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Kim Y, Bae H, Yu D. The in vitro effects of acidemia and acidemia reversal on coagulation in dogs. Front Vet Sci 2024; 11:1427237. [PMID: 39301280 PMCID: PMC11410758 DOI: 10.3389/fvets.2024.1427237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/26/2024] [Indexed: 09/22/2024] Open
Abstract
Background The effect of acidemia on blood coagulation remains inadequately understood in veterinary medicine. Therefore, we assessed the effect of in vitro acidification of canine whole blood on coagulation and investigated whether acidemia-induced coagulopathy could be reversed by reversing acidemia. Methods Citrated whole blood samples were taken from six healthy Beagle dogs and categorized, based on pH adjustment, into neutral, weak acidemia (WA), strong acidemia (SA), and reversal from SA. Then, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen concentration, conventional thromboelastography (TEG) parameters, and velocity curve (V-curve) variables of TEG were assessed. Results The PT, aPTT, and most TEG parameters showed significant coagulopathy in the SA group compared to the neutral group, with additional significant changes in reaction time (R), clot kinetic (K), maximum amplitude (MA), split point (SP), elasticity (E), thrombodynamic potential index (TPI), and coagulation index (CI) between the SA and WA groups. Among V-curve variables, the maximum rate of thrombus generation (MRTG) and total thrombus generation were significantly inhibited in the SA group compared to the neutral group, with significant differences in the time to maximum rate of thrombus generation (TMRTG) between the WA and SA groups. In the reverse group, aPTT, R, K, α-angle, MRTG, TMRTG, SP, TPI, and CI exhibited significant recovery compared to the SA group. Conclusion The in vitro induction of acidemia in canine whole blood leads to impairment of coagulation profiles, and pH correction can reverse most acidemia-induced coagulopathy.
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Affiliation(s)
- Youngju Kim
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyeona Bae
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - DoHyeon Yu
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
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2
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Bai H, Li H, Nie X, Yao Y, Han X, Wang J, Peng L. Development and validation of a nomogram for predicting cefoperazone/sulbactam-induced hypoprothrombinaemia in Hospitalized adult patients. PLoS One 2023; 18:e0291658. [PMID: 37733780 PMCID: PMC10513251 DOI: 10.1371/journal.pone.0291658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023] Open
Abstract
Cefoperazone/sulbactam-induced hypoprothrombinaemia is associated with longer hospital stays and increased risk of death. The aim of this study was to develop and validate a nomogram for predicting the occurrence of cefoperazone/sulbactam-induced hypoprothrombinaemia in hospitalized adult patients. This retrospective cohort study involved hospitalized adult patients at Xi'an Central Hospital from January 2020 to December 2022 based on the Chinese pharmacovigilance system developed and established by the Adverse Drug Reaction Monitoring Center in China. Independent predictors of cefoperazone/sulbactam-induced hypoprothrombinaemia were obtained using multivariate logistic regression and were used to develop and establish the nomogram. According to the same standard, the clinical data of hospitalized patients using cefoperazone/sulbactam at the Third Affiliated Hospital of Xi'an Medical University from January 1, 2023 to June 30, 2023 were collected as the external validation group. The 893 hospitalized patients included 95 who were diagnosed with cefoperazone/sulbactam-induced hypoprothrombinaemia. Our study enrolled 610 patients: 427 in the training group and 183 in the internal validation group. The independent predictors of cefoperazone/sulbactam-induced hypoprothrombinaemia were surgery (odds ratio [OR] = 5.279, 95% confidence interval [CI] = 2.597-10.729), baseline platelet count ≤50×109/L (OR = 2.492, 95% CI = 1.110-5.593), baseline hepatic dysfunction (OR = 12.362, 95% CI = 3.277-46.635), cumulative defined daily doses (OR = 1.162, 95% CI = 1.162-1.221) and nutritional risk (OR = 16.973, 95% CI = 7.339-39.254). The areas under the curve (AUC) of the receiver operating characteristic for the training and internal validation groups were 0.909 (95% CI = 0.875-0.943) and 0.888 (95% CI = 0.832-0.944), respectively. The Hosmer-Lemeshow tests yielded p = 0.475 and p = 0.742 for the training and internal validation groups, respectively, confirming the goodness of fit of the nomogram model. In the external validation group (n = 221), the nomogram was equally robust in cefoperazone/sulbactam-induced hypoprothrombinaemia (AUC = 0.837, 95%CI = 0.736-0.938). The nomogram model constructed in this study had good predictive performance and extrapolation, which can help clinicians to identify patients at high risk of cefoperazone/sulbactam-induced hypoprothrombinaemia early. This will be useful in preventing the occurrence of cefoperazone/sulbactam-induced hypoprothrombinaemia and allowing timely intervention measures to be performed.
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Affiliation(s)
- Hehe Bai
- Department of Pharmacy, Xi’ an Central Hospital, Xi’an, Shaanxi, China
| | - Huan Li
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Xiaojing Nie
- Department of Pharmacy, Xi’ an Central Hospital, Xi’an, Shaanxi, China
| | - Yanqin Yao
- Department of Pharmacy, The Third Affiliated Hospital of Xi ’an Medical University, Xi’an, Shaanxi, China
| | - Xiaonian Han
- Department of Pharmacy, Xi’ an Central Hospital, Xi’an, Shaanxi, China
| | - Jinping Wang
- Department of Pharmacy, Xi’ an Central Hospital, Xi’an, Shaanxi, China
| | - Lirong Peng
- Department of Pharmacy, Xi’ an Central Hospital, Xi’an, Shaanxi, China
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Ns R, Thomas L, A P, Bhatt A. Physico chemical characterisation of pectin incorporated gelatin sponge and its functional evaluation in modulating contact activation haemostasis. J Biomater Appl 2023:8853282231189931. [PMID: 37453032 DOI: 10.1177/08853282231189931] [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: 07/18/2023]
Abstract
Even though it is a common occurrence in practice, maintaining haemostasis can sometimes become a challenging issue in case of trauma, perioperative period, coagulation disorders, cancers, etc. Hemostatic materials are extensively used to assist in the cessation of bleeding. However, the definition of efficiency of haemostasis varies between intended procedures. This paper explores the feasibility of incorporating agents to increase the efficiency of local haemostasis. Pectin or β -D galacto hexopyranuronic acid/β Gal A, a structural polysaccharide widely present in terrestrial plants having an intrinsic hemostatic potential, is blended with gelatin and is explored in modulating passive haemostasis. The sponges are physico chemically characterized, and their hemostatic efficiency is evaluated in vitro using various assays. Biocompatibility evaluation is done by in vitro cytotoxicity assay. The results suggest that this biopolymer combination is a promising candidate for hemostatic control.
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Affiliation(s)
- Remya Ns
- Division of Toxicology, Bio Medical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Lynda Thomas
- Division of Tissue Engineering and Regenerative Technologies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Priyanka A
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Anugya Bhatt
- Applied Biology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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4
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Imamoto T, Sawano M. Effect of ionized calcium level on short-term prognosis in severe multiple trauma patients: a clinical study. Trauma Surg Acute Care Open 2023; 8:e001083. [PMID: 37396952 PMCID: PMC10314608 DOI: 10.1136/tsaco-2022-001083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Hypocalcemia has been reported as an independent predictor of trauma mortality. We investigated the relationship between temporal variations in blood ionized calcium concentration (iCa) and prognosis in severe trauma patients who underwent massive transfusion protocol (MTP). Methods This single-center, retrospective, observational study investigated 117 severe trauma patients treated with MTP in the Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, between March 2013 and March 2019. Multivariate logistic regression analysis was performed, assigning pH-corrected initial and minimum blood ionized calcium concentration within 24 hours of admission (iCa_min), age, initial systolic blood pressure and Glasgow Coma Scale (GCS) score, and incidence of Ca supplementation as independent variables and 28-day mortality as dependent variable. Results The logistic regression analysis identified iCa_min (adjusted OR 0.03, 95% CI 0.002 to 0.4), age (adjusted OR 1.05, 95% CI 1.02 to 1.09), and GCS score (adjusted OR 0.84, 95% CI 0.74 to 0.94) as significant independent predictors of 28-day mortality. The receiver operating characteristic analysis identified optimal cut-off value of iCa_min for predicting 28-day mortality as 0.95 mmoL/L (area under the curve 0.74). Conclusion In the management of patients with traumatic hemorrhagic shock, aggressive correction of the iCa to maintain 0.95 mmol/L or higher within 24 hours of admission may improve short-term outcomes. Level of evidence Therapeutic/care management, level III.
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Affiliation(s)
- Toshiro Imamoto
- Emergency and Critical Care Medicine, Saitama Medical Center, Kawagoe, Japan
| | - Makoto Sawano
- Emergency and Critical Care Medicine, Saitama Medical Center, Kawagoe, Japan
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5
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Elsebai MF, Habib ESE. Blood pH and COVID-19. Arch Pharm (Weinheim) 2023; 356:e2200558. [PMID: 36690587 DOI: 10.1002/ardp.202200558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a worldwide war. Raising the blood pH might be a crucial strategy to chase COVID-19. The human blood is slightly alkaline, which is essential for cell metabolism, normal physiology, and balanced immunity since all of these biological processes are pH-dependent. Varieties of physiologic derangements occur when the blood pH is disrupted. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) proliferates in acidic blood that magnifies the severity of COVID-19. On the other side, blood acidemia is linked to increased morbidity and mortality because of its complications on immunity, especially in the elderly and in critical diseases such as cancer, musculoskeletal degradation, renal, cardiac, and pulmonary disorders, which result in many pathological disorders such as osteomalacia, and disturbing the hematopoiesis. Additionally, acidemia of the blood facilitates viral infection and progression. Thus, correcting the acid-base balance might be a crucial strategy for the treatment of COVID-19, which might be attributed to the distraction of the viral spike protein to its cognate receptor angiotensin-converting enzyme 2 and supporting the over-taxed immunity.
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Affiliation(s)
- Mahmoud Fahmi Elsebai
- Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - El-Sayed E Habib
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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6
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Reade MC. Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level. Crit Care 2022; 26:395. [PMID: 36544203 PMCID: PMC9768970 DOI: 10.1186/s13054-022-04243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Haemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environmental control approach to individual patient management in trauma is well established and embedded in numerous training courses worldwide. Further improvements in trauma outcomes are likely to result from a combination of system-level interventions in prevention and quality improvement, and from a sophisticated approach to clinical innovation. TOP ELEVEN TRAUMA PRIORITIES Based on a narrative review of remaining preventable mortality and morbidity in trauma, the top eleven priorities for those working throughout the spectrum of trauma care, from policy-makers to clinicians, should be: (1) investment in effective trauma prevention (likely to be the most cost-effective intervention); (2) prioritisation of resources, quality improvement and innovation in prehospital care (where the most preventable mortality remains); (3) building a high-performance trauma team; (4) applying evidence-based clinical interventions that stop bleeding, open & protect the airway, and optimise breathing most effectively; (5) maintaining enough circulating blood volume and ensuring adequate cardiac function; (6) recognising the role of the intensive care unit in modern damage control surgery; (7) prioritising good intensive care unit intercurrent care, especially prophylaxis for thromboembolic disease; (8) conducting a thorough tertiary survey, noting that on average the intensive care unit is where approximately 15% of injuries are detected; (9) facilitating early extubation; (10) investing in formal quantitative and qualitative quality assurance and improvement; and (11) improving clinical trial design. CONCLUSION Dramatic reductions in population trauma mortality and injury case fatality rate over recent decades have demonstrated the value of a comprehensive approach to trauma quality and process improvement. Continued attention to these principles, targeting areas with highest remaining preventable mortality while also prioritising functional outcomes, should remain the focus of both clinician and policy-makers.
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Affiliation(s)
- Michael C. Reade
- grid.1003.20000 0000 9320 7537Medical School, University of Queensland, Level 9 Health Sciences Building, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia ,grid.97008.360000 0004 0385 4044Joint Health Command, Australian Defence Force, Canberra, ACT 2610 Australia
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7
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VanZweden E, Tolsma R, Hung V, Awad P, Sawyer R, Li Y. The advances of blood clots used as biomaterials in regenerative medicine. Regen Med 2022; 17:957-969. [DOI: 10.2217/rme-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The physiologic process of blood clot formation is well understood and occurs naturally in the setting of tissue injury to achieve hemostasis and begin the process of wound healing. While the investigation of blood clots as a biomaterial is still in the early stages, there has been some research with similar biomaterials made of the components of blood clots that support the innovative idea of using an autologous blood clot as a scaffold or delivery method for therapeutic agents. Here, we review the physiology of blood clots in wound healing and how using blood clots as a biomaterial and delivery system can potentially promote wound healing, provide targeted therapeutic agent delivery and use it as an innovative tool in regenerative medicine.
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Affiliation(s)
| | - Rachael Tolsma
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Victor Hung
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Peter Awad
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Robert Sawyer
- Department of General Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Yong Li
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
- Department of Orthopaedic Surgery, Biomedical Engineering, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
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8
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Lawson MA, Holle LA, Dow NE, Hennig G, de Laat B, Moore HB, Moore EE, Cohen MJ, Bouchard BA, Freeman K, Wolberg AS. Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy. J Trauma Acute Care Surg 2022; 93:579-587. [PMID: 35687811 PMCID: PMC9613511 DOI: 10.1097/ta.0000000000003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma patients with abnormal fibrinolysis have increased morbidity and mortality. Knowledge of mechanisms differentiating fibrinolytic phenotypes is important to optimize treatment. We hypothesized that subjects with abnormal fibrinolysis identified by whole blood viscoelastometry can also be distinguished by plasma thrombin generation, clot structure, fibrin formation, and plasmin generation measurements. METHODS Platelet-poor plasma (PPP) from an observational cross-sectional trauma cohort with fibrinolysis shutdown (% lysis at 30 minutes [LY30] < 0.9, n = 11) or hyperfibrinolysis (LY30 > 3%, n = 9) defined by whole blood thromboelastography were studied. Noninjured control subjects provided comparative samples. Thrombin generation, fibrin structure and formation, and plasmin generation were measured by fluorescence, confocal microscopy, turbidity, and a fluorescence-calibrated plasmin assay, respectively, in the absence/presence of tissue factor or tissue plasminogen activator (tPA). RESULTS Whereas spontaneous thrombin generation was not detected in PPP from control subjects, PPP from hyperfibrinolysis or shutdown patients demonstrated spontaneous thrombin generation, and the lag time was shorter in hyperfibrinolysis versus shutdown. Addition of tissue factor masked this difference but revealed increased thrombin generation in hyperfibrinolysis samples. Compared with shutdown, hyperfibrinolysis PPP formed denser fibrin networks. In the absence of tPA, the fibrin formation rate was faster in shutdown than hyperfibrinolysis, but hyperfibrinolysis clots lysed spontaneously; these differences were masked by addition of tPA. Tissue plasminogen activator-stimulated plasmin generation was similar in hyperfibrinolysis and shutdown samples. Differences in LY30, fibrin structure, and lysis correlated with pH. CONCLUSION This exploratory study using PPP-based assays identified differences in thrombin generation, fibrin formation and structure, and lysis in hyperfibrinolysis and shutdown subgroups. These groups did not differ in their ability to promote tPA-triggered plasmin generation. The ability to characterize these activities in PPP facilitates studies to identify mechanisms that promote adverse outcomes in trauma. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level III.
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Affiliation(s)
| | - Lori A. Holle
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nathan E. Dow
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Grant Hennig
- Department of Pharmacology, University of Vermont, Burlington, VT, USA
| | - Bas de Laat
- Synapse Research Institute, Maastricht, the Netherlands
| | - Hunter B. Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ernest E. Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Mitchell J. Cohen
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Beth A. Bouchard
- Department of Biochemistry and Laboratory for Clinical Biochemistry Research, University of Vermont, Burlington, VT, USA
| | - Kalev Freeman
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Yegappan R, Lauko J, Wang Z, Lavin MF, Kijas AW, Rowan AE. Snake Venom Hydrogels as a Rapid Hemostatic Agent for Uncontrolled Bleeding. Adv Healthc Mater 2022; 11:e2200574. [PMID: 35652565 DOI: 10.1002/adhm.202200574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Uncontrolled bleeding from traumatic injury remains the leading cause of preventable death with loss of balance between blood clotting (coagulation) and blood clot breakdown (fibrinolysis). A major limitation of existing hemostatic agents is that they require a functioning clotting system to control the bleeding and are largely based on gauze delivery scaffolds. Herein, a novel rapid wound sealant, composed of two recombinant snake venom proteins, the procoagulant ecarin, to rapidly initiate blood clotting and the antifibrinolytic textilinin, to prevent blood clot breakdown within a synthetic thermoresponsive hydrogel scaffold is developed. In vitro, it is demonstrated that clotting is rapidly initiated with only nanomolar concentrations of venom protein and clot breakdown is effectively inhibited by textilinin. A stable clot is formed within 60 s compared to normal clot formation in 8 min. In vivo studies reveal that the snake venom hydrogel rapidly controls warfarin-induced bleeding, reducing the bleed volume from 48% to 12% and has demonstrated immune compatibility. A new class of hemostatic agents that achieve formation of rapid and stable blood clots even in the presence of blood thinners is demonstrated here.
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Affiliation(s)
- Ramanathan Yegappan
- Australian Institute for Bioengineering and Nanotechnology The University of Queensland St Lucia QLD 4072 Australia
| | - Jan Lauko
- Australian Institute for Bioengineering and Nanotechnology The University of Queensland St Lucia QLD 4072 Australia
| | - Zhao Wang
- Australian Institute for Bioengineering and Nanotechnology The University of Queensland St Lucia QLD 4072 Australia
| | - Martin F. Lavin
- University of Queensland Centre for Clinical Research The University of Queensland Herston QLD 4029 Australia
| | - Amanda W. Kijas
- Australian Institute for Bioengineering and Nanotechnology The University of Queensland St Lucia QLD 4072 Australia
| | - Alan E. Rowan
- Australian Institute for Bioengineering and Nanotechnology The University of Queensland St Lucia QLD 4072 Australia
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10
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Li H, Lu Y, Zeng X, Feng Y, Fu C, Duan H, Shu Q, Zhu J. Risk factors for central venous catheter-associated deep venous thrombosis in pediatric critical care settings identified by fusion model. Thromb J 2022; 20:18. [PMID: 35414086 PMCID: PMC9004113 DOI: 10.1186/s12959-022-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background An increase in the incidence of central venous catheter (CVC)-related thrombosis (CRT) has been reported in pediatric intensive care patients over the past decade. Risk factors for the development of CRT are not well understood, especially in children. The study objective was to identify potential clinical risk factors associated with CRT with novel fusion machine learning models. Methods Patients aged 0–18 who were admitted to intensive care units from December 2015 to December 2018 and underwent at least one CVC placement were included. Two fusion model approaches (stacking and blending) were used to build a better performance model based on three widely used machine learning models (logistic regression, random forest and gradient boosting decision tree). High-impact risk factors were identified based on their contribution in both fusion artificial intelligence models. Results A total of 478 factors of 3871 patients and 3927 lines were used to build fusion models, one of which achieved quite satisfactory performance (AUC = 0.82, recall = 0.85, accuracy = 0.65) in 5-fold cross validation. A total of 11 risk factors were identified based on their independent contributions to the two fusion models. Some risk factors, such as D-dimer, thrombin time, blood acid-base balance-related factors, dehydrating agents, lymphocytes and basophils were identified or confirmed to play an important role in CRT in children. Conclusions The fusion model, which achieves better performance in CRT prediction, can better understand the risk factors for CRT and provide potential biomarkers and measures for thromboprophylaxis in pediatric intensive care settings. Supplementary information The online version contains supplementary material available at 10.1186/s12959-022-00378-y.
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Affiliation(s)
- Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
| | - Yang Lu
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuqing Feng
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Cangcang Fu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Jihua Zhu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
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11
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Sekar PK, Liang XM, Kahng SJ, Shu Z, Dichiara AB, Chung JH, Wu Y, Gao D. Simultaneous multiparameter whole blood hemostasis assessment using a carbon nanotube-paper composite capacitance sensor. Biosens Bioelectron 2022; 197:113786. [PMID: 34801797 DOI: 10.1016/j.bios.2021.113786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
Rapid and accurate clinical assessment of hemostasis is essential for managing patients who undergo invasive procedures, experience hemorrhages, or receive antithrombotic therapies. Hemostasis encompasses an ensemble of interactions between the cellular and non-cellular blood components, but current devices assess only partial aspects of this complex process. In this work, we describe the development of a new approach to simultaneously evaluate coagulation function, platelet count or function, and hematocrit using a carbon nanotube-paper composite (CPC) capacitance sensor. CPC capacitance response to blood clotting at 1.3 MHz provided three sensing parameters with distinctive sensitivities towards multiple clotting elements. Whole blood-based hemostasis assessments were conducted to demonstrate the potential utility of the developed sensor for various hemostatic conditions, including pathological conditions, such as hemophilia and thrombocytopenia. Results showed good agreements when compared to a conventional thromboelastography. Overall, the presented CPC capacitance sensor is a promising new biomedical device for convenient non-contact whole-blood based comprehensive hemostasis evaluation.
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Affiliation(s)
- Praveen K Sekar
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Xin M Liang
- Wellman Center for Photomedicine, Division of Hematology and Oncology, Division of Endocrinology, Massachusetts General Hospital, VA Boston Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA.
| | - Seong-Joong Kahng
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Zhiquan Shu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA; School of Engineering and Technology, University of Washington Tacoma, Tacoma, WA, 98402, USA
| | - Anthony B Dichiara
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Jae-Hyun Chung
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Yanyun Wu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA.
| | - Dayong Gao
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA; Department of Bioengineering, University of Washington, Seattle, WA, 98195, USA.
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12
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Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis? CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Sloos PH, Maas MAW, Hollmann MW, Juffermans NP, Kleinveld DJB. The effect of shock duration on trauma-induced coagulopathy in a murine model. Intensive Care Med Exp 2022; 10:1. [PMID: 34993669 PMCID: PMC8738789 DOI: 10.1186/s40635-021-00428-1] [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: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. TIC can present with different coagulation defects. In this study, the aim was to determine the effect of shock duration on TIC characteristics. We hypothesized that longer duration of shock leads to a more hypocoagulable rotational thromboelastometry (ROTEM) profile compared to a shorter duration of shock. Methods Male B57BL/6J(c) mice (n = 5–10 per group) were sedated and mechanically ventilated. Trauma was induced by bilateral lower limb fractures and crush injuries to the liver and small intestine. Shock was induced by blood withdrawals until a mean arterial pressure of 25–30 mmHg was achieved. Groups reflected trauma and shock for 30 min (TS30) and trauma and shock for 90 min (TS90). Control groups included ventilation only (V90) and trauma only (T90). Results Mice in the TS90 group had significantly increased base deficit compared to the V90 group. Mortality was 10% in the TS30 group and 30% in the TS90 group. ROTEM profile was more hypocoagulable, as shown by significantly lower maximum clot firmness (MCF) in the TS30 group (43.5 [37.5–46.8] mm) compared to the TS90 group (52.0 [47.0–53.0] mm, p = 0.04). ROTEM clotting time and parameters of clot build-up did not significantly differ between groups. Conclusions TIC characteristics change with shock duration. Contrary to the hypothesis, a shorter duration of shock was associated with decreased maximum clotting amplitudes compared to a longer duration of shock. The effect of shock duration on TIC should be further assessed in trauma patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-021-00428-1.
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Affiliation(s)
- Pieter H Sloos
- Department of Intensive Care Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - M Adrie W Maas
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Department of Anaesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Derek J B Kleinveld
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands. .,Department of Intensive Care Medicine, Erasmus MC, Rotterdam, The Netherlands.
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14
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Gandhi JK, Heinrich L, Knoff DS, Kim M, Marmorstein AD. Alteration of fibrin hydrogel gelation and degradation kinetics through addition of azo dyes. J Biomed Mater Res A 2021; 109:2357-2368. [PMID: 33973708 DOI: 10.1002/jbm.a.37218] [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: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
Fibrin is a degradable biopolymer with an excellent clinical safety profile. Use of higher mechanical strength fibrin hydrogels is limited by the rapid rate of fibrin polymerization. We recently demonstrated the use of higher mechanical strength (fibrinogen concentrations >30 mg/ml) fibrin scaffolds for surgical implantation of cells. The rapid polymerization of fibrin at fibrinogen concentrations impaired our ability to scale production of these fibrin scaffolds. We serendipitously discovered that the azo dye Trypan blue (TB) slowed fibrin gelation kinetics allowing for more uniform mixing of fibrinogen and thrombin at high concentrations. A screen of closely related compounds identified similar activity for Evans blue (EB), an isomer of TB. Both TB and EB exhibited a concentration dependent increase in clot time, though EB had a larger effect. While gelation time was increased by TB or EB, overall polymerization time was unaffected. Scanning electron microscopy showed similar surface topography, but transmission electron microscopy showed a higher cross-linking density for gels formed with TB or EB versus controls. Based on these data we conclude that addition of TB or EB during thrombin mediated fibrin polymerization slows the initial gelation time permitting generation of larger more uniform fibrin hydrogels with high-mechanical strength.
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Affiliation(s)
- Jarel K Gandhi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren Heinrich
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knoff
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Minkyu Kim
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA.,Department of Materials Science, University of Arizona, Tucson, Arizona, USA.,BIO5 Institute, University of Arizona, Tucson, Arizona, USA
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15
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Pillai S, Davies G, Lawrence M, Whitley J, Stephens J, Williams PR, Morris K, Evans PA. The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic? Clin Hemorheol Microcirc 2021; 77:183-194. [PMID: 32925001 DOI: 10.3233/ch-200957] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS 15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2-6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and -0.675 respectively, p < 0.05). CONCLUSIONS DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.
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Affiliation(s)
- Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Gareth Davies
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK
| | - Matthew Lawrence
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Jeffrey Stephens
- Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | | | | | - Phillip Adrian Evans
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
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16
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Edwards TH, Meledeo MA, Peltier GC, Ruiz DD, Henderson AF, Travieso S, Pusateri AE. Effects of refrigerated storage on hemostatic stability of four canine plasma products. Am J Vet Res 2020; 81:964-972. [PMID: 33251844 DOI: 10.2460/ajvr.81.12.964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess clotting times, coagulation factor activities, sterility, and thromboelastographic parameters of liquid plasma (LP), thawed fresh frozen plasma (FFP-T), and 2 novel formulations of freeze-dried plasma (FDP) stored refrigerated over 35 days. SAMPLE 6 units of canine LP and FFP-T from a commercial animal blood bank and 5 units each of 2 formulations of canine FDP. PROCEDURES Prothrombin time; activated partial thromboplastin time; activities of coagulation factors II, V, VII, VIII, IX, X, XI, and XII; and thromboelastographic parameters were determined for each product on days 0 (baseline), 3, 7, 14, 21, 28, and 35. For each day, a sample of each product was also submitted for aerobic bacterial culture. RESULTS Small changes in coagulation factor activities and mild increased time to initial clot formation in LP and FFP-T were noted over the 35-day storage period. Activities of factor VIII in FDP1 and factor XII in FDP2 were < 50% at baseline but varied throughout. Compared with FFP-T, time to initial clot formation was increased and clot strength was preserved or increased for the FDPs throughout the study. One FDP had decreased pH, compared with other products. No plasma product yielded bacterial growth. CONCLUSIONS AND CLINICAL RELEVANCE Liquid plasma and FFP-T would be reasonable to use when stored refrigerated for up to 35 days. Both FDP products showed variability in coagulation factor activities. Studies investigating the usefulness of these plasma products (FDPs) in dogs and the variable days of refrigerated storage (all products) are warranted. (Am J Vet Res 2020;81:964-972).
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17
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Whitehead Z, Goddard A, Botha WJ, Pazzi P. Haemostatic changes associated with fluid resuscitation in canine parvoviral enteritis. J S Afr Vet Assoc 2020; 91:e1-e9. [PMID: 32787422 PMCID: PMC7433229 DOI: 10.4102/jsava.v91i0.2005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 03/15/2020] [Accepted: 03/30/2020] [Indexed: 11/21/2022] Open
Abstract
The haemostatic status of dogs with canine parvovirus (CPV) enteritis, within 24 h of admission after initial fluid administration, has been described previously, but the haemostatic status at admission and after standard fluid resuscitation, as well as after initial fluid redistribution, has not been investigated previously. The objective of this study was to characterise the haemostatic status at admission and describe the effect of crystalloid fluid resuscitation on haemostatic variables in dogs with CPV enteritis. Twenty-seven client-owned, hospitalised dogs with confirmed natural CPV infection and 15 healthy age-matched controls were included in a prospective, observational clinical study. The volume of resuscitation fluid, haematocrit (HCT), platelet count, thromboelastography (TEG) variables, antithrombin (AT) activity, fibrinogen- and C-reactive protein (CRP) concentrations were measured in all dogs at admission, after fluid resuscitation and, in 10 dogs, after receiving an additional 3 hours of maintenance-rate crystalloid fluids. For the CPV group at admission, the median TEG reaction time (R) and maximum amplitude (MA) or clot strength, as well as the median HCT, fibrinogen and CRP concentrations, were significantly increased compared to the controls. After fluid resuscitation, median R was significantly shorter, MA significantly increased and HCT and AT activity significantly decreased compared to admission values. The haemostatic variables remained unchanged after 3 h of maintenance-rate crystalloid therapy. The increased clot strength present in dogs with CPV enteritis at admission was exacerbated after fluid resuscitation and persisted for hours after large-volume crystalloid fluid administration.
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Affiliation(s)
- Zandri Whitehead
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa; and, Tygerberg Animal Hospital, Cape Town.
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18
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Mitrophanov AY, Szlam F, Sniecinski RM, Levy JH, Reifman J. Controlled Multifactorial Coagulopathy: Effects of Dilution, Hypothermia, and Acidosis on Thrombin Generation In Vitro. Anesth Analg 2020; 130:1063-1076. [PMID: 31609256 DOI: 10.1213/ane.0000000000004479] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Coagulopathy and hemostatic abnormalities remain a challenge in patients following trauma and major surgery. Coagulopathy in this setting has a multifactorial nature due to tissue injury, hemodilution, hypothermia, and acidosis, the severity of which may vary. In this study, we combined computational kinetic modeling and in vitro experimentation to investigate the effects of multifactorial coagulopathy on thrombin, the central enzyme in the coagulation system. METHODS We measured thrombin generation in platelet-poor plasma from 10 healthy volunteers using the calibrated automated thrombogram assay (CAT). We considered 3 temperature levels (31°C, 34°C, and 37°C), 3 pH levels (6.9, 7.1, and 7.4), and 3 degrees of dilution with normal saline (no dilution, 3-fold dilution, and 5-fold dilution). We measured thrombin-generation time courses for all possible combinations of these conditions. For each combination, we analyzed 2 scenarios: without and with (15 nM) supplementation of thrombomodulin, a key natural regulator of thrombin generation. For each measured thrombin time course, we recorded 5 quantitative parameters and analyzed them using multivariable regression. Moreover, for multiple combinations of coagulopathic conditions, we performed routine coagulation tests: prothrombin time (PT) and activated partial thromboplastin time (aPTT). We compared the experimental results with simulations using a newly developed version of our computational kinetic model of blood coagulation. RESULTS Regression analysis allowed us to identify trends in our data (P < 10). In both model simulations and experiments, dilution progressively reduced the peak of thrombin generation. However, we did not experimentally detect the model-predicted delay in the onset of thrombin generation. In accord with the model predictions, hypothermia delayed the onset of thrombin generation; it also increased the thrombin peak time (up to 1.30-fold). Moreover, as predicted by the kinetic model, the experiments showed that hypothermia increased the area under the thrombin curve (up to 1.97-fold); it also increased the height of the thrombin peak (up to 1.48-fold). Progressive acidosis reduced the velocity index by up to 24%; acidosis-induced changes in other thrombin generation parameters were much smaller or none. Acidosis increased PT by 14% but did not influence aPTT. In contrast, dilution markedly prolonged both PT and aPTT. In our experiments, thrombomodulin affected thrombin-generation parameters mainly in undiluted plasma. CONCLUSIONS Dilution with normal saline reduced the amount of generated thrombin, whereas hypothermia increased it and delayed the time of thrombin accumulation. In contrast, acidosis in vitro had little effect on thrombin generation.
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Affiliation(s)
- Alexander Y Mitrophanov
- From the The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland.,DoD Biotechnology High Performance Computing Software Applications Institute (BHSAI), Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Ft Detrick, Maryland
| | - Fania Szlam
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Roman M Sniecinski
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jaques Reifman
- DoD Biotechnology High Performance Computing Software Applications Institute (BHSAI), Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Ft Detrick, Maryland
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19
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Kornblith LZ, Moore HB, Cohen MJ. Response to Letter to the Editor submitted by Dr. Wada and Dr. Yamakawa re: Trauma-induced coagulopathy: The past, present, and future. J Thromb Haemost 2019; 17:1574-1576. [PMID: 31479184 PMCID: PMC6727975 DOI: 10.1111/jth.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
It is with equal appreciation and enthusiasm that we have the opportunity to participate in these valuable scientific discussions with our respected colleagues Dr. Wada and Dr. Yamakawa, as we did with Dr. Gando and Dr. Otomo on their analogous disseminated-intravascular coagulation (DIC)-centric views of trauma-induced coagulopathy (TIC). We welcome and appreciate Drs Wada and Yamakawa’s expounded descriptions on their areas of their expertise specific to the critical thrombin-specific biologies. We find their additions valuable to the overall framing of the state of the science and controversies that exists in TIC investigations. However, we continue to support that it would be erroneous to continue to force an inflexible view of the complex biology of TIC, thereby failing to acknowledge the various competing mechanisms and mediators described throughout the literature, including the sometimes contradictory biomarker phenotypes that are ‘impaired’ in TIC. In addition, much of our following response to Drs Wada and Yamakawa’s letter will involve referring back to what was already addressed within the manuscript that appears to have been overlooked. However, of absolute importance, we would like to stress that TIC remains open science should therefore be regarded with open minds and without siloed opinions.
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Affiliation(s)
- Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, 1001 Potrero Avenue, Building 1, Suite 210, San Francisco, CA 94110
| | - Hunter B. Moore
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
| | - Mitchell J. Cohen
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
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20
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Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: The past, present, and future. J Thromb Haemost 2019; 17:852-862. [PMID: 30985957 PMCID: PMC6545123 DOI: 10.1111/jth.14450] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
Abstract
Trauma remains a leading cause of death worldwide, and most early preventable deaths in both the civilian and military settings are due to uncontrolled hemorrhage, despite paradigm advances in modern trauma care. Combined tissue injury and shock result in hemostatic failure, which has been identified as a multidimensional molecular, physiologic and clinical disorder termed trauma-induced coagulopathy (TIC). Understanding the biology of TIC is of utmost importance, as it is often responsible for uncontrolled bleeding, organ failure, thromboembolic complications, and death. Investigations have shown that TIC is characterized by multiple phenotypes of impaired hemostasis due to altered biology in clot formation and breakdown. These coagulopathies are attributable to tissue injury and shock, and encompass underlying endothelial, immune and inflammatory perturbations. Despite the recognition and identification of multiple mechanisms and mediators of TIC, and the development of targeted treatments, the mortality rates and associated morbidities due to hemorrhage after injury remain high. The purpose of this review is to examine the past and present understanding of the multiple distinct but highly integrated pathways implicated in TIC, in order to highlight the current knowledge gaps and future needs in this evolving field, with the aim of reducing morbidity and mortality after injury.
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Affiliation(s)
- Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, 1001 Potrero Avenue, Building 1, Suite 210, San Francisco, CA 94110
| | - Hunter B. Moore
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
| | - Mitchell J. Cohen
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
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21
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Getz TM, Turgeon A, Wagner SJ. Sodium citrate contributes to the platelet storage lesion. Transfusion 2019; 59:2103-2112. [DOI: 10.1111/trf.15213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Todd M. Getz
- Holland Laboratory; The American Red Cross Biomedical Services; Rockville Maryland
| | - Annette Turgeon
- Holland Laboratory; The American Red Cross Biomedical Services; Rockville Maryland
| | - Stephen J. Wagner
- Holland Laboratory; The American Red Cross Biomedical Services; Rockville Maryland
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22
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Liu QP, Carney R, Sohn J, Sundaram S, Fell M. Single‐donor spray‐dried plasma. Transfusion 2018; 59:707-713. [DOI: 10.1111/trf.15035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/21/2018] [Accepted: 09/23/2018] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Jihae Sohn
- Velico Medical, Inc. Beverly Massachusetts
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23
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Lu L, Xing C, Xin S, Shitao Y, Feng S, Shiwei L, Fusheng L, Congxia X. Alkyl chitosan film-high strength, functional biomaterials. J Biomed Mater Res A 2017; 105:3034-3041. [DOI: 10.1002/jbm.a.36163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/07/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Li Lu
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
- Department of Materials Science and Engineering; The Pennsylvania State University, University Park; Pennsylvania 16802
- Department of Bioengineering; The Pennsylvania State University, University Park; Pennsylvania 16802
| | - Cao Xing
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Shen Xin
- College of Polymer Science and Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Yu Shitao
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Su Feng
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Liu Shiwei
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Liu Fusheng
- College of Chemical Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
| | - Xie Congxia
- Key Laboratory of Eco-Chemical Engineering, Ministry of Education, College of Chemistry and Molecular Engineering; Qingdao University of Science and Technology; Qingdao People's Republic of China
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Meledeo MA, Herzig MC, Bynum JA, Wu X, Ramasubramanian AK, Darlington DN, Reddoch KM, Cap AP. Acute traumatic coagulopathy. J Trauma Acute Care Surg 2017; 82:S33-S40. [DOI: 10.1097/ta.0000000000001431] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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