical analysis software. RESULTS: A total of 135 participants completed follow-up data on the primary outcome after ten days of treatment. Participants in the SMDS combined aspirin group had the highest improvement rate of sensitivity in AA% [p < 0.001, 95% CI (0.00-0.00)], from 30.6% before treatment to 81.6% after treatment. Participants with drug resistance (AA% < 20%) in the SMDS combined with aspirin group also had the highest sensitivity rate [p < 0.001, 95% CI (0.00-0.00)] after treatment (accounting for 81.0% of the combination group and 60.7% of the sensitive participants). The improvement of TCM symptoms in participants treated with SMDS combined with aspirin was significantly better than that of the aspirin group [MD = 1.71, 95% CI (0.15-3.27), p = 0.032]. There were no significant differences in other indexes (R, TPI, MA, K, CI, α value) of TEG, SAQ, platelet aggregation and fasting blood glucose among the three groups. No bleeding tendency or ADRs occurred in all participants. CONCLUSION: SMDS combined with aspirin is a clinically effective and safe intervention to treat adults aged 35 and older with SAP. This trial shows that SMDS combined with aspirin can significantly improve the sensitivity rate of AA% in TEG and the VAS score of TCM symptoms. Further large samples and high-quality research are needed to determine if certain participants might benefit more from SMDS combined with aspirin. The study protocol was registered in the Clinical Trials USA registry (registration No. NCT02694848).


Assuntos
Angina Estável/tratamento farmacológico , Aspirina/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Salvia miltiorrhiza/química , Idoso , Angina Estável/etiologia , Aspirina/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Creatinina/sangue , Depsídeos/uso terapêutico , Quimioterapia Combinada , Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboelastografia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(51): e23553, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371082

RESUMO

ABSTRACT: Total hip replacement revision surgery is accompanied by significant blood loss. Using rotational thrombelastometry (ROTEM) perioperatively to diagnose coagulopathy may help to provide rapid aimed therapy and thus decrease blood loss and the consumption of transfusion products. The aim of this case-control study was to find out whether point of care using of ROTEM may reduce blood loss and the consumption of blood transfusion products in hip replacement revision surgery.Data were prospectively collected from patients who underwent hip replacement revision surgery in the period 2017 to 2018 when the management of bleeding and coagulopathy was based on the results of ROTEM. Data were compared with a group of historical controls for the period 2015 to 2016 when bleeding and coagulopathy management was not based on ROTEM results. The consumption of blood transfusion products and perioperative blood loss were compared between the groups.The total number of analyzed patients was 90. Forty five patients were analyzed in the ROTEM group and the same number of patients were analyzed in the non-ROTEM group. Significantly decreased perioperative consumption of fresh frozen plasma and packed red blood cells was found in the ROTEM, as well as decreased perioperative blood loss comparing to non-ROTEM group. All data were statistically different with P < .05.Perioperative management of bleeding and coagulopathy based on the results of ROTEM during hip replacement revision surgery seems to help to decrease perioperative blood loss and the consumption of blood transfusion products, especially fresh frozen plasma.


Assuntos
Artroplastia de Quadril/métodos , Transtornos da Coagulação Sanguínea/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Reoperação/métodos , Tromboelastografia/estatística & dados numéricos , Idoso , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação/efeitos adversos , Tromboelastografia/métodos
12.
Eur Rev Med Pharmacol Sci ; 24(23): 12466-12479, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33336766

RESUMO

OBJECTIVE: Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection may yield a hypercoagulable state with fibrinolysis impairment. We conducted a single-center observational study with the aim of analyzing the coagulation patterns of intensive care unit (ICU) COVID-19 patients with both standard laboratory and viscoelastic tests. The presence of coagulopathy at the onset of the infection and after seven days of systemic anticoagulant therapy was investigated. PATIENTS AND METHODS: Forty consecutive SARS-CoV-2 patients, admitted to the ICU of a University hospital in Italy between 29th February and 30th March 2020 were enrolled in the study, providing they fulfilled the acute respiratory distress syndrome criteria. They received full-dose anticoagulation, including Enoxaparin 0.5 mg·kg-1 subcutaneously twice a day, unfractionated Heparin 7500 units subcutaneously three times daily, or low-intensity Heparin infusion. Thromboelastographic (TEG) and laboratory parameters were measured at admission and after seven days. RESULTS: At baseline, patients showed elevated fibrinogen activity [rTEG-Ang 80.5° (78.7 to 81.5); TEG-ACT 78.5 sec (69.2 to 87.9)] and an increase in the maximum amplitude of clot strength [FF-MA 42.2 mm (30.9 to 49.2)]. No alterations in time of the enzymatic phase of coagulation [CKH-K and CKH-R, 1.1 min (0.85 to 1.3) and 6.6 min (5.2 to 7.5), respectively] were observed. Absent lysis of the clot at 30 minutes (LY30) was observed in all the studied population. Standard coagulation parameters were within the physiological range: [INR 1.09 (1.01 to 1.20), aPTT 34.5 sec (29.7 to 42.2), antithrombin 97.5% (89.5 to 115)]. However, plasma fibrinogen [512.5 mg·dl-1 (303.5 to 605)], and D-dimer levels [1752.5 ng·ml-1 (698.5 to 4434.5)], were persistently increased above the reference range. After seven days of full-dose anticoagulation, average TEG parameters were not different from baseline (rTEG-Ang p = 0.13, TEG-ACT p = 0.58, FF-MA p = 0.24, CK-R p = 0.19, CKH-R p  = 0.35), and a persistent increase in white blood cell count, platelet count and D-dimer was observed (white blood cell count p < 0.01, neutrophil count p = 0.02, lymphocyte count p < 0.01, platelet count p = 0.13 < 0.01, D-dimer levels p= 0.02). CONCLUSIONS: SARS-CoV-2 patients with acute respiratory distress syndrome show elevated fibrinogen activity, high D-dimer levels and maximum amplitude of clot strength. Platelet count, fibrinogen, and standard coagulation tests do not indicate a disseminated intravascular coagulation. At seven days, thromboelastographic abnormalities persist despite full-dose anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , /sangue , Tromboelastografia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/sangue , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Testes de Coagulação Sanguínea , Enoxaparina/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Estudos Prospectivos , Resultado do Tratamento
13.
PLoS One ; 15(12): e0243604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33320874

RESUMO

BACKGROUND: Coagulation abnormalities in COVID-19 patients have not been addressed in depth. OBJECTIVE: To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. METHODS: Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. RESULTS: Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM-FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C ​​than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability. CONCLUSION: COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.


Assuntos
/sangue , Unidades de Terapia Intensiva , /patogenicidade , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/sangue , Testes de Coagulação Sanguínea , /virologia , Feminino , Fibrinólise/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária/métodos , Proteína C/metabolismo , Proteína S/metabolismo , Tromboelastografia/métodos
14.
Klin Lab Diagn ; 65(12): 744-749, 2020 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33373505

RESUMO

Disorders of the hemostatic system and inflammation play a key role in the pathogenesis of new coronavirus pneumonia (NCP), determining its course and outcome. To study the dynamics of the state of the hemostasis system and the severity of the acute phase response in patients with new coronavirus pneumonia. We determined APTT, prothrombin time (PT), fibrinogen (F), D-dimers (D-d), antitrombin III (AT III), C-reactive protein (CRP), platelet count in 22 patients. In 49 patients, the viscoelastic properties of a blood clot were studied by thromboelastography (TEG) with koalin. The age of the patients ranged from 40 to 77 years. According to CT, the severity of 100% cases corresponded to CT2-CT3. Acute respiratory failure (ARF) was diagnosed in 16 patients. A control group included 25 apparently healthy subjects. During hospitalization, patients with NCP were characterized by: an increase in the concentration of D-d, CRP, Fg, lengthening of APTT and PT, ATIII activity and platelet count not differing from the normal range. 10 days after hospitalization and against the background of ongoing therapy, patients with NCP showed positive dynamics in the hemostasiological profile and the severity of the inflammatory response. Thromboelastography indices in patients with LCP did not differ from control values both at hospitalization and on day 10.Thus, in patients with novel coronavirus pneumonia, an increased prothrombotic activity and a pronounced inflammatory response are recorded. Against the background of treatment, there is a positive dynamics in both the coagulation status and the inflammatory response. Additional studies are needed to determine the diagnostic capabilities of thromboelastography in patients with NCP.


Assuntos
/fisiopatologia , Hemostasia , Inflamação/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Humanos , Inflamação/virologia , Pessoa de Meia-Idade , Tromboelastografia
15.
Medicine (Baltimore) ; 99(47): e23365, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217881

RESUMO

Hypercoagulability and thrombosis remain a challenge in severe coronavirus disease 2019 (COVID-19) infections. Our aim is to investigate the hemostatic profile of critically ill COVID-19 patients on therapeutic anticoagulant treatment.Forty one patients were enrolled into the study. We recruited 11 consecutive, COVID-19, patients who received therapeutic anticoagulant treatment on intensive care unit (ICU) admission. Disease severity indexes, biochemical, hematological and haemostatic parameters, endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1) activity and extrinsically activated rotational thromboelastometry assay (EXTEM) were recorded on days 1, 3, 7. We also enrolled 9 ICU non-COVID-19, 21 non-ICU COVID-19 patients and 20 healthy blood donors as control populations.Critically ill COVID-19 patients demonstrated a more hypercoagulable and hypofibrinolytic profile related to those with COVID-19 mild illness, based on EXTEM amplitude at 10 min (A10), maximum clot firmness (MCF) and lysis index at 60 min (LI60) variables (p = 0.020, 0.046 and 0.001, respectively). Similarly, a more hypercoagulable state was detected in COVID-19 ICU patients related to non-COVID-19 ICU patients based on A10 and MCF parameters (p = 0.03 and 0.04, respectively). On the contrary, ETP and EXTEM (clotting time) CT values were similar between patients with severe and mild form of the COVID-19 infection, probably due to anticoagulant treatment given.Critically ill COVID-19 patients showed a hypercoagulable profile despite the therapeutic anticoagulant doses given. Due to the small sample size and the study design, the prognostic role of the hypercoagulability in this clinical setting remains unknown and further research is required in order to be assessed.


Assuntos
Anticoagulantes/farmacologia , Infecções por Coronavirus/sangue , Hemostasia/efeitos dos fármacos , Pneumonia Viral/sangue , Trombofilia/tratamento farmacológico , Trombose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Testes de Coagulação Sanguínea , Estudos de Casos e Controles , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Prognóstico , Índice de Gravidade de Doença , Tromboelastografia , Trombofilia/sangue , Trombofilia/virologia , Trombose/sangue , Trombose/virologia , Resultado do Tratamento
16.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1699-1703, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33067977

RESUMO

OBJECTIVE: To investigate the diagnostic value of thromboelastography(TEG) for acute disseminated intravascular coagulation(DIC). METHODS: The clinical data and data of blood routine indexes, blood coagulation indexes and TEG indexes of acute 155 DIC patients were collected and analyzed retrospectively. RESULTS: The CDSS scores of DIC and non-DIC groups were 9.2±1.4 and 4.2±1.1 respectively, and the CDSS scores of DIC group was significantly higher than those in non-DIC group(P<0.05). The PLT level in DIC group was significantly lower than that in non-DIC group(P<0.05), the PT, APTT, INT, DD and FIB levels in DIC group were significantly higher than those in non-DIC group(P<0.05). The R time, K time and LY30 in DIC group were significantly higher than those in non-DIC group(P<0.05), and the α and MA in DIC group were significantly lower than those in non-DIC group(P<0.05). ROC curve analysis showed that the best cutoff value of R time, K time, α, MA and LY30 were 8.4 min, 6.2 min, 52.5°, 43.2 mm and 6.7% respectively. The AUC of total scores≥1, ≥2, ≥3 and ≥4 were 0.552, 0.650, 0.687 and 0.613 respectively. CONCLUSION: The TEG possesses the certain value in the diagnosing of DIC.


Assuntos
Coagulação Intravascular Disseminada , Tromboelastografia , Testes de Coagulação Sanguínea , Coagulação Intravascular Disseminada/diagnóstico , Humanos , Curva ROC , Estudos Retrospectivos
17.
Anaesth Intensive Care ; 48(5): 339-353, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016097

RESUMO

Hypofibrinogenaemia during cardiac surgery may increase blood loss and bleeding complications. Viscoelastic point-of-care tests provide more rapid diagnosis than laboratory measurement, allowing earlier treatment. However, their diagnostic test accuracy for hypofibrinogenaemia has never been reviewed systematically. We aimed to systematically review their diagnostic test accuracy for the identification of hypofibrinogenaemia during cardiac surgery. Two reviewers assessed relevant articles from seven electronic databases, extracted data from eligible articles and assessed quality. The primary outcomes were sensitivity, specificity and positive and negative predictive values. A total of 576 articles were screened and 81 full texts were assessed, most of which were clinical agreement or outcome studies. Only 10 diagnostic test accuracy studies were identified and only nine were eligible (ROTEMdelta 7; TEG5000 1; TEG6S 1, n = 1820 patients) (ROTEM, TEM International GmbH, Munich, Germany; TEG, Haemonetics, Braintree, MA, USA). None had a low risk of bias. Four ROTEM studies with a fibrinogen threshold less than 1.5-1.6 g/l and FIBTEM threshold A10 less than 7.5-8 mm had point estimates for sensitivity of 0.61-0.88; specificity 0.54-0.94; positive predictive value 0.42-0.70; and negative predictive value 0.74-0.98 (i.e. false positive rate 30%-58%; false negative rate 2%-26%). Two ROTEM studies with higher thresholds for both fibrinogen (<2 g/l) and FIBTEM A10 (<9.5 mm) had similar false positive rates (25%-46%), as did the two TEG studies (15%-48%). This review demonstrates that there have been few diagnostic test accuracy studies of viscoelastic point-of-care identification of hypofibrinogenaemia in cardiac surgical patients. The studies performed so far report false positive rates of up to 58%, but low false negative rates. Further diagnostic test accuracy studies of viscoelastic point-of-care identification of hypofibrinogenaemia are required to guide their better use during cardiac surgery.


Assuntos
Afibrinogenemia , Procedimentos Cirúrgicos Cardíacos , Afibrinogenemia/diagnóstico , Alemanha , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Tromboelastografia
19.
Anesth Analg ; 131(5): 1373-1379, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079858

RESUMO

BACKGROUND: Postpartum hemorrhage is a leading cause of maternal mortality. Antifibrinolytic therapy has the potential to influence outcomes in postpartum hemorrhage, but the incidence of elevated fibrinolytic activity in postpartum hemorrhage is unknown. METHODS: We retrospectively reviewed thromboelastography (TEG) results obtained for postpartum hemorrhage from 118 deliveries at The University of Chicago. TEG results were obtained as part of our postpartum hemorrhage protocol when blood loss exceeded 500 mL after vaginal delivery or 1000 mL after cesarean delivery. Our primary outcome was the incidence of elevated fibrinolytic activity, which we predefined as clot lysis ≥3% at 30 minutes (Ly30) on kaolin TEG. Platelet-mediated clot retraction can also lead to an elevated Ly30 on kaolin TEG. Therefore, to distinguish between fibrinolysis and clot retraction, we evaluated clot lysis using functional fibrinogen TEG, which contains a platelet inhibitor. We considered a kaolin TEG Ly30 ≥3% in conjunction with a nonzero functional fibrinogen TEG Ly30 suggestive of elevated fibrinolytic activity. We also recorded quantitative blood loss, primary etiology of hemorrhage, standard laboratory measurements of coagulation, and demographic and obstetric characteristics of the study population. RESULTS: The median kaolin TEG Ly30 was 0.2% (interquartile range: 0%-0.8%). Fifteen of 118 women (12.7%; 95% confidence interval, 7.9%-19.9%) had kaolin TEG Ly30 values ≥3%. Of 15 patients with elevated Ly30 values, functional fibrinogen TEG Ly30 was available for 13, of which none demonstrated detectable clot lysis. CONCLUSIONS: Our observation that none of the patients in our sample with kaolin TEG Ly30 values ≥3% had a nonzero functional fibrinogen TEG Ly30 value suggests that the observed elevations in kaolin TEG Ly30 may have been secondary to platelet-mediated clot retraction as opposed to fibrinolysis. Platelet-mediated clot retraction should be distinguished from fibrinolysis when assayed using viscoelastic techniques in postpartum hemorrhage. Further research is necessary to determine the optimal methods to assess fibrinolytic activity in postpartum hemorrhage.


Assuntos
Fibrinólise , Hemorragia Pós-Parto/sangue , Hemorragia Pós-Parto/epidemiologia , Tromboelastografia/métodos , Adulto , Testes de Coagulação Sanguínea , Viscosidade Sanguínea , Retração do Coágulo , Parto Obstétrico , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Incidência , Inibidores da Agregação de Plaquetas/farmacologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 994-997, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912416

RESUMO

OBJECTIVE: To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis. METHODS: The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded. RESULTS: Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. CONCLUSIONS: Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.


Assuntos
Cateterismo Venoso Central , Veias Jugulares , Tromboelastografia , Trombose , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
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