In-vitro thromboelastographic characterization of reconstituted whole blood utilizing cryopreserved platelets

A Nomogram Prediction Model for Clinical Outcome of Trauma-induced Coagulopathy Patients with Severe Multiple Trauma

Introduction

The objective of this study was to investigate the predictive value of thromboelastography (TEG) combined with conventional coagulation test parameters for the clinical outcome of patients with trauma-induced coagulopathy (TIC) and establish and evaluate a clinical nomogram for predicting the prognosis of TIC patients.

Methods

Clinical data of severe multiple trauma patients who underwent emergency treatment in the hospital from November 2018 to August 2021 were enrolled retrospectively. The prognosis was evaluated according to the length of hospital stay and the 30-day survival rate. Multivariable logistic regression model was used to evaluate the correlation between TEG parameters and clinical outcomes. A nomogram model was constructed and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value.

Results

Univariate analysis indicated that there were significant differences in age, hypertension, temperature fluctuation (>3°C), transfusion, kinetics time (K), angle (α) value, maximal amplitude (MA), and international normalized ratio between the good and poor outcome group (P < 0.05). Multivariate logistic regression analysis showed that age, Glasgow Coma Scale scores, temperature fluctuation (>3°C), and MA parameters were independent risk factors for poor outcome, and we established the nomogram prediction model. According to ROC curve analysis, the area under the curve for MA parameter was 0.689 (95% confidence interval [CI]: 0.610-0.760), and the corresponding sensitivity and specificity were 44.12% and 91.87%, respectively. The area under the curve for temperature fluctuation (>3°C) was 0.697 (95% CI: 0.618-0.768), and the corresponding sensitivity and specificity were 60.00% and 79.67%, respectively.

Conclusion

TEG parameters combined with relevant clinical indicators can be used to evaluate the prognosis of TIC patients with severe multiple trauma. The establishment of correlation nomogram model was guiding significance for clinical evaluation of long-term prognosis of trauma patients.

Exploring microplastic impact on whole blood clotting dynamics utilizing thromboelastography

This study investigates the influence of microplastics on blood clotting. It addresses the lack of comprehensive research on the effects of microplastic size and surface modification on clotting dynamics in human whole blood. Thromboelastography was used to examine aminated (aPS), carboxylated (cPS), and non-functionalized (nPS) polystyrene particles with sizes of 50, 100, and 500  nm. Results show that cPS consistently activated the clotting cascade, demonstrating increased fibrin polymerization rates, and enhanced clot strength in a size and concentration-dependent manner. nPS had minimal effects on clotting dynamics except for 50  nm particles at the lowest concentration. The clotting effects of aPS (100  nm particles) resembled those of cPS but were diminished in the 500  nm aPS group. These findings emphasize the importance of microplastic surface modification, size, concentration, and surface area on in-vitro whole blood clotting dynamics.

Effect of Chandler loop shear and tubing size on thrombus architecture

Thrombosis can lead to a wide variety of life-threatening circumstances. As current thrombolytic drug screening models often poorly predict drug profiles, leading to failure of thrombolytic therapy or clinical translation, more representative clot substrates are necessary for drug evaluation. Utilizing a Chandler loop device to form clot analogs at high shear has gained popularity in stroke societies. However, shear-dependent clot microstructure has not been fully addressed and low shear conditions are often overlooked. We herein characterized the impact of wall shear rate (126 to 951 s^-1) on clot properties in the Chandler loop. Different revolutions (20-60) per minute and tubing sizes (3.2 to 7.9 mm) were employed to create different sized clots to mimic various thrombosis applications. Increased shear resulted in decreased RBC counts (76.9 ± 4.3% to 17.6 ± 0.9%) and increased fibrin (10 to 60%) based on clot histology. Increased fibrin sheet morphology and platelet aggregates were observed at higher shear under scanning electron microscope. These results show the significant impact of shear and tubing size on resulting clot properties and demonstrate the capability of forming a variety of reproducible in-vivo-like clot analogs in the Chandler loop device controlling for simple parameters to tune clot characteristics.

Real-time tracking of fibrinolysis under constant wall shear and various pulsatile flows in an in-vitro thrombolysis model

A great need exists for the development of a more representative in-vitro model to efficiently screen novel thrombolytic therapies. We herein report the design, validation, and characterization of a highly reproducible, physiological scale, flowing clot lysis platform with real-time fibrinolysis monitoring to screen thrombolytic drugs utilizing a fluorescein isothiocyanate (FITC)-labeled clot analog. Using this Real-Time Fluorometric Flowing Fibrinolysis assay (RT-FluFF assay), a tPa-dependent degree of thrombolysis was observed both via clot mass loss as well as fluorometrically monitored release of FITC-labeled fibrin degradation products. Percent clot mass loss ranged from 33.6% to 85.9% with fluorescence release rates of 0.53 to 1.17 RFU/min in 40 and 1000 ng/mL tPa conditions, respectively. The platform is easily adapted to produce pulsatile flows. Hemodynamics of human main pulmonary artery were mimicked through matching dimensionless flow parameters calculated using clinical data. Increasing pressure amplitude range (4-40 mmHg) results in a 20% increase of fibrinolysis at 1000 ng/mL tPA. Increasing shear flow rate (205-913 s-1) significantly increases fibrinolysis and mechanical digestion. These findings suggest pulsatile level affects thrombolytic drug activities and the proposed in-vitro clot model offers a versatile testing platform for thrombolytic drug screening.

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

Purpose

To investigate the changes in thromboelastography (TEG) in patients with dyslipidemia to study its effect on the blood coagulation status.

Methods

131 patients hospitalized in Fujian Provincial Jinshan Hospital from January 2018 to December 2020 were selected, and 64 cases in the hyperlipidemia (HL) group and 67 cases in the non-HL group were set according to whether their blood lipids were abnormal. By measuring the changes of each parameter of TEG in patients, the relevant parameters R value, K value, α angle, and MA value were calculated. And routine blood coagulation (PT, APTT, INR, FIB, and TT) and routine blood (platelet count) tests were performed on all study subjects to analyze the changes of each index of the coagulation function and each parameter of TED in both groups and explore the clinical value of TEG on HL diseases.

Results

Compared with the non-HL group, R and K values decreased, and angle and MA values increased in the HL group (P < 0.05). PT, APTT, and INR values decreased, and FIB values increased in the HL group compared with the nonhyperlipidemic group (P < 0.05). The TT levels were similar in the non-HL group and the HL group (P > 0.05). Compared with the non-HL group, PLT values decreased, and PDW and MPV values increased in the HL group (P < 0.05). R value was positively correlated with APTT, r= 0.373, P=0.002. K value was negatively correlated with PLT, r= -0.399, P=0.002. α angle and MA values were positively correlated with PLT, r= 0.319/0.475, P=0.010/P < 0.001. The rest of the indexes did not correlate with each parameter of TEG significant correlation.

Conclusion

TEG can predict the hypercoagulability and hypocoagulability of blood by the changes of R value, K value, α angle, and MA to evaluate the effect of hyperlipidemia on the coagulation status, which is important for guiding the adjustment of lipid-lowering, antithrombotic, and anticoagulation programs in patients with atherosclerosis combined with hyperlipidemia or postsurgery combined with hyperlipidemia.