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Russo I, Brookles CG, Barale C, Melchionda E, Mousavi AH, Biolè C, Chinaglia A, Bianco M. Current Strategies to Guide the Antiplatelet Therapy in Acute Coronary Syndromes. Int J Mol Sci 2024; 25:3981. [PMID: 38612792 PMCID: PMC11011739 DOI: 10.3390/ijms25073981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
The role of antiplatelet therapy in patients with acute coronary syndromes is a moving target with considerable novelty in the last few years. The pathophysiological basis of the treatment depends on platelet biology and physiology, and the interplay between these aspects and clinical practice must guide the physician in determining the best therapeutic options for patients with acute coronary syndromes. In the present narrative review, we discuss the latest novelties in the antiplatelet therapy of patients with acute coronary syndromes. We start with a description of platelet biology and the role of the main platelet signal pathways involved in platelet aggregation during an acute coronary syndrome. Then, we present the latest evidence on the evaluation of platelet function, focusing on the strengths and weaknesses of each platelet's function test. We continue our review by describing the role of aspirin and P2Y12 inhibitors in the treatment of acute coronary syndromes, critically appraising the available evidence from clinical trials, and providing current international guidelines and recommendations. Finally, we describe alternative therapeutic regimens to standard dual antiplatelet therapy, in particular for patients at high bleeding risk. The aim of our review is to give a comprehensive representation of current data on antiplatelet therapy in patients with acute coronary syndromes that could be useful both for clinicians and basic science researchers to be up-to-date on this complex topic.
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Affiliation(s)
- Isabella Russo
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Turin, Italy; (I.R.); (C.B.); (E.M.)
| | - Carola Griffith Brookles
- Cardiology Division, San Luigi Gonzaga University Hospital, I-10043 Orbassano, Italy; (C.G.B.); (A.H.M.); (C.B.); (A.C.)
- Department of Medical Sciences, University of Turin, I-10124 Turin, Italy
| | - Cristina Barale
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Turin, Italy; (I.R.); (C.B.); (E.M.)
| | - Elena Melchionda
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Turin, Italy; (I.R.); (C.B.); (E.M.)
| | - Amir Hassan Mousavi
- Cardiology Division, San Luigi Gonzaga University Hospital, I-10043 Orbassano, Italy; (C.G.B.); (A.H.M.); (C.B.); (A.C.)
- Department of Medical Sciences, University of Turin, I-10124 Turin, Italy
| | - Carloalberto Biolè
- Cardiology Division, San Luigi Gonzaga University Hospital, I-10043 Orbassano, Italy; (C.G.B.); (A.H.M.); (C.B.); (A.C.)
| | - Alessandra Chinaglia
- Cardiology Division, San Luigi Gonzaga University Hospital, I-10043 Orbassano, Italy; (C.G.B.); (A.H.M.); (C.B.); (A.C.)
| | - Matteo Bianco
- Cardiology Division, San Luigi Gonzaga University Hospital, I-10043 Orbassano, Italy; (C.G.B.); (A.H.M.); (C.B.); (A.C.)
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Buckley MS, Benanti GE, Meckel J, Tekle LA, Gilbert B, Puebla Neira D, McNierney DA, Korkames G, Yerondopoulos M, Park A, O'Hea JA, MacLaren R. Correlation between partial thromboplastin time and thromboelastography in adult critically ill patients requiring bivalirudin for extracorporeal membrane oxygenation. Pharmacotherapy 2023; 43:196-204. [PMID: 36759323 DOI: 10.1002/phar.2776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
STUDY OBJECTIVE Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin. DESIGN Multicenter, retrospective, cohort study conducted over a 2-year period. SETTING Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ. PATIENTS Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations. MEASUREMENTS AND MAIN RESULTS A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub-, supra-, or therapeutic according to the institution's classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among "therapeutic" aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories. CONCLUSIONS Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Luwam A Tekle
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Brian Gilbert
- Department of Pharmacy, Wesley Medical Center, Wichita, Kansas, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Dakota A McNierney
- Department of Medicine, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace Korkames
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Melanie Yerondopoulos
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Andrew Park
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Jennifer A O'Hea
- Division of Pulmonary/Critical Care, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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Chen F, Zhang L, Bai X, Wang X, Geng Z. Clinical Application of Thromboelastography in Acute Ischemic Stroke. Clin Appl Thromb Hemost 2022; 28:10760296221131801. [PMID: 36285384 PMCID: PMC9608017 DOI: 10.1177/10760296221131801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute ischemic stroke (AIS), characterized by high morbidity and mortality, has imposed a considerable burden on society. Despite rapid development in the treatment of AIS, there is still a high risk of recurrence. Furthermore, there is a time delay in waiting for the results of conventional coagulation tests in candidate patients for intravenous thrombolysis therapy. Heterogeneous responses to antiplatelet, intravascular thrombolysis, and endovascular therapies also worsen the situation. Thromboelastography (TEG), as a global and portable detection method for hemostasis, facilitates clinicians in disease monitoring, treatment evaluation, and prognosis prediction in AIS. In this narrative review, we provided a comprehensive summary of the clinical application of TEG in ischemic stroke and gave insights to further studies.
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Affiliation(s)
- Feng Chen
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liren Zhang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolin Bai
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuzhe Wang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Zhi Geng, 600 Yishan Road, Xuhui District, Shanghai, 200233 China.
Xiuzhe Wang, 600 Yishan Road, Xuhui District, Shanghai, 200233 China
| | - Zhi Geng
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Griebsch C, Hall E, Barrs VR. Effectiveness of aspirin vs. clopidogrel in dogs with immune mediated haemolytic anaemia evaluated by serial thromboelastography and platelet mapping. Vet J 2022; 287:105882. [PMID: 35963596 DOI: 10.1016/j.tvjl.2022.105882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
Most dogs with immune mediated haemolytic anaemia (IMHA) are hypercoagulable, as measured by thromboelastography (TEG). Thromboelastography-platelet mapping (TEG-PM) has been used to assess platelet function in human patients treated with aspirin or clopidogrel. The aim of this study was to compare platelet thromboxane A2-receptor inhibition (TXA2-RI) and platelet adenosine diphosphate (ADP)-receptor inhibition (ADP-RI) as measured by TEG-PM in dogs with primary IMHA receiving aspirin or clopidogrel to determine if TEG-PM might be useful to monitor treatment. Eighteen client-owned dogs with IMHA were enroled in a prospective double blinded study. Dogs were randomised to receive aspirin or clopidogrel in addition to standard therapy. Thromboelastography was measured before, and 1 and 4 days after commencing treatment. Thromboelastography-PM was performed on days 1 and 4. Non-responders were defined as < 50 % platelet thromboxane A2-receptor inhibition (TXA2-RI) in the aspirin group and < 50 % platelet adenosine diphosphate (ADP)-receptor inhibition (ADP-RI) in the clopidogrel group, on day 4. Mean platelet TXA2-RI and platelet ADP-RI were not significantly different between groups at any timepoint (P > 0.05). The overall mean percentage inhibition of TXA2-receptor was 25 % (aspirin 33 %, clopidogrel 15 %), and of ADP-receptor was 82 % (aspirin 83 %, clopidogrel 80 %). On day 4, 6/9 dogs (66 %) in the aspirin group and 2/8 dogs (25 %) in the clopidogrel group were non-responders (P = 0.086). Two dogs defined as responders based on TEG-PM developed thromboembolism. Overall, there was no significant difference in efficacy between aspirin and clopidogrel based on measurement of receptor inhibition using TEG-PM (P > 0.05), and routine TEG was not reliable for monitoring treatment response in dogs with IMHA. In some dogs, there was a discrepancy between TEG-PM results and clinical response. Further investigation of TEG-PM use in dogs, including its usefulness to monitor treatment response and adjust treatment in individual dogs and any effect of anaemia, is warranted.
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Affiliation(s)
- C Griebsch
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, Australia.
| | - E Hall
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, Australia
| | - V R Barrs
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, Australia; Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
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Use of thromboelastography in children on extracorporeal membrane oxygenation. J Pediatr Surg 2022; 57:1056-1061. [PMID: 35304022 DOI: 10.1016/j.jpedsurg.2022.01.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) profoundly impacts inflammatory and coagulation pathways, and strict monitoring is essential to guide therapeutic anticoagulation. Thromboelastography (TEG) offers a global evaluation of whole blood hemostatic system components and may be a valuable measurement of hemostatic function in these patients. There is a paucity of data correlating TEG parameters with standard measures of coagulation in heparinized pediatric patients. METHODS Children on ECMO during a 10-year period were retrospectively reviewed. Standard measures of coagulation were matched to TEGs drawn within 30 min of each other. RESULTS Out of 296 unique patients with 331 ECMO runs, 74.3% (n = 246) had at least one set of matched laboratory samples for a total of 2502 matched samples. The aPTT correlated with R-time (p<0.001). Platelets and fibrinogen correlated with α-angle (p<0.001). Fibrinogen (p<0.001) and platelets (p<0.001) were each associated with maximum amplitude (MA). 158 (47.7%) patients had at least one bleeding complication, and 100 (30.2%) had at least one thrombotic complication. Interestingly, a decreasing MA was associated with increased thrombotic complications (p<0.001). DISCUSSION TEG correlated well with traditional measures of hemostasis in pediatric ECMO patients. However, there was not a clear benefit of the TEG over these other measures LEVEL OF EVIDENCE: III.
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Tyagi T, Jain K, Gu SX, Qiu M, Gu VW, Melchinger H, Rinder H, Martin KA, Gardiner EE, Lee AI, Ho Tang W, Hwa J. A guide to molecular and functional investigations of platelets to bridge basic and clinical sciences. NATURE CARDIOVASCULAR RESEARCH 2022; 1:223-237. [PMID: 37502132 PMCID: PMC10373053 DOI: 10.1038/s44161-022-00021-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/17/2022] [Indexed: 07/29/2023]
Abstract
Platelets have been shown to be associated with pathophysiological process beyond thrombosis, demonstrating critical additional roles in homeostatic processes, such as immune regulation, and vascular remodeling. Platelets themselves can have multiple functional states and can communicate and regulate other cells including immune cells and vascular smooth muscle cells, to serve such diverse functions. Although traditional platelet functional assays are informative and reliable, they are limited in their ability to unravel platelet phenotypic heterogeneity and interactions. Developments in methods such as electron microscopy, flow cytometry, mass spectrometry, and 'omics' studies, have led to new insights. In this Review, we focus on advances in platelet biology and function, with an emphasis on current and promising methodologies. We also discuss technical and biological challenges in platelet investigations. Using coronavirus disease 2019 (COVID-19) as an example, we further describe the translational relevance of these approaches and the possible 'bench-to-bedside' utility in patient diagnosis and care.
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Affiliation(s)
- Tarun Tyagi
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
| | - Kanika Jain
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
| | - Sean X Gu
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
- Department of Laboratory Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Miaoyun Qiu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Vivian W Gu
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Melchinger
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
| | - Henry Rinder
- Department of Laboratory Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Kathleen A Martin
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth E Gardiner
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wai Ho Tang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - John Hwa
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, New Haven, CT, USA
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Cannata G, Mariotti Zani E, Argentiero A, Caminiti C, Perrone S, Esposito S. TEG ® and ROTEM ® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit. Diagnostics (Basel) 2021; 11:diagnostics11091642. [PMID: 34573982 PMCID: PMC8465234 DOI: 10.3390/diagnostics11091642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022] Open
Abstract
The concentration of the majority of hemostatic proteins differs considerably in early life, especially in neonates compared to adulthood. Knowledge of the concept of developmental hemostasis is an essential prerequisite for the proper interpretation of conventional coagulation tests (CCT) and is critical to ensure the optimal diagnosis and treatment of hemorrhagic and thrombotic diseases in neonatal age. Viscoelastic tests (VETs) provide a point-of-care, real-time, global, and dynamic assessment of the mechanical properties of the coagulation system with the examination of both cellular and plasma protein contributions to the initiation, formation, and lysis of clots. In this work, we provide a narrative review of the basic principles of VETs and summarize current evidence regarding the two most studied point-of-care VETs, thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), in the field of neonatal care. A literature analysis shows that viscoelastic hemostatic monitoring appears to be a useful additive technique to CCT, allowing targeted therapy to be delivered quickly. These tools may allow researchers to determine the neonatal coagulation profile and detect neonatal patients at risk for postoperative bleeding, coagulation abnormalities in neonatal sepsis, and other bleeding events in a timely manner, guiding transfusion therapies using the goal-oriented transfusion algorithm. However, diagnosis and treatment algorithms incorporating VETs for neonatal patients in a variety of clinical situations should be developed and applied to improve clinical outcomes. Further studies should be performed to make routinary diagnostic and therapeutic application possible for the neonatal population.
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Affiliation(s)
- Giulia Cannata
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (G.C.); (E.M.Z.); (A.A.)
| | - Elena Mariotti Zani
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (G.C.); (E.M.Z.); (A.A.)
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (G.C.); (E.M.Z.); (A.A.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (G.C.); (E.M.Z.); (A.A.)
- Correspondence: ; Tel.: +39-0521-903524
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Permadi W, Ritonga MA, Bayuaji H, Helja N, Khoirunnisa CD, Djuwantono T. Relationship Between Estradiol and Hemostasis Determined Through Thromboelastography Profile in Controlled Ovarian Stimulation Cycles. J Blood Med 2021; 12:361-368. [PMID: 34079414 PMCID: PMC8166257 DOI: 10.2147/jbm.s293434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to analyze the relationship between estradiol level and thromboelastography profile. Patients and Methods This prospective study with comparative analysis was performed on nineteen samples undergoing an IVF procedure in two fertility clinics in Bandung city. Blood samples taken on the second and twelfth days of the IVF cycle. Results There were significant differences in the value of estradiol, fibrin formation time (α), and coagulation index (CI) (p<0.05). Correlation tests showed no relationship and no significant correlation between an increased level of estradiol and coagulation index (CI) (r s=0.054; p=0.827) and between an increased level of estradiol and fibrinolysis time (LY30) (r s=-0.151; p=0.536). A moderate significant relationship was observed between age and coagulation index (CI) (r s=-0.430; p=0.033) and between age and maximum amplitude (MA) (r s=-0.494; p=0.032). Conclusion Supraphysiological estradiol levels in controlled ovarian stimulation cycles affect the coagulation index and change mainly the fibrin formation time.
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Affiliation(s)
- Wiryawan Permadi
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Mulyanusa Amarullah Ritonga
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Hartanto Bayuaji
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Niswan Helja
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Corina Delarosa Khoirunnisa
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Tono Djuwantono
- Department of Obstetrics & Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Luo D, Chelales EM, Beard MM, Kasireddy N, Khismatullin DB. Drop-of-blood acoustic tweezing technique for integrative turbidimetric and elastometric measurement of blood coagulation. Anal Bioanal Chem 2021; 413:3369-3379. [PMID: 33796930 PMCID: PMC8016159 DOI: 10.1007/s00216-021-03278-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
Many patients develop coagulation abnormalities due to chronic and hereditary disorders, infectious disease, blood loss, extracorporeal circulation, and oral anticoagulant misuse. These abnormalities lead to bleeding or thrombotic complications, the risk of which is assessed by coagulation analysis. Current coagulation tests pose safety concerns for neonates and small children due to large sample volume requirement and may be unreliable for patients with coagulopathy. This study introduces a containerless drop-of-blood method for coagulation analysis, termed "integrated quasi-static acoustic tweezing thromboelastometry" (i-QATT™), that addresses these needs. In i-QATT™, a single drop of blood is forced to levitate and deform by the acoustic radiation force. Coagulation-induced changes in drop turbidity and firmness are measured simultaneously at different instants. The parameters describing early, intermediate, and late stages of the coagulation process are evaluated from the resulting graphical outputs. i-QATT™ rapidly (<10 min) detected hyper- and hypo-coagulable states and identified single deficiency in coagulation factors VII, VIII, IX, X, and XIII. The linear relationship (r2 > 0.9) was established between fibrinogen concentration and two i-QATT™ parameters: maximum clot firmness and maximum fibrin level. Factor XIII activity was uniquely measured by the fibrin network formation time (r2 = 0.9). Reaction time, fibrin formation rate, and time to firm clot formation were linearly correlated with heparin concentration (r2 > 0.7). tPA-induced hyperfibrinolysis was detected in the clot firmness output at 10 min. i-QATT™ provides comprehensive coagulation analysis in point-of-care or laboratory settings, well suited to the needs of neonatal and pediatric patients and adult patients with anemia or blood collection issues.
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Affiliation(s)
- Daishen Luo
- Department of Biomedical Engineering and Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, 6823 St. Charles Avenue 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Erika M Chelales
- Department of Biomedical Engineering and Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, 6823 St. Charles Avenue 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Millicent M Beard
- Department of Biomedical Engineering and Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, 6823 St. Charles Avenue 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Nithya Kasireddy
- Department of Biomedical Engineering and Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, 6823 St. Charles Avenue 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Damir B Khismatullin
- Department of Biomedical Engineering and Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, 6823 St. Charles Avenue 500 Lindy Boggs Center, New Orleans, LA, 70118, USA.
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Assessment of endogenous fibrinolysis in clinical practice using novel tests: ready for clinical roll-out? SN APPLIED SCIENCES 2021. [DOI: 10.1007/s42452-021-04517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThe occurrence of thrombotic complications, which can result in excess mortality and morbidity, represent an imbalance between the pro-thrombotic and fibrinolytic equilibrium. The mainstay treatment of these complications involves the use of antithrombotic agents but despite advances in pharmacotherapy, there remains a significant proportion of patients who continue to remain at risk. Endogenous fibrinolysis is a physiological counter-measure against lasting thrombosis and may be measured using several techniques to identify higher risk patients who may benefit from more aggressive pharmacotherapy. However, the assessment of the fibrinolytic system is not yet accepted into routine clinical practice. In this review, we will revisit the different methods of assessing endogenous fibrinolysis (factorial assays, turbidimetric lysis assays, viscoelastic and the global thrombosis tests), including the strengths, limitations, correlation to clinical outcomes of each method and how we might integrate the assessment of endogenous fibrinolysis into clinical practice in the future.
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Lemon AV, Goddard A, Hooijberg EH. Effects of storage time and temperature on thromboelastographic analysis in dogs and horses. Vet Clin Pathol 2021; 50:9-19. [PMID: 33622027 DOI: 10.1111/vcp.12980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The accessibility of thromboelastography (TEG) to general practitioners is limited by short sample storage times (30 minutes) and storage temperatures (20-23°C). OBJECTIVES We aimed to evaluate the stability of canine and equine citrated blood samples when stored for extended periods of time, both at room temperature (RT) (20-23°C) and refrigerator temperature (FT) (2-7.5°C). METHODS Citrated whole blood samples from healthy dogs and horses (n = 10 for each) were stored for 30 minutes (baseline) at RT before TEG analysis. Baseline values for TEG variables R, K, α, MA, LY30, and LY60 were compared with those from samples stored for 2, 8, and 22.5 h, at RT and FT. Results were compared using an ANOVA (P < .05). Total allowable analytical error (TEa ) based on biological variation data was used to evaluate stability. RESULTS In dogs, statistically significant differences included shorter R, longer K, decreased MA, and increased LY60 at various time points and storage temperatures from 2 h onward. Only samples stored for 2 h at FT showed acceptable stability compared with TEa . In horses, statistically significant differences included shorter R and K, and decreased α, LY30, and LY60 at various time points and storage temperatures from 2 h onward. Samples were not stable at any time compared with TEa , regardless of the temperature. CONCLUSIONS In this study, canine samples could be stored for up to 2 h at FT without affecting TEG results; equine samples should be stored for 30 minutes at RT.
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Affiliation(s)
- Ashleigh V Lemon
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Amelia Goddard
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Emma H Hooijberg
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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12
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Gilbert BW, Dingman JS, Huffman JB. Utilization of lysis percentage via thromboelastography for tissue plasminogen activator-induced symptomatic intracranial hemorrhage. Am J Emerg Med 2021; 43:31-34. [PMID: 33493994 DOI: 10.1016/j.ajem.2021.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Brian W Gilbert
- Emergency Medicine Clinical Pharmacy Specialist Wesley Medical Center, Wichita, KS, United States of America.
| | - J Spencer Dingman
- Neurocritical Care Clinical Pharmacy Specialist Wesley Medical Center, Wichita, KS, United States of America.
| | - Joel B Huffman
- Emergency Medicine Clinical Pharmacy Specialist Wesley Medical Center, Wichita, KS, United States of America.
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13
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Huang L, Liu X, Ou Y, Huang H, Zhang X, Wang Y, Liang Y, Yu X, Zheng W, Zhang H, Li Z. Microengineered Flexural Post Rings for Effective Blood Sample Fencing and High-Throughput Measurement of Clot Retraction Force. ACS Sens 2020; 5:3949-3955. [PMID: 33197179 DOI: 10.1021/acssensors.0c01596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During blood clotting, clot retraction alters its mechanical properties and critically affects hemostasis. Despite that, existing clot retraction assays hold limitations such as large footprint and low throughput. In this work, we report the design of flexural post rings for a miniaturized assay of clot retraction force (CRF) with high throughput. Leveraging surface tensions, the post rings hold blood samples in a highly reproducible fashion while simultaneously serving as cantilever beams to measure the CRF. We investigated the effect on the device performance of major parameters, namely, surface hydrophobicity, post number, and post stiffness. We then tested the devices using 14 patient samples and revealed the correlation between CRF and fibrinogen levels. We further implemented an automated liquid handler and developed a high-throughput platform for clot retraction assay. The device's small sample consumption, simple operation, and good compatibility with existing automation facilities make it a promising high-throughput clot retraction assay.
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Affiliation(s)
- Lanzhu Huang
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Xinyu Liu
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Faculty of Information Technology, Collaborative Laboratory for Intelligent Science and Systems and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macao 999078, China
| | - Yuanbin Ou
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Haofan Huang
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Xia Zhang
- Department of Laboratory Medicine, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Yize Wang
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | - Yong Liang
- Faculty of Information Technology, Collaborative Laboratory for Intelligent Science and Systems and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macao 999078, China
| | - Xiaxia Yu
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Weidong Zheng
- Department of Laboratory Medicine, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Huisheng Zhang
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Zida Li
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen 518060, China
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14
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Scala E, Marcucci C. Massive Hemorrhage: The Role of Whole Blood Viscoelastic Assays. Hamostaseologie 2020; 40:515-523. [PMID: 33091949 DOI: 10.1055/a-1227-8050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Viscoelastic whole blood tests are increasingly used to guide hemostatic therapy in bleeding patients in the perioperative, trauma, and obstetric settings. Compared with standard laboratory tests of hemostasis, they have a shorter turnaround time and provide simultaneous information on various aspects of clot formation and lysis. The two available brands TEG (thromboelastography) and ROTEM (rotational thromboelastometry) provide devices that are either manually operated or fully automated. The automation allows for the assays to be used as point-of-care tests increasing their usefulness in massively bleeding patients with rapidly changing hemostatic profiles. While the number of research papers on the subject and the number of published treatment algorithms increase rapidly, the influence of the use of these devices on patient outcome needs yet to be established. In this article, we first review the technology of these devices and the parameters provided by the assays. Next, we present the problems encountered when choosing cut-off values that trigger intervention. Furthermore, we discuss the studies examining their influence on clinical outcomes, and finally, we briefly highlight some of the most important limitations and pitfalls inherent to these assays.
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Affiliation(s)
- Emmanuelle Scala
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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15
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Retrospective Analysis of Thromboelastography-Directed Transfusion in Isolated CABG: Impact on Blood Product Use, Cost, and Outcomes. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:103-111. [PMID: 32669736 DOI: 10.1182/ject-2000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/30/2020] [Indexed: 11/20/2022]
Abstract
Cardiac surgeries account for approximately 20% of blood use in the United States. Allogeneic transfusion has been associated with increased risk of morbidity and mortality, further justifying the need to reduce blood use. This study aimed at determining whether a point-of-care coagulation test, thromboelastography (TEG), impacted blood product administration and outcomes. Patients undergoing isolated coronary artery bypass grafting (CABG) were retrospectively reviewed before the use of TEG (2008-2009) (n = 640) and after implementation (2011-2012) (n = 458). Blood product use was compared between time frames. Logistic regression and generalized linear models were created to estimate the impact on outcomes including the reoperation rate, mortality, and cost. The mean use of each blood product was significantly reduced in the perioperative period. Overall blood product use was decreased by over 40%. Mediastinal re-exploration of bleeding was significantly reduced with TEG (4.8 vs. 1.5%). Six-month mortality was not impacted in this cohort nor was the readmission rate or hospital length of stay. However, blood cost and patient charges were significantly lower after TEG was introduced. The use of TEG to guide the administration of blood products during isolated CABG significantly affected the amounts and types of products given intra- and perioperatively. This resulted in less chest tube drainage, fewer returns to the operating room, and more accurate diagnosis of coagulopathic status. Cost savings to the patient and institution were appreciated as a consequence of these improved clinical outcomes.
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16
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Walker CB, Moore HB, Nydam TL, Schulick AC, Yaffe H, Pomposelli JJ, Wachs M, Bak T, Conzen K, Adams M, Pshak T, Choudhury R, Chapman MP, Pomfret EA, Kennealey P. The use of thromboelastography to assess post-operative changes in coagulation and predict graft function in renal transplantation. Am J Surg 2020; 220:1511-1517. [PMID: 32878689 PMCID: PMC7450953 DOI: 10.1016/j.amjsurg.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/28/2020] [Accepted: 08/19/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) is associated with elevated fibrinogen levels and fibrinolysis inhibition. However, there is a paucity of data on how renal transplantation impacts coagulation. we hypothesize that renal transplantation recipients with good functioning grafts will have improved fibrinolytic activity following surgery. METHODS Kidney recipients were analyzed pre-operatively and on post-operative day 1(POD1) using three different TEG assays with and without two concentration of tissue-plasminogen activator (t-PA). TEG indices and percent reduction in creatinine from pre-op to POD1 were measured, with >50% defining "good" graft function. Follow up was done at 6, 12, and 24 months. RESULTS Percent lysis(LY30) on POD1 the t-PA TEG was significantly correlated to change creatinine from pre-op to POD-1(p = 0.006). A LY30 ≥ 23% was associated with good early graft function, and lower creatinine at 24-months(p = 0.028) compared to recipients with low POD1 LY30. CONCLUSIONS Post-operative tPA-TEG LY30 is associated with favorable early and late outcomes in kidney transplant.
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Affiliation(s)
- Carson B Walker
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA.
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Alexander C Schulick
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hillary Yaffe
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - James J Pomposelli
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael Wachs
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Bak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Kendra Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Megan Adams
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Pshak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Rashikh Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael P Chapman
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Elizabeth A Pomfret
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Peter Kennealey
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
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17
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Rossi JM, Diamond SL. Scalable manufacture of a disposable, storage-stable eight-channel microfluidic device for rapid testing of platelet, coagulation, and drug function under whole blood flow. BIOMICROFLUIDICS 2020; 14:054103. [PMID: 33014235 PMCID: PMC7527242 DOI: 10.1063/5.0023312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/17/2020] [Indexed: 05/04/2023]
Abstract
Custom polydimethylsiloxane (PDMS) microfluidic devices allow for small-volume human blood research under hemodynamic conditions of bleeding and clotting. However, issues of PDMS molding/assembly, bio-coating, and sample preparation often limit their point-of-care use. We aim to develop a microfluidic device that has the same utility as previously established PDMS devices but which is more usable in point-of-care operation. We designed an injection-molded 1 × 3 in.2 device with eight flow paths crossing a bio-printed surface of a collagen/tissue factor. The device is rapidly primed and compatible with multi-channel pipetting (<0.5 ml blood) and operates under venous or arterial shear rates using constant flow rate or constant pressure modes. Platelet and fibrin deposition were monitored dynamically by the imaging of immunofluorescence. For whole blood clotting at a wall shear rate of 200 s-1, the intrachip CV at 400 s for platelet and fibrin deposition was 10% and the interdonor CV at 400 s was 30% for platelet and 22% for fibrin deposition (across 10 healthy donors). No significant difference was detected for samples tested on a new chip vs a chip stored for 6 months at 4 °C. Using the fibrin signal, dose-response testing of whole blood revealed IC50's of 120 nM for rivaroxaban and apixaban, and 60 nM for dabigatran. A complete reversal of apixaban inhibition was observed for an equimolar addition of Xa DOAC reversal agent Andexanet Alfa. We demonstrate the ability to manufacture single-use, storage-stable eight-channel chips. In clinical settings, such chips may help evaluate patient bleeding risk, therapy choice, drug activity, or reversal.
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Affiliation(s)
| | - Scott L. Diamond
- Author to whom correspondence should be addressed:. Tel.: +1 215 573 5704. Fax: +1 215 573 6815
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18
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Shao T, Cheng Y, Jin J, Huang L, Yang D, Luo C, Han Z, Wang Z, Ge W, Xu Y. A comparison of three platelet function tests in ischemic stroke patients with antiplatelet therapy. J Clin Neurosci 2020; 78:91-96. [PMID: 32624366 DOI: 10.1016/j.jocn.2020.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 06/06/2020] [Indexed: 12/31/2022]
Abstract
Predicting the effectiveness of antiplatelet drugs is critical to precision antiplatelet therapy. However, there is a lack of an acceptable method, although there are a variety of methods for detecting platelet function. In this study, we compared three major platelet function tests to assess their performance and found better methods for platelet function evaluation after aspirin or clopidogrel treatment in ischemic stroke patients by comparative study. A total of 249 ischemic stroke patients were enrolled who were treated with aspirin or clopidogrel or both. Three platelet function tests including light transmittance aggregometry (LTA), thromboelastography (TEG), platelet function analyzer (PFA) were performed as well as CYP2C19 genotype determination. Correlation analyses and kappa statistics were used. All three methods were effective in evaluating aspirin function. However, only LTA and TEG had good correlation and consistency (r = -0.37, kappa = 0.634). TEG-ADP was the least sensitive for clopidogrel, as the platelet inhibition ratio did not differ between the clopidogrel-user group and the control (P = 0.074), while LTA and PFA were sensitive (P < 0.001). Correlations between platelet assays were poor for clopidogrel (the absolute value of r range from 0.13 to 0.35) and so was the agreement (Kappa from 0.232 to 0.314). LTA and PFA have a good correlation with CYP2C19 genotyping (P = 0.034 and 0.014). In conclusion, all three tests were able to evaluate aspirin effect, LTA-AA and TEG-AA had a good correlation. TEG perform badly for clopidogrel effect detection. The fair-to-modest agreement among assays indicated further study was indispensable.
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Affiliation(s)
- Tengfei Shao
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jiali Jin
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lili Huang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Caimei Luo
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhou Han
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhongyuan Wang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weihong Ge
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
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Zhang J, Xue S, Zhu X, Zhao Y, Chen Y, Tong J, Shi X, Du Y, Zhong Z, Ye Q. Emerging chitin nanogels/rectorite nanocomposites for safe and effective hemorrhage control. J Mater Chem B 2020; 7:5096-5103. [PMID: 31432879 DOI: 10.1039/c9tb01019j] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Excessive bleeding due to trauma, surgery and diseases may cause severe mortalities. Here, an emerging chitin nanogel/rectorite nanocomposite is developed for effective hemorrhage control. Chitin chains are intercalated into rectorite and subsequent mechanical high speed stirring generates chitin nanogels, which assemble on the surface of the rectorite nanoplates through electrostatic interactions to form a sandwich structure. The in vitro experiments reveal that the nanocomposite exhibits favorable biocompatibility and negligible hemolysis (<3.5%) as compared to rectorite (40%). The nanocomposite stops bleeding in 121 s in rat tail incision and exhibits higher hemostatic activity in the rabbit artery injury model as compared to a commercialized chitosan hemostat, Celox. The efficient blood clotting activity is attributed to the induction of a coagulation cascade by rectorite and the quick adsorption and aggregation of platelets and red blood cells by chitin. The enhanced biocompatibility and hemostatic activity of the chitin/rectorite nanocomposite make it a safe and cost effective hemostat to control bleeding.
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Affiliation(s)
- Jianwei Zhang
- School of Resource and Environmental Science, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, Wuhan University, Wuhan 430079, China.
| | - Shuai Xue
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan 430071, China.
| | - Xinyi Zhu
- School of Resource and Environmental Science, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, Wuhan University, Wuhan 430079, China.
| | - Yanan Zhao
- Department of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yun Chen
- Department of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Jun Tong
- School of Resource and Environmental Science, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, Wuhan University, Wuhan 430079, China.
| | - Xiaowen Shi
- School of Resource and Environmental Science, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, Wuhan University, Wuhan 430079, China.
| | - Yumin Du
- School of Resource and Environmental Science, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, Wuhan University, Wuhan 430079, China.
| | - Zibiao Zhong
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan 430071, China.
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan 430071, China.
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20
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Gilbert BW, Bissell BD, Santiago RD, Rech MA. Tracing the Lines: A Review of Viscoelastography for Emergency Medicine Clinicians. J Emerg Med 2020; 59:201-215. [PMID: 32418869 DOI: 10.1016/j.jemermed.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Viscoelastography (VE) is an established method to identify coagulopathies in various disease processes. Clinical decisions can be made with real-time tracings and quantitative values at the bedside. Thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been utilized in several disease states with clinical varying success. OBJECTIVES This review will summarize the literature and provide recommendations pertaining to major disease processes where VE may be beneficial, including trauma, anticoagulation reversal, liver disease, acute ischemic stroke, and acquired brain injuries. DISCUSSION VE has a role in many emergency medicine patients encountered by clinicians. Reduced mortality, decreased blood product utilization, and prognostication ability makes VE an intriguing tool that can be utilized by providers to improve patient care. CONCLUSION This review serves as a way for emergency medicine clinicians to utilize VE in their practice and provides an insightful literature overview.
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Affiliation(s)
- Brian W Gilbert
- Department of Emergency Medicine, Wesley Medical Center, Wichita, Kansas
| | - Brittany D Bissell
- Medical Intensive Care Unit, University of Kentucky Healthcare, Lexington, Kentucky
| | - Ruben D Santiago
- Department of Emergency Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Megan A Rech
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, Illinois
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21
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Liu HC, Kijanka P, Urban MW. Optical coherence tomography for evaluating capillary waves in blood and plasma. BIOMEDICAL OPTICS EXPRESS 2020; 11:1092-1106. [PMID: 32206401 PMCID: PMC7041467 DOI: 10.1364/boe.382819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 05/18/2023]
Abstract
Capillary waves are associated with fluid mechanical properties. Optical coherence tomography (OCT) has previously been used to determine the viscoelasticity of soft tissues or cornea. Here we report that OCT was able to evaluate phase velocities of capillary waves in fluids. The capillary waves of water, porcine whole blood and plasma on the interfacial surface, air-fluid in this case, are discussed in theory, and phase velocities of capillary waves were estimated by both our OCT experiments and theoretical calculations. Our experiments revealed highly comparable results with theoretical calculations. We concluded that OCT would be a promising tool to evaluate phase velocities of capillary waves in fluids. The methods described in this study could be applied to determine surface tensions and viscosities of fluids for differentiating hematological diseases in the future potential biological applications.
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Affiliation(s)
- Hsiao-Chuan Liu
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Piotr Kijanka
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Robotics and Mechatronics, AGH University of Science and Technology, Al. Mickiewicza 30, Krakow 30-059, Poland
| | - Matthew W. Urban
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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22
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Cheng D, Li X, Zhao S, Hao Y. Establishment of thromboelastography reference intervals by indirect method and relevant factor analyses. J Clin Lab Anal 2020; 34:e23224. [PMID: 32004399 PMCID: PMC7307360 DOI: 10.1002/jcla.23224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Thromboelastography (TEG) as a global coagulation test has been continuously developed for many decades in either research or clinical practice. The versatility of TEG test leads to difficulty in standardization and result interpretation. Reference intervals (RIs) of TEG may be one of the most controversial factors that influence its wide applications. RIs establishment with the traditional method is time‐consuming and laborious as well as beyond general laboratory capability. Indirect method using stored data and with statistical calculation and small cost is emerging as an alternative approach for RIs determination. Gender, age, or both affect RIs and must be taken into account before RIs estimation. The present study retrospectively collected a total of 930 TEG results as subjects and established RIs with indirect method for Kaolin‐activated TEG, including the parameters of R, K, αAngle, MA, and CI. Furthermore, gender, age, and gender‐dependent age subsets analyses were performed to determine their effects on RIs of TEG. In this study, we found that TEG parameters showed more hypercoagulability in female than male, most of the measured TEG variables were significantly associated with aging, but only in male statistical significance was found among different age stratification and 60‐year‐old could be considered as cutting point to differentiate coagulation ability in male. In addition, RIs of TEG were estimated by indirect method suitably and verified to be valid in our study. Finally, the RIs of TEG by indirect method were basically significantly different to the RIs recommended by manufacturer, but the consistent percentage is relatively high in the most of measured parameters. In conclusion, it is suggestive that the indirect method for RIs establishment is feasible, but relevant factors, such as gender and age, specifically gender‐dependent age effect, should be considered before RIs determinations.
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Affiliation(s)
- Daye Cheng
- Transfusion Department, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoying Li
- Transfusion Department, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuo Zhao
- Transfusion Department, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yiwen Hao
- Transfusion Department, First Affiliated Hospital of China Medical University, Shenyang, China
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Chen X, Wang M, Zhao G. Point-of-Care Assessment of Hemostasis with a Love-Mode Surface Acoustic Wave Sensor. ACS Sens 2020; 5:282-291. [PMID: 31903758 DOI: 10.1021/acssensors.9b02382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Monitoring of the hemostasis status is essential for therapeutic anticoagulants, undergoing surgery, cardiovascular diseases, etc. Although the clinical values of conventional blood coagulation tests have been well demonstrated, these devices have limitations such as large and expensive equipment, excessive sample volumes, long turnaround times, and difficulty in miniaturization for point-of-care use. Here, we present a novel strategy to evaluate blood hemostasis using the single-port Love-mode surface acoustic wave (SLSAW) sensor. The SLSAW sensor was designed as a plug-and-play-type unit for disposable use and operated under the harmonic resonant mode to produce frequency response to the blood coagulation cascade. Compared with a quartz crystal microbalance, Lamb wave, and film bulk acoustic resonator, the frequency shift of SLSAW was significantly increased, ranging from approximately 8960 to 10 368 kHz, which indicated enhancement of the signal-to-noise ratio. To demonstrate the feasibility of the SLSAW, studies were carried out to examine the effects of temperature and clotting reagents on coagulation times and kinetics. Activated partial thromboplastin times of plasma were validated by comparing with SYSMEX CA-7000 with the correlation (R2) as 0.996. In terms of coagulation kinetics, reaction time, clot formation time, maximum frequency shift, and clot formation rate of whole blood correlated well with corresponding parameters of the standard thromboelastography (TEG) analyzer (R2 = 0.9942, 0.9868, 0.9712, and 0.9939, respectively). The SLSAW sensor, with the advantages of low cost, small size, little sample consumption (1 μL), disposable use, and simple operation, is a promising tool for point-of-care diagnosis of hemostasis.
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Affiliation(s)
- Xi Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
| | - Meng Wang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
| | - Gang Zhao
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
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Nair AB, Parker RI. Hemostatic Testing in Critically Ill Infants and Children. Front Pediatr 2020; 8:606643. [PMID: 33490001 PMCID: PMC7820389 DOI: 10.3389/fped.2020.606643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022] Open
Abstract
Children with critical illness frequently manifest imbalances in hemostasis with risk of consequent bleeding or pathologic thrombosis. Traditionally, plasma-based tests measuring clot formation by time to fibrin clot generation have been the "gold standard" in hemostasis testing. However, these tests are not sensitive to abnormalities in fibrinolysis or in conditions of enhanced clot formation that may lead to thrombosis. Additionally, they do not measure the critical roles played by platelets and endothelial cells. An added factor in the evaluation of these plasma-based tests is that in infants and young children plasma levels of many procoagulant and anticoagulant proteins are lower than in older children and adults resulting in prolonged clot generation times in spite of maintaining a normal hemostatic "balance." Consequently, newer assays directly measuring thrombin generation in plasma and others assessing the stages hemostasis including clot initiation, propagation, and fibrinolysis in whole blood by viscoelastic methods are now available and may allow for a global measurement of the hemostatic system. In this manuscript, we will review the processes by which clots are formed and by which hemostasis is regulated, and the rationale and limitations for the more commonly utilized tests. We will also discuss selected newer tests available for the assessment of hemostasis, their "pros" and "cons," and how they compare to the traditional tests of coagulation in the assessment and management of critically ill children.
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Affiliation(s)
- Alison B Nair
- Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Robert I Parker
- Pediatric Hematology/Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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Schmidt AE, Israel AK, Refaai MA. The Utility of Thromboelastography to Guide Blood Product Transfusion. Am J Clin Pathol 2019; 152:407-422. [PMID: 31263903 DOI: 10.1093/ajcp/aqz074] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To provide an overview of the clot viscoelastic testing technology and to describe its utility in guiding blood product transfusions. METHODS A case scenario will be discussed as well as interpretation of thromboelastography (TEG) tracings. In addition, literature examining the utility of viscoelastic testing in guiding patient management and blood product transfusions will be reviewed. RESULTS TEG/rotational thromboelastometry (ROTEM) is useful in evaluating clot kinetics in trauma and acutely bleeding patients. TEG/ROTEM parameters are reflective of values measured using standard coagulation assays; however, TEG/ROTEM parameters are more rapidly available and more costly. TEG and ROTEM are used in three main settings: cardiac surgery, liver transplantation, and trauma to assess global hemostasis and administration of blood products. CONCLUSIONS TEG/ROTEM can be helpful in guiding resuscitation and blood product transfusion. Several studies have demonstrated a reduction in transfusion of blood components with TEG/ROTEM; however, other studies have suggested that TEG/ROTEM is not clinically effective in guiding transfusion.
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Affiliation(s)
- Amy E Schmidt
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Anna Karolina Israel
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
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Comparison between thromboelastography and conventional coagulation test: Should we abandon conventional coagulation tests in polytrauma patients? Cir Esp 2019; 96:443-449. [PMID: 29764673 DOI: 10.1016/j.ciresp.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION TEG provides an in-vivo assessment of viscoelastic clot strength in whole blood compared with CCT, which may not reflect the influence of platelets. The aim of this study was to compare TEG vs. CCT in trauma patients stratified by mechanism of injury (MOI) and pre-existing coagulation status. METHODS A retrospective, observational study of 230 polytrauma patients admitted to a University Hospital Level 1 Trauma Center, with TEG and CCT on admission stratified by MOI: multiple trauma (MT), isolated traumatic brain injury (TBI) or MT+TBI. Statistical analysis included correlation between TEG and CCT in all groups and a subgroup analysis of anticoagulated patients. Data were analyzed with ANOVA, Spearman and lineal regression when appropriate. Statistical significance was accepted at P<0.05. RESULTS TEG was normal in 28.7%, hypercoagulable in 68.3%, hypocoagulable in 7%. There was no difference in TEG status among the groups. The coagulation status was not affected by age, ISS or shock. The CCT were abnormal in 63.6% of patients with normal TEG. Normal or hypercoagulable-TEG was found in 21/23 patients on Coumadin who had elevated INR and in 10/11 patients on NOAC. An analysis of the 23 patients on Coumadin stratified by INR showed a normal or hypercoagulable-TEG in 21/23 patients. Only 2 patients had a hypocoagulable-TEG. Mortality was 5.2% (58.3% severe TBI). CONCLUSIONS TEG is more useful than CCT in polytrauma patients, including patients on anticoagulants. TBI could increase the incidence of hypercoagulability in trauma. CCT are not useful from the standpoint of treatment.
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Karan N, Bakshi SG, Patil V, Sayed A. Use of Thromboelastography for Solving Neuraxial Blockade Dilemma. Turk J Anaesthesiol Reanim 2019; 47:355-356. [PMID: 31380520 DOI: 10.5152/tjar.2019.05695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nupur Karan
- Department of Anaesthesia, Pain and Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sumitra G Bakshi
- Department of Anaesthesia, Pain and Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijaya Patil
- Department of Anaesthesia, Pain and Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Atikh Sayed
- Department of Anaesthesia, Pain and Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Fisher C, Mo A, Warrillow S, Smith C, Jones D. Utility of Thromboelastography in Managing Acquired Factor VIII Inhibitor Associated Massive Haemorrhage. Anaesth Intensive Care 2019; 41:799-803. [DOI: 10.1177/0310057x1304100617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C. Fisher
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care
| | - A. Mo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Haematology
| | - S. Warrillow
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care
| | - C. Smith
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Haematology
| | - D. Jones
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine; Adjunct Associate Professor, Department of Surgery
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Lordkipanidzé M, Hvas AM, Harrison P. Clinical Tests of Platelet Function. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Saini A, Spinella PC, Ignell SP, Lin JC. Thromboelastography Variables, Immune Markers, and Endothelial Factors Associated With Shock and NPMODS in Children With Severe Sepsis. Front Pediatr 2019; 7:422. [PMID: 31681719 PMCID: PMC6814084 DOI: 10.3389/fped.2019.00422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/03/2019] [Indexed: 01/17/2023] Open
Abstract
Objective: Evaluate hemostatic dysfunction in pediatric severe sepsis by thromboelastography (TEG) and determine if TEG parameters are associated with new or progressive multiple organ dysfunction syndrome (NPMODS) or shock, defined as a lactate ≥2mmol/L. We explored the relationship between TEG variables, selective cytokines, and endothelial factors. Design: Prospective observational. Setting: Single-center, quaternary care pediatric intensive care unit. Patients: Children aged 6- months to 14- years with severe sepsis with expected PICU stay for >72 h. Interventions: None. Measurements and Main Results: Twenty-eight children were enrolled with median (IQR) age of 7.3 years (4.4-11.4), PELOD score (study day-1) of 11(1.25-13), and PICU length of stay of 10 days (5-28). TEG-defined hypercoagulable state occurred most commonly in 73% (94/129) of samples, followed by hypocoagulable state in 7.8% (10/129) and mixed coagulation state in 1.5% (2/129) of samples in the study cohort. In contrast, hypocoagulable state occurred most commonly in 66% (98/148) of samples based on standard coagulation parameters. In the seven children who developed shock with NPMODS compared to eight patients with shock without NPMODS and 12 patients with severe sepsis only, we found more profound coagulopathy [thrombocytopenia (p = 0.04), elevated INR (p = 0.038), low fibrinogen level (p = 0.049), and low TEG-G value (p = 0.01)] and higher peak of interleukin-6 (p = 0.0014) and IL-10 (p = 0.007). Peak lactate in the first 5 study days had moderate correlation with standard coagulation assays, TEG parameters, and selective cytokines. Peak lactate did not correlate with markers of endothelial activation. Lowest TEG -G value had moderate correlation with peak IL-10 (ρ -0.442, p =0.019), peak VCAM (ρ - 0.495, p = 0.007), and peak lactate (ρ -0.542, p = 0.004) in the first 5 study days. A combination of TEG-G value and IL-6 concentration best discriminated children with shock and NPMODS [AUC 0.979 (95%CI 0.929-1.00), p < 0.001]. Conclusion: This exploratory analysis of hemostasis dysfunction on TEG in pediatric severe sepsis suggests that while hypercoagulability is more common, a hypocoagulable state is associated with shock and NPMODS. In addition, TEG abnormalities are also associated with immune and endothelial factors. A larger cohort study is needed to validate these findings.
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Affiliation(s)
- Arun Saini
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Philip C Spinella
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Steven P Ignell
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - John C Lin
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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Ghirardello S, Raffaeli G, Scalambrino E, Chantarangkul V, Cavallaro G, Artoni A, Mosca F, Tripodi A. The intra-assay reproducibility of thromboelastography in very low birth weight infants. Early Hum Dev 2018; 127:48-52. [PMID: 30312859 DOI: 10.1016/j.earlhumdev.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/26/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. STUDY DESIGN Observational study. SUBJECTS One hundred VLBW newborns. OUTCOME MEASURES We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. RESULTS We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4%, ±12.9), lowest for MA (3.6%, ±8.0) and moderate for R (7.9%, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. CONCLUSIONS In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.
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Affiliation(s)
- Stefano Ghirardello
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Genny Raffaeli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Erica Scalambrino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Veena Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Andrea Artoni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Armando Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Tur Martínez J, Petrone P, Axelrad A, Marini CP. Comparison Between Thromboelastography and Conventional Coagulation Test: Should We Abandon Conventional Coagulation Tests in Polytrauma Patients? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.cireng.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jeong YH, Bliden K, Shuldiner A, Tantry U, Gurbel P. Thrombin-induced platelet-fibrin clot strength: Relation to high on-clopidogrel platelet reactivity, genotype, and post-percutaneous coronary intervention outcomes. Thromb Haemost 2017; 111:713-24. [DOI: 10.1160/th13-08-0643] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/03/2013] [Indexed: 01/01/2023]
Abstract
SummaryThe relationship between thrombin-induced platelet-fibrin clot strength (MATHROMBIN), genotype and high on-treatment platelet reactivity (HPR) is unknown. The aim of this study is to assess the influence of MATHROMBIN measured by thrombelastography on HPR and long-term major adverse cardiovascular events (MACE) in percutaneous coronary intervention (PCI)-treated patients during aspirin and clopidogrel therapy. MATHROMBIN, platelet aggregation, genotype, and two-year MACE were assessed in 197 PCI-treated patients. HPR was defined as 5 µM ADP-induced PR46% measured by conventional aggregometry. Both high MATHROMBIN ( 68 mm) and CYP2C19*2 allele carriage were independently associated with ADP-induced platelet aggregation ([uni03B2] coefficient: 8.3% and 12.0%, respectively). The combination of CYP2C19*2 allele carriage and high MATHROMBIN increased the predictive value for the risk of HPR (odds ratio: 13.89; 95% confidence interval: 3.41 to 55.56; p < 0.001). MACE occurred in 25 patients (12.7%). HPR and high MATHROMBIN were both associated with MACE (hazard ratio: 3.09 and 2.24, respectively), and patients with both HPR and high MATHROMBIN showed an increased risk for MACE (adjusted hazard ratio: 5.56; 95% confidence interval: 1.85 to 16.67; p = 0.002). In conclusion, this is the first study to demonstrate that high platelet-fibrin clot strength is an independent determinant of HPR in PCI-treated patients. Combining the measurements of platelet aggregation and platelet-fibrin clot strength may enhance post-PCI risk stratification and deserves further study.
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Gue YX, Gorog DA. Importance of Endogenous Fibrinolysis in Platelet Thrombus Formation. Int J Mol Sci 2017; 18:ijms18091850. [PMID: 28841147 PMCID: PMC5618499 DOI: 10.3390/ijms18091850] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022] Open
Abstract
The processes of thrombosis and coagulation are finely regulated by endogenous fibrinolysis maintaining healthy equilibrium. When the balance is altered in favour of platelet activation and/or coagulation, or if endogenous fibrinolysis becomes less efficient, pathological thrombosis can occur. Arterial thrombosis remains a major cause of morbidity and mortality in the world despite advances in medical therapies. The role endogenous fibrinolysis in the pathogenesis of arterial thrombosis has gained increasing attention in recent years as it presents novel ways to prevent and treat existing diseases. In this review article, we discuss the role of endogenous fibrinolysis in platelet thrombus formation, methods of measurement of fibrinolytic activity, its role in predicting cardiovascular diseases and clinical outcomes and future directions.
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Affiliation(s)
- Ying X Gue
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire SG1 4AB, UK.
| | - Diana A Gorog
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire SG1 4AB, UK.
- Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK.
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Holt RG, Luo D, Gruver N, Khismatullin DB. Quasi-static acoustic tweezing thromboelastometry. J Thromb Haemost 2017; 15:1453-1462. [PMID: 28453901 PMCID: PMC5495613 DOI: 10.1111/jth.13724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Indexed: 11/29/2022]
Abstract
Essentials Blood coagulation measurement during contact with an artificial surface leads to unreliable data. Acoustic tweezing thromboelastometry is a novel non-contact method for coagulation monitoring. This method detects differences in the blood coagulation state within 10 min. Coagulation data were obtained using a much smaller sample volume (4 μL) than currently used. SUMMARY Background Thromboelastography is widely used as a tool to assess the coagulation status of critical care patients. It allows observation of changes in material properties of whole blood, beginning with early stages of clot formation and ending with clot lysis. However, the contact activation of the coagulation cascade at surfaces of thromboelastographic systems leads to inherent variability and unreliability in predicting bleeding or thrombosis risks. Objectives To develop acoustic tweezing thromboelastometry as a non-contact method for perioperative assessment of blood coagulation. Methods Acoustic tweezing is used to levitate microliter drops of biopolymer and human blood samples. By quasi-statically changing the acoustic pressure we control the sample drop location and deformation. Sample size, deformation and location are determined by digital imaging at each pressure. Results Simple Newtonian liquid solutions maintain a constant, reversible location vs. deformation curve. In contrast, the location/deformation curves for gelatin, alginate, whole blood and blood plasma uniquely change as the samples solidify. Increasing elasticity causes the sample to deform less, leading to steeper stress/strain curves. By extracting a linear regime slope, we show that whole blood or blood plasma exhibits a unique slope profile as it begins to clot. By exposing blood samples to pro- or antithrombotic agents, the slope profile changes, allowing detection of hyper- or hypocoagulable states. Conclusions We demonstrate that quasi-static acoustic tweezing can yield information about clotting onset, maturation and strength. The advantages of small sample size, non-contact and rapid measurement make this technique desirable for real-time monitoring of blood coagulation.
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Affiliation(s)
- R. G. Holt
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - D. Luo
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
| | - N. Gruver
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - D. B. Khismatullin
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
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Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients. Am J Emerg Med 2017; 35:632-636. [DOI: 10.1016/j.ajem.2016.12.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 11/24/2022] Open
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Binay C, Bozkurt Turhan A, Simsek E, Bor O, Akay OM. Evaluation of Coagulation Profile in Children with Type 1 Diabetes Mellitus Using Rotational Thromboelastometry. Indian J Hematol Blood Transfus 2017; 33:574-580. [PMID: 29075072 DOI: 10.1007/s12288-017-0793-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/18/2017] [Indexed: 10/20/2022] Open
Abstract
The prothrombotic state in type 1 diabetes mellitus (T1DM) has been reported as a plausible cause of vascular complications. Rotational thromboelastometry (ROTEM) assay enables the global assessment of coagulation status. This study aimed to assess hypercoagulability in children with T1DM using ROTEM. A total of 43 T1DM children (20 females and 23 males) aged 2-18 years and age- and sex-matched 30 healthy control subjects were enrolled in the study group. ROTEM assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] were used to measure and analyze coagulation time (CT), clot formation time, maximum clot firmness (MCF). Glycated hemoglobin levels (HbA1c), diabetic complications, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and dimerized plasmin fragment D (D-dimer) were determined in the study group. The mean duration of T1DM diagnosis was 3.15 ± 2.49 years, and the mean HbA1c level was 8.94 ± 1.88% (74.29 ± 20.59 mmol/mol). None of the patients had macrovascular complications. Nephropathy was present in five patients. In the T1DM group, EXTEM-CT [80.00 (66.75-108.50)] was significantly lower, and EXTEM-MCF [65.00 (64.00-70.00)] and INTEM-MCF [65.00 (62.00-68.00)] were significantly higher than in the controls (p < 0.001, p = 0.026, and p = 0.004, respectively). However, the duration of T1DM and the degree of metabolic control had no influence on these parameters. Platelet count, PT, aPTT, fibrinogen and D-dimer levels were comparable between the diabetic patients and the control group. There were statistically significant correlations between fibrinogen level and INTEM-MCF and EXTEM-MCF (p < 0.001, p = 0.002 and r = 0.545, r = 0.454, respectively) This study shows that decreased levels of CT and increased levels of MCF suggest hypercoagulability in patients with T1DM. Further studies are needed to confirm our findings on a larger number of diabetic patients.
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Affiliation(s)
- Cigdem Binay
- Division of Pediatric Endocrinology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ayse Bozkurt Turhan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Enver Simsek
- Division of Pediatric Endocrinology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ozcan Bor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Olga Meltem Akay
- Department of Hematology and Oncology, Osmangazi University School of Medicine, Eskisehir, Turkey
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Dias JD, Haney EI, Mathew BA, Lopez-Espina CG, Orr AW, Popovsky MA. New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables. Arch Pathol Lab Med 2017; 141:569-577. [DOI: 10.5858/arpa.2016-0088-oa] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Thromboelastography (TEG) is a whole blood, real-time analyzer measuring the viscoelastic properties of the hemostasis process and allowing for individualized goal-directed therapy. However, routine use of TEG requires validation of sample storage effect on clot parameters.
Objectives.—
To establish the minimum time required for equilibration time and the maximum time for sample storage for all commercially available TEG tests for the new-generation TEG 6s and to determine how those times compare with the older generation TEG 5000.
Design.—
Citrated and heparinized whole blood samples obtained from 20 healthy donors were analyzed for clot parameters at multiple time points for both the TEG 6s and the TEG 5000. Samples were activated with the citrated multichannel cartridge or the platelet-mapping cartridge in the TEG 6s or with recalcified kaolin in the TEG 5000.
Results.—
All blood samples yielded TEG parameter results within reference ranges and had a tendency toward hypercoagulable profiles with increased storage time. Sample storage resulted in increased platelet inhibition with significant differences at 4 hours in the platelet-mapping cartridge (arachidonic acid percentage of inhibition, P = .002; adenosine diphosphate percentage of inhibition, P = .02).
Conclusions.—
For nonemergent cases or in a central laboratory setting, all tests provided reliable results for up to 4 hours in the citrated multichannel cartridge and for 3 hours for platelet function information in the platelet-mapping cartridge. In emergent/urgent situations in which the sample needs to be run immediately, RapidTEG and functional fibrinogen tests may be preferred.
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Affiliation(s)
| | | | | | | | | | - Mark A. Popovsky
- From the Department of Clinical Marketing, Haemonetics SA, Signy, Switzerland (Dr Dias); the Department of Scientific Research & Development, Haemonetics Corporation, Rosemont, Illinois (Mss Haney and Mathew and Mr Lopez-Espina); and the Department of Medical & Clinical Affairs, Haemonetics Corporation, Braintree, Massachusetts (Mr Orr and Dr Popovsky). Mr Orr is now with Anika Therapeutics Inc,
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Rafiq S, Johansson PI, Kofoed KF, Lund JT, Olsen PS, Bentsen S, Steinbrüchel DA. Thrombelastographic hypercoagulability and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial): a randomized controlled trial. Platelets 2017; 28:786-793. [DOI: 10.1080/09537104.2017.1280147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sulman Rafiq
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Pär I. Johansson
- Capital Region Blood Bank, Section for Transfusion Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Klaus F. Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Jens T. Lund
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Peter S. Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Simon Bentsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
| | - Daniel A. Steinbrüchel
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
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40
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Schoergenhofer C, Buchtele N, Schwameis M, Bartko J, Jilma B, Jilma-Stohlawetz P. The use of frozen plasma samples in thromboelastometry. Clin Exp Med 2017; 17:489-497. [PMID: 28210886 PMCID: PMC5653723 DOI: 10.1007/s10238-017-0454-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
Thromboelastometry is increasingly used in the clinical and scientific setting. The use of frozen plasma samples may be useful in overcoming certain limitations such as local and timely availability. Whole blood (WB) samples of 20 healthy volunteers were obtained, and plasma was generated. NATEM (n = 20), EXTEM (n = 20) and INTEM (n = 8) analyses were performed in WB, fresh plasma and frozen and thawed plasma. Dabigatran (500, 1000 ng/ml), rivaroxaban (100, 200 ng/ml) or alteplase (333 ng/ml) were added ex vivo to WB, and thromboelastometry was performed in WB and in frozen and thawed plasma samples. Clot formation time, mean clot firmness and the area under the curve were significantly altered in plasma compared to WB. In INTEM and EXTEM analysis, clotting time (CT) was comparable between WB (100%) and fresh (INTEM 114% and EXTEM 93%, ratio of the means) and frozen plasma samples (85 and 99%), whereas in NATEM analysis, the CT increased in fresh (193%) and frozen plasma samples (130%). Dabigatran dose-dependently increased the CT approximately 5- and 9-fold in WB and even more pronounced 10- and 26-fold in plasma. Accordingly, rivaroxaban dose-dependently increased the CT 2- and 2.7-fold in WB, and 3.5- and 4-fold in plasma samples. Hyperfibrinolysis was achieved by addition of alteplase in all WB samples and was reproducible in plasma samples. In conclusion, thromboelastometry, especially INTEM and EXTEM analyses, is possible using frozen and stored plasma samples with comparable results to the corresponding whole blood samples.
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Affiliation(s)
- Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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41
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42
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Hvas AM, Grove EL. Platelet Function Tests: Preanalytical Variables, Clinical Utility, Advantages, and Disadvantages. Methods Mol Biol 2017; 1646:305-320. [PMID: 28804838 DOI: 10.1007/978-1-4939-7196-1_24] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Platelet function tests are mainly used in the diagnostic work-up of platelet disorders. During the last decade, the additional use of platelet function tests to evaluate the effect of antiplatelet therapy has also emerged in an attempt to identify patients with an increased risk of arterial thrombosis. Furthermore, platelet function tests are increasingly used to measure residual effect of antiplatelet therapy prior to surgery with the aim of reducing the risk of bleeding. To a limited extend, platelet function tests are also used to evaluate hyperaggregability as a potential marker of a prothrombotic state outside the setting of antiplatelet therapy. This multifaceted use of platelet function tests and the development of simpler point-of-care tests with narrower application have increased the use of platelet function testing and also facilitated the use of platelet function tests outside the highly specialized laboratories. The present chapter describes the preanalytical variables, which should be taken into account when planning platelet function testing. Also, the most widely used platelet function tests are introduced, and their clinical utility and their relative advantages and disadvantages are discussed.
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Affiliation(s)
- Anne-Mette Hvas
- Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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43
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Kreitzer NP, Bonomo J, Kanter D, Zammit C. Review of Thromboelastography in Neurocritical Care. Neurocrit Care 2016; 23:427-33. [PMID: 26275677 DOI: 10.1007/s12028-015-0187-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Natalie P Kreitzer
- Neurocritical Care and Neurovascular Emergencies, University of Cincinnati, Cincinnati, OH, USA.
| | - Jordan Bonomo
- Neurosurgery/Neurocritical Care, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel Kanter
- Division of Neurocritical Care, University of Cincinnati, Cincinnati, OH, USA
| | - Christopher Zammit
- Neurosurgery/Neurocritical Care, University of Cincinnati, Cincinnati, OH, USA
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Li Z, Li X, McCracken B, Shao Y, Ward K, Fu J. A Miniaturized Hemoretractometer for Blood Clot Retraction Testing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2016; 12:3926-34. [PMID: 27248117 PMCID: PMC4980575 DOI: 10.1002/smll.201600274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/16/2016] [Indexed: 05/13/2023]
Abstract
Blood coagulation is a critical hemostatic process that must be properly regulated to maintain a delicate balance between bleeding and clotting. Disorders of blood coagulation can expose patients to the risk of either bleeding disorders or thrombotic diseases. Coagulation diagnostics using whole blood is very promising for assessing the complexity of the coagulation system and for global measurements of hemostasis. Despite the clinic values that existing whole blood coagulation tests have demonstrated, these systems have significant limitations that diminish their potential for point-of-care applications. Here, recent advancements in device miniaturization using functional soft materials are leveraged to develop a miniaturized clot retraction force assay device termed mHemoRetractoMeter (mHRM). The mHRM is capable of precise measurements of dynamic clot retraction forces in real time using minute amounts of whole blood. To further demonstrate the clinical utility of the mHRM, systematic studies are conducted using the mHRM to examine the effects of assay temperature, treatments of clotting agents, and pro- and anti-coagulant drugs on clot retraction force developments of whole blood samples. The mHRM's low fabrication cost, small size, and consumption of only minute amounts of blood samples make the technology promising as a point-of-care tool for future coagulation monitoring.
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Affiliation(s)
- Zida Li
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Xiang Li
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Brendan McCracken
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Yue Shao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Kevin Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Jianping Fu
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan 48109, USA, Department of Biomedical Engineering, Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan 48109, USA
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45
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Rafiq S, Johansson PI, Kofoed KF, Olsen PS, Steinbrüchel DA. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients. J Card Surg 2016; 31:565-71. [DOI: 10.1111/jocs.12807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Sulman Rafiq
- Department of Cardiothoracic Surgery; the Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Pär I. Johansson
- Capital Region Blood Bank; Section for Transfusion Medicine, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Klaus F. Kofoed
- Department of Cardiology; the Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Peter S. Olsen
- Department of Cardiothoracic Surgery; the Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Daniel A. Steinbrüchel
- Department of Cardiothoracic Surgery; the Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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46
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Ramalingam G, Jones N, Besser M. Platelets for anaesthetists—part 1: physiology and pathology. BJA Educ 2016. [DOI: 10.1093/bjaed/mkv027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Abuelkasem E, Lu S, Tanaka K, Planinsic R, Sakai T. Comparison between thrombelastography and thromboelastometry in hyperfibrinolysis detection during adult liver transplantation. Br J Anaesth 2016; 116:507-512. [DOI: 10.1093/bja/aew023] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Azoulay Z, Rapaport H. The assembly state and charge of amphiphilic β-sheet peptides affect blood clotting. J Mater Chem B 2016; 4:3859-3867. [DOI: 10.1039/c6tb00330c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hydrogels composed of designed β-sheet amphiphilic peptides have been exploited in several biomedical applications. Here the peptide's charge shows influence on blood compatibility with antithrombotic or no effects on clotting blood given by the anionic and zwitterionic peptides.
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Affiliation(s)
- Ziv Azoulay
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering
- Ben-Gurion University of the Negev
- Beer-Sheva 84105
- Israel
| | - Hanna Rapaport
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering
- Ben-Gurion University of the Negev
- Beer-Sheva 84105
- Israel
- Ilse Katz Institute for Nano-Science and Technology (IKI)
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Biocompatibility Assessment of the CentriMag-Novalung Adult ECMO Circuit in a Model of Acute Pulmonary Hypertension. ASAIO J 2015; 60:429-35. [PMID: 24658516 DOI: 10.1097/mat.0000000000000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is rarely used in patients with severe pulmonary hypertension (PH) as a bridge to lung transplantation. In this study, we assess the blood biocompatibility of the integrated CentriMag-Novalung ECMO system (venoarterial) in an acute model of PH. Severe PH (≥2/3 systemic) was induced in eight sheep through progressive ligation of the main pulmonary artery. System performance, platelet activation, thromboelastography (TEG) parameters, fibrinogen, plasma-free hemoglobin, and total plasma protein were measured at initiation, 3, and 6 hr of support in the ECMO (N = 4) and sham (N = 4) groups. A stable ECMO flow (2.2 ± 0.1 L/min), low transmembrane pressure gradient, and steady blood O2 and CO2 levels were maintained. Platelet activation was low (<4%) in both the groups, whereas platelet responsiveness to agonist (platelet activating factor) was reduced in the sham group when compared with the ECMO group. There were no differences in the TEG parameters, fibrinogen concentration, plasma-free hemoglobin (<10 mg/dl), and plasma total protein between the two groups. The findings of low levels of platelet activation and plfHb suggest adequate blood biocompatibility of the integrated CentriMag-Novalung circuit use for short-term support in a model of PH.
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50
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Ramalingam G, Jones N, Besser M. Platelets for anaesthetists—part 1: physiology and pathology. BJA Educ 2015. [DOI: 10.1093/bjaceaccp/mkv027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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