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1.
Medicine (Baltimore) ; 99(10): e19447, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150098

RESUMO

Antiplatelet agents have been administered to patients with acute ischemic stroke after endovascular therapy. This study was designed to provide initial data to compare thromboelastography (TEG) with the conventional coagulation test (CCT) to analyze the coagulation function of antiplatelet drugs in such patients.The present retrospective cohort study included 240 patients who received endovascular therapy from September 2012 to December 2017. The baseline and clinical characteristics of these patients were collected with respect to TEG (parameters: R, K, maximal amplitude (MA), and α angle) and CCT (parameters: PT, activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT)) on day 5 after aspirin and clopidogrel post-endovascular interventions. The correlation and agreement of these 2 detecting methods were analyzed. Additionally, the area under the receiver operating characteristic curve (AUROC) was used to analyze the effectiveness of these 2 methods in detecting unfavorable clinical outcomes, including symptomatic intracranial hemorrhage and early neurological deterioration.The 3 pairs of parameters (R and APTT, K and APTT, and α angle and FIB) were in agreement for identifying hypercoagulability, while R and APTT, K and APTT, K and PLT, and α angle and PLT were in agreement for identifying hypocoagulability. The AUROC of parameter R for detecting symptomatic intracranial hemorrhage was 0.817, while that of parameter FIB for predicting early neurological deterioration was 0.887.Parameter FIB derived from CCT might be advantageous for evaluating early neurological deterioration, while parameter R detected by TEG might be superior for evaluating symptomatic intracranial hemorrhage.


Assuntos
Testes de Coagulação Sanguínea , Isquemia Encefálica/terapia , Hemorragias Intracranianas/diagnóstico , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/terapia , Tromboelastografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Procedimentos Endovasculares , Feminino , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
2.
Medicine (Baltimore) ; 99(5): e18960, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000422

RESUMO

To investigate the changes in blood coagulability as measured by thromboelastography (TEG) in patients with nephrotic syndrome of different etiologies as well as in patients with venous thromboembolic events (VTE).From January 2013 to October 2017, patients who were diagnosed as idiopathic membranous nephropathy (IMN), minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) were enrolled into this retrospective study in which their clinical characteristics, including TEG variables, were investigated. According to the presence or absence of VTE, the patients with IMN were divided into 2 groups of VTE and non-VTE. The risk factors of VTE were analyzed with logistic regression.Significant differences in TEG parameters were found among the 3 groups of patients with R and K values lower, while the α-angle, maximum amplitude (MA) and confidence interval (CI) values higher, in the IMN group than those in the MCD and FSGS groups (P < .01). Multiple linear regression analysis indicated that the histologic subtype was an independent relevant factor of K time, angle, MA, and CI values. Multivariate logistic regression analysis revealed that serum albumin and CI value were independent risk factors of VTE (P < .05).The results showed that IMN patients may have higher whole blood coagulability than MCD and FSGS patients. The hypercoagulability in IMN patients may be attributed to platelet hyperactivity and the accelerated fibrin-platelet interaction. Hypoproteinemia and increased CI value were independent risk factors of VTE in IMN.


Assuntos
Síndrome Nefrótica/complicações , Tromboelastografia/métodos , Trombofilia/diagnóstico , Trombofilia/etiologia , Adulto , Feminino , Glomerulosclerose Segmentar e Focal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/complicações , Estudos Retrospectivos , Fatores de Risco
4.
J Surg Res ; 246: 605-613, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668435

RESUMO

BACKGROUND: Platelet function tests such as thrombelastography platelet mapping and impedance aggregometry have demonstrated universal platelet dysfunction in trauma patients. In this study, we introduce the measurement of platelet contraction force as a test of platelet function. We hypothesize that force will correlate with established coagulation tests such as thrombelastography, demonstrate significant differences between healthy subjects and trauma patients, and identify critically ill trauma patients. METHODS: Blood samples were prospectively collected from level 1 trauma patients at initial presentation, assayed for force of and time to contraction and compared with thrombelastography. Blood from healthy subjects was assayed to establish a reference range. Results from trauma patients were compared with healthy controls and trauma patients that died. RESULTS: The study includes one hundred trauma patients with mean age 45 y, 74% were male, and median injury severity score of 14 ± 12. Patients that survived (n = 90) demonstrated significantly elevated platelet contraction force compared with healthy controls (n = 12) (6390 ± 2340 versus 4790 ± 470 µN, P = 0.043) and trauma patients that died (n = 10) (6390 ± 2340 versus 2860 ± 1830 µN, P = 0.0001). Elapsed time to start of platelet contraction was faster in trauma patients that survived compared with healthy controls (660 ± 467 versus 1130 ± 140 s, P = 0.0022) and those that died (660 ± 470 versus 1460 ± 1340 s, P < 0.0001). CONCLUSIONS: In contrast with all existing platelet function tests reported in the literature, which report platelet dysfunction in trauma patients, contractile force demonstrates hyperfunction in surviving trauma patients and dysfunction in nonsurvivors. Platelet contraction reflects platelet metabolic reserve and thus may be a potential biomarker for survival after trauma. Contractile force warrants further investigation to predict mortality in severely injured trauma patients.


Assuntos
Transtornos Plaquetários/diagnóstico , Plaquetas/fisiologia , Ferimentos e Lesões/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Coagulação Sanguínea/fisiologia , Transtornos Plaquetários/sangue , Transtornos Plaquetários/etiologia , Transtornos Plaquetários/fisiopatologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Tromboelastografia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adulto Jovem
5.
J Trauma Acute Care Surg ; 88(2): 279-285, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31738314

RESUMO

BACKGROUND: Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS: Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn ≤1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices. RESULTS: A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ß) and linear correlation estimates (p) were as follows: CK.R (ß = 1.05, ρ = 0.9), CFF.MA (ß = 0.99, ρ = 0.95), CK.LY30 (ß = 1.01, ρ = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ß = 1.06, ρ = 0.86) as well as versus CRT.MA (TEG 5000) (ß = 0.93, ρ = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30. CONCLUSION: The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing. LEVEL OF EVIDENCE: Diagnostic test, level II.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Tromboelastografia/instrumentação , Ferimentos e Lesões/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/sangue , Adulto Jovem
6.
J Surg Res ; 246: 182-189, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31593862

RESUMO

BACKGROUND: Trauma patients with pelvic fractures have a high rate of venous thromboembolism (VTEs). The reason for this high rate is unknown. We hypothesize that fibrinolysis shutdown (SD) predicts VTE in patients with severe pelvic fracture. METHODS: Retrospective chart review of trauma patients who presented with pelvic fracture from 2007 to 2017 was performed. Inclusion criteria were injury severity score > 15, abdomen/pelvis abbreviated injury scale >/= 3, blunt mechanism, admission citrated rapid thrombelastography (TEG). Fibrinolytic phenotypes were defined by fibrinolysis on citrated rapid TEG as hyperfibrinolysis, physiologic lysis, and SD. Univariate analysis of TEG measurements and clinical outcomes, followed by multivariable logistic regression (MV) with stepwise selection, was performed. RESULTS: Overall, 210 patients were included. Most patients (59%) presented in fibrinolytic shutdown. VTE incidence was 11%. There were no significant differences in fibrinolytic phenotypes or other TEG measurements between those who developed VTE and those who did not. There was a higher rate of VTE in patients who underwent pelvic external fixation or resuscitative thoracotomy. On MV, pelvic fixation and resuscitative thoracotomy were independent predictors of VTE. CONCLUSIONS: In severely injured patients with pelvic fractures, there was a high rate of VTE and the majority presented in SD. However, we were unable to correlate initial SD with VTE. Ultimately, the high rate of VTE in this patient population supports the concept of implementing VTE chemoprophylaxis measures as soon as hemostasis is achieved.


Assuntos
Fibrinólise/fisiologia , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Tromboembolia Venosa/epidemiologia , Ferimentos não Penetrantes/complicações , Escala Resumida de Ferimentos , Adulto , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/fisiopatologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboelastografia , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/fisiopatologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/fisiopatologia
7.
Anaesthesia ; 75(3): 366-373, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31845321

RESUMO

Coagulopathic bleeding during and after cardiac surgery is associated with increased morbidity and mortality. Viscoelastic testing is increasingly used instead of laboratory testing. Our aim was to compare a new viscoelastic point-of-care device, the Quantra® System, with thromboelastography and standard laboratory testing. After ethical approval and with written informed consent, we prospectively recruited adult patients undergoing urgent cardiac surgery at increased risk of bleeding. Clot time and clot stiffness values were compared before, during and after cardiopulmonary bypass. We prospectively recruited 52 patients, of whom 34 (65%) were transfused with red blood cells. Our usual transfusion thresholds for fibrinogen (1.5 g.l-1 ), platelets (100,000.µl-1 ), prothrombin time (20 s), activated partial thromboplastin time (48 s) and maximum amplitude on thromboelastography (50 mm) corresponded to Quantra values of fibrinogen clot stiffness 2.0 hPa, platelet clot stiffness 13.5 hPa, clot time 159 s, clot time 183 s and clot stiffness 17.0 hPa, respectively. These Quantra thresholds showed high negative predictive value for low platelets (platelet clot stiffness, 97.4%), prolonged activated partial thromboplastin time (clot time, 92.6%) and reduced maximum amplitude on thromboelastography (clot stiffness, 93.6%). The Quantra predicted clinical need for transfusion of platelets (area under the curve 0.71, p = 0.001) but all tests performed poorly at predicting the need for fresh frozen plasma transfusion. We have shown that point-of-care testing using the novel Quantra system provides useful data for guiding transfusion management.


Assuntos
Transfusão de Sangue/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Hemostasia , Testes Imediatos , Tromboelastografia/métodos , Idoso , Idoso de 80 Anos ou mais , Testes de Coagulação Sanguínea , Viscosidade Sanguínea , Estudos de Coortes , Elasticidade , Serviços Médicos de Emergência , Transfusão de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Plasma , Transfusão de Plaquetas , Valor Preditivo dos Testes , Estudos Prospectivos
8.
Acta Neurochir Suppl ; 127: 165-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407079

RESUMO

Subarachnoid hemorrhage after cerebral aneurysm rupture (aSAH) leads to delayed cerebral ischemia (DCI) in 25-35% of surviving patients. It is believed that DCI has a multifactorial etiology, including vasospasm. Furthermore, aSAH is associated with the development of hypercoagulation and microthrombosis; thus, its pharmacological correction may help to prevent DCI. We encountered a case where hypercoagulation was detected using rotational thromboelastometry (ROTEM), although the standard coagulation test results were within the normal ranges. Based on reviews of viscoelastic tests in cases of aSAH, ROTEM could be more sensitive to hypercoagulation after aSAH, compared to standard coagulation testing.


Assuntos
Isquemia Encefálica , Infarto Cerebral , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Trombofilia , Isquemia Encefálica/etiologia , Infarto Cerebral/complicações , Humanos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Tromboelastografia , Trombofilia/complicações
10.
Int J Mol Sci ; 20(19)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31574907

RESUMO

Snake venom enzymes of the L-amino acid oxidase (LAAO) class are responsible for tissue hemorrhage, edema, and derangement of platelet function. However, what role, if any, these flavoenzymes play in altering plasmatic coagulation have not been well defined. Using coagulation kinetomic analyses (thrombelastograph-based), it was determined that the LAAO derived from Crotalus adamanteus venom displayed a procoagulant activity associated with weak clot strength (no factor XIII activation) similar to thrombin-like enzymes. The procoagulant activity was not modified in the presence of reduced glutathione, demonstrating that the procoagulant activity was likely due to deamination, and not hydrogen peroxide generation by the LAAO. Further, unlike the raw venom of the same species, the purified LAAO was not inhibited by carbon monoxide releasing molecule-2 (CORM-2). Lastly, exposure of the enzyme to phenylmethylsulfonyl fluoride (PMSF) resulted in the LAAO expressing anticoagulant activity, preventing contact activation generated thrombin from forming a clot. In sum, this investigation for the first time characterized the LAAO of a snake venom as both a fibrinogen polymerizing and an anticoagulant enzyme acting via oxidative deamination and not proteolysis as is the case with thrombin-like enzymes (e.g., serine proteases). Using this thrombelastographic approach, future investigation of purified enzymes can define their biochemical nature.


Assuntos
Crotalus , L-Aminoácido Oxidase/metabolismo , L-Aminoácido Oxidase/farmacologia , Venenos de Serpentes/enzimologia , Animais , Anticoagulantes/química , Anticoagulantes/metabolismo , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Cálcio/metabolismo , Cálcio/farmacologia , Coagulantes/química , Coagulantes/metabolismo , Coagulantes/farmacologia , Ácido Edético/farmacologia , Glutationa/metabolismo , Glutationa/farmacologia , Heparina/farmacologia , Humanos , Cinética , L-Aminoácido Oxidase/química , Compostos Organometálicos/farmacologia , Tromboelastografia
11.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 27(5): 1622-1626, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31607323

RESUMO

OBJECTIVE: To analyze and compare the correlation of platelet aggregation rate measured by platelet analyzer, platelet aggregometer and thromboelastography. METHODS: The performance of platelet analyzer in platelet count and platelet aggregation function was evaluated. The platelet aggregation rate of 55 patients with type 2 diabetes mellitus (T2DM) before and after taking aspirin alone (32 cases) and clopidogrel alone (23 cases) was measured by thromboelastography, platelet aggregometer and platelet analyzer respectively, and the analytical results were compared. The correlation between the results measured by different instruments and equipment were further analyzed and the data were included in the statistical analysis. RESULTS: The precision of platelet analyzer in day and in batch was 1/3 lower than the total error (7%). The contamination rate was 0.30%. The slope of regression equation was 1.02 and R2 was 0.99 in the linear range of 4.15×109/L to 1379.95×109/L. The coincidence rate of platelet count and platelet reference method was 85%, which met the requirements of industry standards. The platelet aggregation rates of patients with T2DM after clopidogrel or aspirin by using thromboelastography, platelet aggregometer and platelet analyzer respectively was significantly lower than those whom before clopidogrel administration (P<0.01). CONCLUSION: Platelet analyzer can provide reliable, objective and accurate information for clinical detection of platelet count and aggregation function, which is meet the requirements of industry standards, and its results are similar to those of platelet aggregometer and thromboelastography.


Assuntos
Diabetes Mellitus Tipo 2 , Agregação Plaquetária , Humanos , Inibidores da Agregação de Plaquetas , Testes de Função Plaquetária , Tromboelastografia
12.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 611-615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31625678

RESUMO

OBJECTIVE: To determine the effect of Yunnan Baiyao (YB) on hemostatic parameters measured by thromboelastography (TEG) in apparently healthy cats administered 1 capsule of YB orally twice daily for 1 week. DESIGN: Prospective study of client-owned cats at a small animal specialty hospital. SETTING: One private referral center. ANIMALS: Twenty client-owned adult cats were prospectively enrolled. INTERVENTIONS: All cats underwent echocardiographic examination by the same board-certified cardiologist to rule out occult cardiomyopathy. Blood samples were collected for analysis of baseline CBC, fibrinogen, and kaolin-activated TEG values. Cats were administered 1 capsule (250 mg/capsule) of YB twice daily orally for 1 week and the physical examination, CBC, fibrinogen, and TEG were re-evaluated. Any side effects attributed to YB were noted at this time. MEASUREMENTS AND MAIN RESULTS: Three cats were excluded as 2 cats were identified with underlying cardiomyopathy and another cat had a cystic mass in the cranial mediastinum identified via echocardiography. Seventeen cats were treated with YB; however, 1 cat could not complete the study due to severe vomiting associated with YB administration. The remaining 16 cats completed the study, although 2 additional cats experienced transient vomiting. Yunnan Baiyao administration was associated with a significant decrease in HCT and red blood cell count, although no cat became anemic. None of the TEG parameters significantly changed compared to baseline after 1 week of YB therapy. CONCLUSIONS: The results of this study suggest YB at a dose of 1 capsule orally twice daily in cats fails to produce any significant change in hemostatic parameters as measured by TEG, although it did significantly reduce HCT and red blood cell count. Yunnan Baiyao was tolerated for most of the cats, although 3 of 17 (17.6%) cats experienced vomiting. Clinicians should be aware of these effects before considering the use of YB in cats.


Assuntos
Gatos/sangue , Medicamentos de Ervas Chinesas/farmacologia , Hemostasia/efeitos dos fármacos , Hemostáticos/farmacologia , Tromboelastografia/veterinária , Administração Oral , Animais , Gatos/fisiologia , China , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Fibrinogênio , Hemostáticos/administração & dosagem , Masculino , Estudos Prospectivos , Tromboelastografia/efeitos dos fármacos
13.
Medicine (Baltimore) ; 98(39): e17357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574880

RESUMO

Preoperative autologous blood donation is a well-established procedure to reduce the need for allogeneic blood transfusion. We hypothesized that coagulation activity is maintained in cold-stored whole blood, because the fundamental polymerization properties of fibrin are preserved.Fifty adult patients who underwent elective cardiothoracic surgery were enrolled.Autologous whole blood collected 2 to 4 times at almost 1-week intervals before surgery was stored at approximately 4°C until reinfusion at the time of surgery. Blood samples were drawn just before reinfusion, and rotational thromboelastometry variables and fibrinogen levels were measured.A total of 158 samples were analyzed. The mean duration of cold storage was 16.7 ±â€Š7.4 days (range: 6-33 days). Platelet counts were very low due to collection through a leukoreduction filter. The mean fibrinogen level was 2.3 ±â€Š0.6 g/L. Amplitude at 10 minutes after CT (A10), amplitude at 20 minutes after CT (A20), and maximum clot firmness (MCF) values as determined by FIBTEM analysis were 10.8 ±â€Š3.8, 12.2 ±â€Š4.2, and 13.1 ±â€Š4.7 mm, respectively. Fibrinogen levels were strongly correlated with A10, A20, and FIBTEM-MCF values (ρ = 0.83, P < .0001, ρ = 0.84, P < .0001, ρ = 0.85, P < .0001, respectively). Fibrinogen levels were not correlated with the duration of cold storage (ρ = 0.06, P = .43).The results of the present study demonstrate that fibrin polymerization occurs in cold-stored autologous whole blood, and that such activity is strongly correlated with fibrinogen levels. Furthermore, our data suggest that cold-stored leukoreduced autologous whole blood retains fibrin polymerization properties throughout 33 days.


Assuntos
Coagulação Sanguínea , Transfusão de Sangue/métodos , Tromboelastografia/métodos , Tempo de Coagulação do Sangue Total , Idoso , Testes de Coagulação Sanguínea , Temperatura Baixa , Feminino , Fibrina/química , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Polimerização , Estudos Prospectivos
14.
Med. intensiva (Madr., Ed. impr.) ; 43(7): 410-415, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185868

RESUMO

Introducción: La hipoperfusión juega un papel central en el shock, y es un desencadenante de la coagulopatía. El estudio del perfil ROTEM durante la parada cardíaca prolongada podría ofrecer nuevos conocimientos sobre la fisiopatología de la coagulopatía por shock. Objetivo: Describir el perfil de tromboelastometría rotacional en una cohorte de donantes en asistolia y determinar la incidencia de hiperfibrinólisis. Diseño: Cohortes prospectivo. Incluimos 18 pacientes ingresados tras parada cardíaca extrahospitalaria no recuperada. Se recopiló el primer ritmo cardíaco registrado, los tiempos de parada y los de asistencia. Al ingreso se realizaron test de coagulación convencional y ROTEM (EXTEM, APTEM, FIBTEM) en los 30min tras la obtención de la muestra. Ámbito: El estudio se llevó a cabo en un hospital de tercer nivel incluido en un programa de donación en asistolia. Participantes: Pacientes en parada cardíaca extrahospitalaria no recuperada. Resultados: La mediana de edad fue de 50años y 14 de los participantes eran hombres (77,8%). La mediana de tiempo (rango intercuartílico) desde la parada hasta la obtención de muestras fue de 91min (75-104). Los resultados de la coagulación fueron: INR 1,25 (1,19-1,34), TTPA 55s (45-73) y fibrinógeno 161mg/dl (95-295). Los resultados del ROTEM (APTEM): CT 126s (104-191), CFT 247s (203-694). En 15 (83,3%) se cumplió el criterio de hiperfibrinólisis. También se observó mejoría del MCF en APTEM frente a EXTEM. Tiempos más prolongados se asociaron con niveles inferiores de fibrinógeno y un MCF FIBTEM inferior (p<0,05). Conclusiones: El análisis ROTEM mostró una profunda alteración en la formación del coágulo junto con alta incidencia de hiperfibrinólisis


Background: Hypoperfusion plays a central role in shock states, and has been proposed as a coagulopathy trigger. The study of the rotational thromboelastometry (ROTEM) profile during cardiac arrest could offer new insights to the role of hypoperfusion in coagulation during shock states. Outcome: To describe the ROTEM profile in a cohort of asystole donors and elucidate the incidence of hyperfibrinolysis. Design: A prospective observational study was carried out in 18 patients consecutively admitted to the ICU after out-of-hospital non-recovered cardiac arrest (CA). Initial rhythm and time between CA and admission were recorded. Conventional coagulation and ROTEM (EXTEM, APTEM, FIBTEM) tests were performed within 30minutes after blood sample collection. Scope: An asystole donor reference hospital. Participants: Patients admitted to the ICU after out-of-hospital non-recovered CA. Results: The median age was 50years, and 14 of the patients were men (77.8%). The time from CA to hospital admission expressed as the median (interquartile range) was 91minutes (75-104). The results of the routine tests were: INR 1.25 (1.19-1.34), aPTT 55s (45-73) and fibrinogen 161mg/dl (95-295). For the ROTEM APTEM assay the results were: CT 126s (104-191), CFT 247s (203-694). Hyperfibrinolysis criteria were recorded in 15 patients (83.3%). In addition, MCF improved in APTEM versus EXTEM. Prolonged CA times were associated to lower fibrinogen levels and lower values for MCF FIBTEM (P<.05). Conclusions: The ROTEM assays revealed severe alterations of the clot formation parameters and a high incidence of hyperfibrinolysis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tromboelastografia , Estudos de Coortes , Fibrinólise , Doadores de Tecidos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Fibrilação Ventricular
15.
Cir Cir ; 87(S1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501621

RESUMO

Introduction: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. Objective: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. Method: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. Conclusions: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.


Assuntos
Transfusão de Componentes Sanguíneos/métodos , Choque/terapia , Tromboelastografia/métodos , Tempo de Coagulação do Sangue Total/métodos , Adolescente , Afibrinogenemia/tratamento farmacológico , Afibrinogenemia/etiologia , Plaquetas/fisiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Soluções Cristaloides/administração & dosagem , Emergências , Transfusão de Eritrócitos/métodos , Evolução Fatal , Feminino , Fibrinogênio/uso terapêutico , Humanos , México , Plasma , Choque/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
16.
Am Surg ; 85(8): 861-864, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560304

RESUMO

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group (P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent (P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively (P = 0.73). Blood product utilization was significantly lower in the TEG group (P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.


Assuntos
Anticoagulantes/administração & dosagem , Lesões Encefálicas Traumáticas/sangue , Hemorragias Intracranianas/sangue , Ressuscitação/métodos , Tromboelastografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Molecules ; 24(17)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480278

RESUMO

The physicochemical properties and potential hemostatic application of Wenchang kaolin and Maoming kaolin were inspected and evaluated. Chemical composition analysis, Fourier transform infrared (FTIR) spectroscopy, surface area determination, X-ray diffraction, particle size, scanning electron microscopy (SEM) observations, and zeta potential analysis were performed to quantify the physical and chemical properties of the two kaolins. The results showed that both kaolins have typical FTIR bands of kaolinite with a weight fraction for kaolinite over 90 wt%. Larger conglobate aggregates of Maoming kaolin demonstrated wider particle size distributions with two peaks at 3.17 and 35.57 µm, while the book-like Wenchang kaolin had narrow particle size distribution, with a frequent size of 5.64 µm. Furthermore, thrombelastography, the whole blood clotting tests (WBCT), plasma recalcification time (PRT) measurement, and MTT assay were performed to measure the clotting activities and biocompatibility of the two kaolins. The results showed that both kaolins could promote blood coagulation with good cytocompatibility, while Wenchang kaolin had a better procoagulant activity than Maoming kaolin. These findings demonstrated Wenchang kaolin to be a more suitable local source material for application as a hemostatic agent.


Assuntos
Hemostáticos/farmacologia , Caulim/farmacologia , Animais , Coagulação Sanguínea/efeitos dos fármacos , Testes de Coagulação Sanguínea , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , China , Cães , Concentração de Íons de Hidrogênio , Caulim/química , Camundongos , Tamanho da Partícula , Coelhos , Espectroscopia de Infravermelho com Transformada de Fourier , Eletricidade Estática , Tromboelastografia , Difração de Raios X
18.
J Stroke Cerebrovasc Dis ; 28(11): 104336, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488374

RESUMO

BACKGROUND: Rupture of unstable carotid plaque and consequently occlusive thrombus formation for the most part cause ischemic cerebral vascular event. Many researchers have been studying on the risk predictors of carotid plaque formation. But the risk factors for unstable carotid plaque have not been researched for so much. In the current study, we aimed to evaluate the association of coagulation function and carotid plaque especially unstable plaque by thrombelastography (TEG). METHODS: This was a cross-sectional study. Consecutive eligible patients with acute ischemic stroke were included and their TEG data were collected. Carotid plaque was evaluated by carotid ultrasound. Echolucent plaque and heterogeneous echo plaque in ultrasound were classified as unstable carotid plaque. Patients were classified according to being with carotid plaque or unstable plaque for comparison. RESULTS: Four hundred and seven patients were enrolled. Compared to those without carotid plaques, patients with carotid plaques had higher ages, higher incidence of hypertension and diabetes mellitus, lower k (P = .017) and higher angle (P = .021) on TEG. In the comparison between groups with unstable plaque and stable plaque, no significant difference was found in baseline characteristics; higher serum fibrinogen and higher maximum amplitude on TEG were significantly correlated to unstable carotid plaques (P = .051, P = .009). Multivariate logistic analysis revealed that age, hypertension, and smoking were independent risk factors of carotid plaques formation; higher serum fibrinogen was an independent risk factor of unstable plaques formation. CONCLUSIONS: This study demonstrates that carotid plaques formation in ischemic stroke patients has a link to abnormal coagulation function, while high platelet activity has an additional contribution to unstable plaque formation.


Assuntos
Coagulação Sanguínea , Plaquetas/metabolismo , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico , Placa Aterosclerótica , Acidente Vascular Cerebral/etiologia , Tromboelastografia , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Ruptura Espontânea , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico
20.
Surgery ; 166(6): 1122-1127, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31522748

RESUMO

BACKGROUND: Plasma thrombin generation has been used to characterize trauma-induced coagulopathy, but description of whole blood thrombin generation is lacking. This study aimed to evaluate plasma and whole blood thrombin generation in healthy volunteers and trauma patients. We hypothesized that (1) plasma and whole blood thrombin generation are distinct, (2) whole blood thrombin generation is more pronounced in trauma patients than in healthy volunteers, and (3) thrombin generation correlates with clinical coagulation assays. METHODS: Blood was collected from healthy volunteers and trauma patients at a single, level-1 trauma center. Whole blood thrombin generation was assessed with a prototype point-of-care whole blood thrombin generation device, and plasma thrombin generation was measured with a calibrated automated thrombogram analogue. Plasma and whole blood thrombin generation were compared and correlated with international normalized ratio and thrombelastography. RESULTS: Overall, 10 healthy volunteers (average age 30, 50% men) were included and 58 trauma patients (average age 34, 76% men, 55% blunt mechanism, and with a median new injury severity score of 17) were included. Plasma and whole blood thrombin generation differed with more robust thrombin generation in plasma. Trauma patients had a significantly increased whole blood thrombin generation compared with healthy volunteers]. Plasma thrombin generation correlated with international normalized ratio, whereas whole blood thrombin generation did not correlate with thrombelastography. CONCLUSION: Plasma and whole blood thrombin generation are distinct, highlighting the need to perform standardized assays to better understand their correlation and to assess how whole blood thrombin generation confers differential outcomes in trauma.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Plasma/metabolismo , Trombina/metabolismo , Ferimentos e Lesões/complicações , Adulto , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Feminino , Voluntários Saudáveis , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tromboelastografia/métodos , Trombina/análise , Ferimentos e Lesões/sangue , Ferimentos e Lesões/diagnóstico
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