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Jigar Panchal H, Kent NJ, Knox AJS, Harris LF. Microfluidics in Haemostasis: A Review. Molecules 2020; 25:E833. [PMID: 32075008 PMCID: PMC7070452 DOI: 10.3390/molecules25040833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
Haemostatic disorders are both complex and costly in relation to both their treatment and subsequent management. As leading causes of mortality worldwide, there is an ever-increasing drive to improve the diagnosis and prevention of haemostatic disorders. The field of microfluidic and Lab on a Chip (LOC) technologies is rapidly advancing and the important role of miniaturised diagnostics is becoming more evident in the healthcare system, with particular importance in near patient testing (NPT) and point of care (POC) settings. Microfluidic technologies present innovative solutions to diagnostic and clinical challenges which have the knock-on effect of improving health care and quality of life. In this review, both advanced microfluidic devices (R&D) and commercially available devices for the diagnosis and monitoring of haemostasis-related disorders and antithrombotic therapies, respectively, are discussed. Innovative design specifications, fabrication techniques, and modes of detection in addition to the materials used in developing micro-channels are reviewed in the context of application to the field of haemostasis.
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Affiliation(s)
- Heta Jigar Panchal
- School of Biological and Health Sciences, Technological University Dublin (TU Dublin) - City Campus, Kevin Street, Dublin D08 NF82, Ireland; (H.J.P.); (A.J.S.K.)
| | - Nigel J Kent
- engCORE, Faculty of Engineering, Institute of Technology Carlow, Kilkenny Road, Carlow R93 V960, Ireland;
| | - Andrew J S Knox
- School of Biological and Health Sciences, Technological University Dublin (TU Dublin) - City Campus, Kevin Street, Dublin D08 NF82, Ireland; (H.J.P.); (A.J.S.K.)
| | - Leanne F Harris
- School of Biological and Health Sciences, Technological University Dublin (TU Dublin) - City Campus, Kevin Street, Dublin D08 NF82, Ireland; (H.J.P.); (A.J.S.K.)
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Levesque AA, Lewin AR, Rimsans J, Sylvester KW, Coakley L, Melanson F, Mallidi H, Mehra M, Givertz MM, Connors JM. Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support. Clin Appl Thromb Hemost 2019; 25:1076029619837362. [PMID: 30907120 PMCID: PMC6714942 DOI: 10.1177/1076029619837362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Patients receiving durable mechanical circulatory support (MCS) require life-long
anticoagulation with a vitamin K antagonist (VKA). Due to alternations in hemostasis,
concomitant therapy with antiplatelet agents and critical illness, they are at increased
risk of thromboembolic and bleeding complications compared with the general population
managed on VKAs. To prevent thrombotic events, current guidelines recommend that patients
with MCS receive long-term anticoagulation with a VKA to maintain a target international
normalized ratio (INR) as specified by device manufacturers, but limited data exist
regarding specific routine management of anticoagulation therapy and its potential
complications. To optimize anticoagulation management and minimize risk in these patients,
we have centralized anticoagulation management in a collaborative approach between the
inpatient hemostatic and antithrombotic (HAT) stewardship service and between ambulatory
anticoagulation management service (AMS) and the advanced heart disease team. Patients are
followed by these three services beginning when the device is implanted and extending the
duration that patients have the device. The teams include multiple clinicians from cardiac
surgery, cardiology, hematology, pharmacy, nursing, case management, nutrition, and
psychiatry, therefore, in order to standardize practice among clinicians without
compromising patient centered decision making, we assembled an interdisciplinary team to
create multiple treatment guidelines. In addition to a centralized and collaborative
approach, our guidelines ensure seamless transitions of care between the inpatient and
outpatient settings. We believe our approach has demontrated a positive improvement in the
care of these challenging patients. In this article, we present our comprehensive
centralized anticoagulation management approach for patients with left ventricular assist
systems (LVAS).
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Affiliation(s)
- Amy A Levesque
- 1 Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea R Lewin
- 1 Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Rimsans
- 1 Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Katelyn W Sylvester
- 1 Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Lara Coakley
- 2 Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank Melanson
- 2 Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hari Mallidi
- 3 Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mandeep Mehra
- 2 Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael M Givertz
- 2 Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jean M Connors
- 4 Department of Medicine, Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
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Yaraş YS, Gündüz AB, Sağlam G, Ölçer S, Civitçi F, Baris İ, Yaralioğlu G, Urey H. Coagulation measurement from whole blood using vibrating optical fiber in a disposable cartridge. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-8. [PMID: 29127692 DOI: 10.1117/1.jbo.22.11.117001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
In clinics, blood coagulation time measurements are performed using mechanical measurements with blood plasma. Such measurements are challenging to do in a lab-on-a-chip (LoC) system using a small volume of whole blood. Existing LoC systems use indirect measurement principles employing optical or electrochemical methods. We developed an LoC system using mechanical measurements with a small volume of whole blood without requiring sample preparation. The measurement is performed in a microfluidic channel where two fibers are placed inline with a small gap in between. The first fiber operates near its mechanical resonance using remote magnetic actuation and immersed in the sample. The second fiber is a pick-up fiber acting as an optical sensor. The microfluidic channel is engineered innovatively such that the blood does not block the gap between the vibrating fiber and the pick-up fiber, resulting in high signal-to-noise ratio optical output. The control plasma test results matched well with the plasma manufacturer's datasheet. Activated-partial-thromboplastin-time tests were successfully performed also with human whole blood samples, and the method is proven to be effective. Simplicity of the cartridge design and cost of readily available materials enable a low-cost point-of-care device for blood coagulation measurements.
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Affiliation(s)
- Yusuf Samet Yaraş
- Koc University, College of Engineering, Department of Electrical and Electronics Engineering, Istanb, Turkey
| | - Ali Bars Gündüz
- Koc University, College of Engineering, Department of Electrical and Electronics Engineering, Istanb, Turkey
| | - Gökhan Sağlam
- Koc University, College of Engineering, Department of Electrical and Electronics Engineering, Istanb, Turkey
| | - Selim Ölçer
- Koc University, College of Engineering, Department of Electrical and Electronics Engineering, Istanb, Turkey
| | - Fehmi Civitçi
- Istanbul Technical University, Department of Electronics and Communication Engineering, Faculty of E, Turkey
| | - İbrahim Baris
- Koc University, College of Sciences, Department of Molecular Biology and Genetics, Istanbul, Turkey
| | - Göksenin Yaralioğlu
- Ozyegin University, Faculty of Engineering, Department of Electrical and Electronics Engineering, Is, Turkey
| | - Hakan Urey
- Koc University, College of Engineering, Department of Electrical and Electronics Engineering, Istanb, Turkey
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Joubert J, van Zyl M, Raubenheimer J. Performance evaluation of the microINR®
point-of-care INR-testing system. Int J Lab Hematol 2017; 40:115-122. [DOI: 10.1111/ijlh.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/31/2017] [Indexed: 12/01/2022]
Affiliation(s)
- J. Joubert
- National Health Laboratory Service (NHLS); Universitas Hospital; Haematology Academic Laboratories; Bloemfontein South Africa
- Department of Haematology and Cell Biology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - M.C. van Zyl
- Department of Haematology and Cell Biology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - J. Raubenheimer
- Department of Biostatistics; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
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Gorlin J, Kinney S, Fung MK, Tinmouth A. Prothrombin complex concentrate for emergent reversal of warfarin: an international survey of hospital protocols. Vox Sang 2017. [DOI: 10.1111/vox.12539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- J. Gorlin
- Innovative Blood Resources/Memorial Blood Centers; St. Paul MN USA
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - S. Kinney
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - M. K. Fung
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington VT USA
| | - A. Tinmouth
- Ottawa Hospital Centre for Transfusion Research; Ottawa Hospital Research Institute; Ottawa ON Canada
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