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Ma W, Zhao T, Yu L, Liu W, Wang H, Zhao P. Incidence, clinical features, and risk factors of hemocoagulase-induced hypofibrinogenemia: A retrospective real-world study. Medicine (Baltimore) 2024; 103:e37773. [PMID: 38608074 PMCID: PMC11018171 DOI: 10.1097/md.0000000000037773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
The objective of this study was to explore the real-world incidence, severity, clinical features, and potential risk factors associated with hypofibrinogenemia induced by hemocoagulase. Based on Chinese Hospital Pharmacovigilance System, a retrospective case-control study was conducted, enrolling hospitalized patients who received hemocoagulase for the treatment or prevention of hemorrhage in Weifang People's Hospital in China from January 2021 to May 2022. Univariate and multivariate logistic regression was performed to analyze the potential risk factors. Out of 10,397 hospitalized patients who received hemocoagulase, 341 patients showed positive triggers, with 235 patients ultimately conformed as hemocoagulase-associated hypofibrinogenemia. The system positive alarm rate was 68.91%, and the overall incidence of hemocoagulase-induced hypofibrinogenemia was 2.26%, predominantly characterized by mild to moderate severity levels. The incidence varied among the 4 types of hemocoagulase, with the highest incidence observed in hemocoagulase Agkistrodon Halys Pallas at 4.59%. The incidence of hemocoagulase from Deinagkistrodon acutus, Bothrops Atrox and Adder were 0.97%, 0.44% and 0.12%, respectively. Multivariate logistic regression analysis revealed that age (odds ratios [OR] = 177.328, P < .001), source of snake venom (OR = 5.641, P < .05), albumin (OR = 2.487, P < .001), and cumulative dosage (OR = 1.106, P < .001) were independent risk factors. Increased risk of hemocoagulase-related hypofibrinogenemia may be associated with children, elderly patients, low albumin levels, high cumulative doses and hemocoagulase from Agkistrodon Halys Pallas. Early recognition and close drug monitoring for these high-risk patients are vital in clinical practice.
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Affiliation(s)
- Wenming Ma
- Department of Clinical Pharmacy, Weifang People’s Hospital, Kuiwen District, Weifang, Shandong Province, P. R. China
| | - Ting Zhao
- Department of Clinical Pharmacy, Weifang People’s Hospital, Kuiwen District, Weifang, Shandong Province, P. R. China
| | - Lihong Yu
- Department of Clinical Pharmacy, Weifang People’s Hospital, Kuiwen District, Weifang, Shandong Province, P. R. China
| | - Wenyu Liu
- Department of Pharmacy, Weifang People’s Hospital, Kuiwen District, Weifang, Shandong Province, P. R. China
| | - Hang Wang
- School of Foreign Languages, Weifang University, Kuiwen District, Weifang, Shandong Province, P.R. China
| | - Pengfei Zhao
- Department of Clinical Pharmacy, Weifang People’s Hospital, Kuiwen District, Weifang, Shandong Province, P. R. China
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Lee JK, Yoon CS, Na YO, Park HK, Oh HJ, Kho BG, Park HY, Kim TO, Shin HJ, Kwon YS, Kim YI, Lim SC. Risk factors and clinical outcomes associated with acquired hypofibrinogenemia in patients administered hemocoagulase batroxobin for hemoptysis. J Thorac Dis 2023; 15:65-76. [PMID: 36794140 PMCID: PMC9922611 DOI: 10.21037/jtd-22-717] [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: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
Background Hemocoagulase batroxobin is used to prevent hemostasis or bleeding in surgical and trauma patients; however, the role of batroxobin in patients with hemoptysis is not well understood. We evaluated the risk factors and prognosis of acquired hypofibrinogenemia in hemoptysis patients treated systemically with batroxobin. Methods We retrospectively reviewed the medical charts of hospitalized patients who were administered batroxobin for hemoptysis. Acquired hypofibrinogenemia was defined as a plasma fibrinogen level >150 mg/dL at baseline, decreasing to <150 mg/dL after batroxobin administration. Results Overall, 183 patients were enrolled, of whom 75 had acquired hypofibrinogenemia after the administration of batroxobin. There was no statistical difference in the median age of the patients in the non-hypofibrinogenemia and hypofibrinogenemia groups (72.0 vs. 74.0 years, respectively). The patients in the hypofibrinogenemia group showed a higher rate of intensive care unit (ICU) admission (11.1% vs. 22.7%; P=0.041) and tended to have more massive hemoptysis than those in the non-hyperfibrinogenemia group (23.1% vs. 36.0%; P=0.068). The patients in the hypofibrinogenemia group further showed a higher requirement for transfusion (10.2% vs. 38.7%; P<0.000) than those in the non-hyperfibrinogenemia group. Low levels of baseline plasma fibrinogen and a prolonged and higher total dose of batroxobin were associated with the development of acquired hypofibrinogenemia. Acquired hypofibrinogenemia was associated with increased 30-day mortality [hazard ratio (HR), 4.164; 95% confidence interval (CI), 1.318-13.157]. Conclusions The plasma fibrinogen levels in patients who were administered batroxobin for hemoptysis should be monitored, and batroxobin should be discontinued if hypofibrinogenemia occurs.
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Affiliation(s)
- Jae-Kyeong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chang-Seok Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young-Ok Na
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hwa Kyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyung-Joo Oh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bo-Gun Kho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ha-Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hong-Joon Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
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Effect of Hemocoagulase on the Prevention of Bleeding after Percutaneous Renal Biopsy. Toxins (Basel) 2022; 14:toxins14030223. [PMID: 35324720 PMCID: PMC8951486 DOI: 10.3390/toxins14030223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
A percutaneous renal biopsy is an essential tool for the diagnosis of various renal diseases; however, post-biopsy bleeding is a major complication. Hemocoagulase is a detoxified and purified snake venom enzyme that is widely used to prevent post-procedural bleeding. In this study, we retrospectively analyzed the effect of hemocoagulase on post-renal biopsy bleeding. We included 221 patients who underwent percutaneous renal biopsy between April 2017 and December 2020 and analyzed post-renal biopsy hemoglobin (Hb) decline in patients who were administered a periprocedural hemocoagulase injection. After the renal biopsy, the mean Hb decrease in the entire patient cohort was 0.33 ± 0.84 g/dL. Periprocedural hemocoagulase injection lowered the Hb decline post-renal biopsy (0.50 ± 0.87 vs. 0.23 ± 0.80 g/dL, p = 0.0204). The propensity-matched cohort was also adjusted for factors influencing postprocedural bleeding; periprocedural hemocoagulase injection reduced the Hb decline post-renal biopsy (0.56 ± 0.89 vs. 0.17 ± 0.74 g/dL, p = 0.006). There were no adverse events (e.g., thrombosis and anaphylactic shock) due to hemocoagulase. Our study demonstrated the beneficial effect of hemocoagulase on post-renal biopsy Hb decline, suggesting its clinical value in preventing post-renal biopsy bleeding.
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