Journal articles on the topic 'Blood coagulation tests'
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1
FUJIKATA, Akira, and Yayoi IKEDA. "Blood coagulation and clotting tests in carp." NIPPON SUISAN GAKKAISHI 51, no. 6 (1985): 933–39. http://dx.doi.org/10.2331/suisan.51.933.
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Yavas, Soner, Selime Ayaz, Serdal Kenan Kose, Fatma Ulus, and Tulga Ahmet Ulus. "Influence of Blood Collection Systems on Coagulation Tests." Turkish Journal of Hematology 29, no. 4 (2012): 367–75. http://dx.doi.org/10.5505/tjh.2012.59254.
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Kozmin, L. D., A. I. Martinov, T. A. Lisitsina, T. M. Reshetnyak, V. I. Lauga, and O. P. Bliznukov. "C-reactive protein prolongs blood coagulation time in phospholipids-dependent coagulation tests." Rheumatology Science and Practice, no. 3 (June 15, 2003): 16. http://dx.doi.org/10.14412/1995-4484-2003-1353.
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Wisser, Dirk, Klaus van Ackern, Ernst Knoll, Hermann Wisser, and Thomas Bertsch. "Blood Loss from Laboratory Tests." Clinical Chemistry 49, no. 10 (October 1, 2003): 1651–55. http://dx.doi.org/10.1373/49.10.1651.
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Abstract Background: Laboratory tests can be an important source of blood loss in hospitals, especially for newborns and patients in intensive care. The aim of this study was to quantify blood loss for laboratory diagnostic tests in a large number of patients in a teaching hospital. Methods: We estimated blood loss by multiplying the number and volumes of sampling tubes collected from 2654 adult inpatients. We compared the number of tests per patient for all inpatients and intensive care unit patients during the first period and again in the same time period 1 year later when cumulative blood-loss volumes were being reported to physicians and educational information had been given to decrease blood loss from laboratory tests. Results: For 95% of the patients, blood loss during hospitalization was <196 mL. The largest proportion of the blood samples was used for clinical chemical tests (median, 45%), followed by hematologic (median, 26%) and coagulation (median, 17%) tests. In the surgical and cardiovascular surgical intensive care units, however, blood gas analyses accounted for 19–34% (medians) of the use. For 5% of the patients, all undergoing intensive care, blood loss was >200 mL and for 0.7% was >600 mL during their hospital stay. Such high blood losses were observed in patients with long-term ventilation, coagulation disorders, and repeated surgery. The largest median blood loss was in patients undergoing cardiovascular surgery (median, 201 mL). The mean number of tests was 44 per inpatient before cumulative blood loss was being reported and 46 when it was being reported. Conclusions: Blood loss from laboratory diagnostic testing is not likely to pose a problem for most hospitalized patients. Blood loss is greater in intensive care patients and after cardiovascular surgical procedures. Reporting of the cumulative individual blood loss did not decrease blood loss for laboratory testing.
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KITAJIMA, Isao. "The clinical laboratory tests of blood coagulation and fibrinolysis." Japanese Journal of Thrombosis and Hemostasis 19, no. 4 (2008): 462–66. http://dx.doi.org/10.2491/jjsth.19.462.
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Ferrigno, D., G. Buccheri, and I. Ricca. "Prognostic significance of blood coagulation tests in lung cancer." European Respiratory Journal 17, no. 4 (April 1, 2001): 667–73. http://dx.doi.org/10.1183/09031936.01.17406670.
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Norén, Ingrid, and Astrid Gårde. "Value of Blood Coagulation Tests in Ischemic Cerebral Disease." European Neurology 25, no. 5 (1986): 330–38. http://dx.doi.org/10.1159/000116031.
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Edwards, Richard L., Frederick R. Rickles, Thomas E. Moritz, William G. Henderson, Leo R. Zacharski, Walter B. Forman, C. J. Cornell, et al. "Abnormalities of Blood Coagulation Tests in Patients with Cancer." American Journal of Clinical Pathology 88, no. 5 (November 1, 1987): 596–602. http://dx.doi.org/10.1093/ajcp/88.5.596.
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Krishnamurthy, Dr Vani, and Rubiya Ahmad. "Comparison of various principles of coagulation tests in handling hemolysed blood samples." Tropical Journal of Pathology and Microbiology 7, no. 4 (August 31, 2021): 188–93. http://dx.doi.org/10.17511/jopm.2021.i04.06.
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Background: Rejection of hemolysed samples for coagulation test is the standard practice.However, when clinicians deal with extremely sick patients where repeat sampling is difficult toobtain, rejection of the sample is a lost opportunity for the lab physician to assist inpatient care.Proceeding with the test and providing a clinically helpful interpretation of the results will ensure theactive participation of the laboratory physician. Different principles of coagulation testing handle thehemolysed samples differently. It is essential to know the best principle to proceed with thehemolysed sample if need be. This study set out to estimate the predictive values of post-hemolyticsample coagulation test results with various coagulation test principles. Methods: This is aprospective experimental study where the non-hemolysed samples were processed for coagulationtests. Part of the sample was deliberately hemolysed, and the coagulation tests were repeated.Results: Two hundred and forty-eight samples were studied. A median of 11% hemolysis wasachieved experimentally. The mean difference in prothrombin time between pre and post hemolyticsamples with normal PT was 0.9 and with abnormal PT, it was 1.1 seconds. The same for APTT was4.9 and 1.1 seconds, respectively. The majority of the samples showed prolonged coagulation posthemolysis. Positive (PPV) and negative (NPV) predictive values for prothrombin time are 97.3 and73.4%, respectively. Similarly, PPV and NPV for APTT are 97.4 and 47.1%, respectively.Conclusions: Samples with normal values after hemolysis are more likely to be normal.
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Gabarin, Nadia, Martina Trinkaus, Rita Selby, Nicola Goldberg, Jessica Petrucci, Hina Chaudhry, and Michelle Sholzberg. "Can an Online Educational Module Improve Medical Trainee Confidence and Knowledge of Coagulation?" Blood 134, Supplement_1 (November 13, 2019): 4695. http://dx.doi.org/10.1182/blood-2019-129385.
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Background: Coagulation has notoriously been a topic that medical trainees find challenging to learn. A lack of understanding around coagulation has led to widespread inappropriate ordering of commonly used coagulation tests, including the prothrombin time (PT) and the activated partial thromboplastin time (aPTT). Despite these tests being validated for specific clinical indications, they are frequently ordered as screening tests in unselected patients, and often ordered together, suggesting a gap in physician understanding of coagulation and appropriate testing. To explore this further, we conducted a root-cause-analysis survey of 10 medical trainees. 70% of the surveyed trainees did not feel comfortable with their knowledge regarding coagulation and the appropriate use of coagulation tests. Trainees attributed their suboptimal knowledge to the manner in which coagulation is taught in training programs. Furthermore, they identified a scarcity of practical resources on coagulation and expressed interest in a web-accessible resource. Methods: We created an educational module on coagulation testing for trainees, available online at www.coagtesting.com. This module was created with the intent of simplifying the teaching of coagulation, with a focus on emphasizing clinically-relevant concepts. The module was evaluated at the University of Toronto with 50 participating medical trainees (11 medical students, 39 internal medicine residents [14 PGY1, 15 PGY2, 10 PGY3 residents]). Participation in our study included completing a validated knowledge pre-quiz on coagulation, completion of the educational module, and then the post-quiz following the module. To assess longer term knowledge retention, participants were asked to repeat the knowledge quiz three months following their initial participation. Our educational intervention was evaluated according to the Kirkpatrick Model, a framework for learning evaluation, with educational outcomes organized into four ranked levels (level 1, reaction; level 2, learning; level 3, behaviour; level 4, results). The primary objective of this study was to determine if the module improves trainee knowledge of coagulation, as indicated by their quiz results (level 2, learning). The secondary objective was to evaluate if the module has an influence on trainee ordering practices as assessed by a follow-up survey (level 3, behaviour). Results: The median pre-module quiz score was 67% (range 24% - 86%) with an increase of 24% to a median post-module quiz score of 91% (range 64% - 100%). Notably, in the pre-module quiz, 94% of trainees overestimated the sensitivity and specificity of the PT and aPTT in detecting a bleeding disorder, and 44% of trainees underestimated the cost of a PT test. 80% of trainees described increased confidence regarding their knowledge of coagulation and the use of coagulation tests following completion of the module. In addition, we have demonstrated sustained knowledge acquisition with a 3-month post-quiz median score of 89% (n=15, range 67%-100%). 100% of trainees who completed the 3-month follow-up survey (n=15) felt that the educational module had a positive influence on their practice and 87% of trainees were more likely to consider the sensitivity, specificity, and cost of a lab test prior to ordering it. In the seven months since the module was launched, it has been completed by over 2,000 unique visitors worldwide, with use in Canada, the United States, the United Kingdom, Australia, France, and Saudi Arabia according to data from our website host. Furthermore, several visitors to the website have re-visited the module multiple times. Conclusion: We have successfully demonstrated a significant increase in trainee knowledge and confidence regarding coagulation and appropriate use of coagulation tests with our educational intervention. Using the expertise of medical educators and incorporating feedback from trainees, we have employed a novel approach to the teaching of coagulation to maximize its approachability and clinical relevance. Our module also incorporates education on the cost of coagulation testing and appropriate use of these tests thus in line with the tenets of Choosing Wisely. The degree to which trainees have been utilizing and re-referring to our educational module worldwide emphasizes the need for this resource and its importance in bridging a large gap in medical training. Disclosures Sholzberg: Novartis: Honoraria; Amgen: Honoraria, Research Funding.
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Larsen, Julie, and Anne-Mette Hvas. "Predictive Value of Whole Blood and Plasma Coagulation Tests for Intra- and Postoperative Bleeding Risk: A Systematic Review." Seminars in Thrombosis and Hemostasis 43, no. 07 (July 18, 2017): 772–805. http://dx.doi.org/10.1055/s-0037-1602665.
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AbstractExcessive perioperative bleeding is associated with increased morbidity and mortality as well as increased economic costs. A range of whole blood laboratory tests for hemostatic monitoring has emerged, but their ability to predict perioperative bleeding is still debated. We conducted a systematic review of the existing literature assessing the ability of whole blood coagulation (thromboelastography [TEG]/thromboelastometry [ROTEM]/Sonoclot), platelet function tests, and standard plasma-based coagulation tests to predict bleeding in the perioperative setting. We searched PubMed and Embase, covering the period from 1966 to November 2016. In total, 99 original studies were included. The included studies assessed TEG/ROTEM/Sonoclot (n = 29), platelet function tests (n = 27), both test types (n = 8), and standard coagulation tests only (n = 18), and some (n = 17) investigated the predictive value of testing in patients receiving antithrombotic medication. In general, studies reported low positive predictive values for perioperative testing, whereas negative predictive values were high. The studies yielded moderate areas under receiver operator characteristics (ROC) curve (for the majority, 0.60–0.80). In conclusion, while useful in the diagnosis and management of patients with overt bleeding, whole blood coagulation and platelet function tests as well as standard coagulation tests demonstrated limited ability to predict perioperative bleeding in unselected patients. Therefore, we recommend that both whole blood and plasma-based coagulation tests are primarily used in case of bleeding and not for screening in unselected patients prior to surgery.
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FUKUTAKE, Katsuyuki. "Necessity and current state of standardization in blood coagulation tests." Japanese Journal of Thrombosis and Hemostasis 27, no. 6 (2016): 617–22. http://dx.doi.org/10.2491/jjsth.27.617.
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Brown, J. M., and G. Dimeski. "Contamination of coagulation tests with heparin from blood gas samples." British Journal of Anaesthesia 87, no. 4 (October 2001): 628–29. http://dx.doi.org/10.1093/bja/87.4.628.
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Ahmed, A. "Monitoring of blood clotting during bleeding." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 12–13. http://dx.doi.org/10.32902/2663-0338-2020-3.2-12-13.
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Background. The risk of bleeding and thrombotic events should be weighed before, during and after surgery. To facilitate this process, it is advisable to ask yourself the following questions: if we start the operation now, will the bleeding develop? If we delay the intervention, will a thrombotic event occur? Are the patient’s antithrombotic drugs effective?
Objective. To describe the blood coagulation monitoring system.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Coagulopathy can be congenital and acquired, the latter including iatrogenic. The causes of congenital coagulopathies include hemophilia, von Willebrand factor deficiency, thrombocytopenia, and antiphospholipid syndrome. Antiplatelet drugs and direct oral anticoagulants are the main causes of iatrogenic coagulopathies. Other causes of acquired coagulopathies include hemostasis failure, disseminated intravascular coagulation syndrome, and post-surgical coagulopathies of various types. In order to treat bleeding in coagulopathies, desmopressin, tranexamic acid, coagulation factors, and protamine are administered. Laboratory tests needed to detect coagulopathies include prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, fibrinogen levels, and coagulation factors. The limitations of these tests include their non-dynamic nature, lack of ability to predict the risk of bleeding, time and financial costs, inability to understand the pathophysiological mechanism of bleeding. There may also be an error in the analysis due to the addition of citrate and calcium to the samples. Rapid tests to assess the hemostasis system include determination of activated coagulation time, Hepcon heparin monitoring system, thromboelastography and platelet mapping, platelet aggregometry using multiple electrodes, rotational thromboelastometry, and sonoreometry.
Conclusions. 1. For best results, coagulopathy should be anticipated, detected, and treated in a timely manner. 2. The strength of blood clots depends on platelets and fibrinogen. 3. It is advisable to use rapid tests to assess hemostasis and repeat them regularly, as bleeding and blood clotting are dynamic processes. 4. The effects of hemodilution, acid-base balance and temperature should be kept in mind.
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IRIE, Yohji, Hiroko YOSHIDA, Katsuyuki KAI, Yasushi MAKINO, Shinji SHIBATA, and Katsuya KITOH. "Reference Intervals Using the Dry-system Coagulation Analyzer COAG2V for Blood Coagulation Tests in Dogs." Journal of the Japan Veterinary Medical Association 72, no. 7 (July 20, 2019): 417–22. http://dx.doi.org/10.12935/jvma.72.417.
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Ataullakhanov, F. I., and A. G. Rumyantsev. "New insights into the blood clotting." Russian Journal of Children Hematology and Oncology 5, no. 3 (September 14, 2018): 13–22. http://dx.doi.org/10.17650/2311-1267-2018-5-3-13-22.
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In recent years, an active revision of ideas about the mechanisms of blood clotting has been performed. Traditional views were largely inaccurate, which is the main reason for the inconsistency of the modern standard set of coagulation tests. This set was found to be insensitive, especially to hypercoagulable disorders. In this paper, we consider modern concepts of how blood clotting occurs. From this consideration follows the need for a critical review of existing methods for assessing the status of hemostasis and a standard set of laboratory tests. The lecture ends with a brief examination of which methods are the most informative today and could form the basis of a new informative coagulation testing set.
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Putnis, Soni, Joe Nanuck, and Dugal Heath. "An Audit of Preoperative Blood Tests." Journal of Perioperative Practice 18, no. 2 (February 2008): 56–59. http://dx.doi.org/10.1177/175045890801800201.
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Purpose Audit of the use of preoperative blood tests in elective general surgery in a district general hospital. Comparison is made with the National Institute for Health and Clinical Excellence (NICE) guidelines and recommendations. Methodology Retrospective audit of preoperative blood tests performed for elective general surgical patients in a district general hospital over a one month period. Findings Patients attending preoperative assessment for general surgery have blood tests performed in excess of the NICE guidelines. The most frequently requested test that is performed against NICE guidelines is a coagulation screen. This was requested in excess of the national guidelines in 17.8% of cases. Practical implications This audit highlights the overuse of preoperative blood tests and provides suggestions for improving efficiency and economics in the preoperative setting. Originality/value of paper There have been no published audits assessing the current practice against the 2003 NICE guidelines for the use of routine preoperative tests for elective surgery.
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Park, Sun Young. "Viscoelastic coagulation test for liver transplantation." Anesthesia and Pain Medicine 15, no. 2 (April 30, 2020): 143–51. http://dx.doi.org/10.17085/apm.2020.15.2.143.
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Coagulation and transfusion management in patients undergoing liver transplantation is challenging. Proper perioperative monitoring of hemostasis is essential to predict the risk of bleeding during surgery, to detect potential causes of hemorrhage in time, and to guide hemostatic therapy. The value of conventional coagulation test is questionable in the acute perioperative setting due to their long turnaround time and the inability to adequately reflect the complex changes in hemostasis in patients with liver disease. Viscoelastic coagulation tests provide simultaneous measurement of multiple aspects of whole-blood coagulation including plasmatic coagulation and fibrinolytic factors and inhibitors that reflect most aspects of hemostasis. Coagulation initiation, mechanical clot stability, and fibrinolysis can be estimated immediately using point-of-care techniques. Therefore, viscoelastic coagulation tests including ROTEM & TEG would be useful to guide patient blood management strategy during liver transplantation.
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Simioni, Paolo. "Classical and Point-of-Care tests in severe hemorrhage management." AboutOpen 9 (July 31, 2022): 47–51. http://dx.doi.org/10.33393/ao.2022.2433.
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Hemorrhage is defined as an acute loss of blood from the cardiovascular system. The hemostatic cascade (comprising the vasculature, coagulation factors, the fibrinolytic and the platelet systems) is the physiological mechanism meant to control this event. Coagulation assessment is fundamental in the monitoring and treatment of hemorrhage. Over the years several classical laboratory-based diagnostic tests have been developed for the management of severe hemorrhage, however their main downside is the time necessary to obtain a result, which can be significant (between 40 minutes and an hour) and therefore not be entirely representative of a fastchanging clinical picture. Based on this need of faster results, Point-of-Care tests have been developed and implemented, since they can represent a diagnostic tool that allows a reduction of the time interval before appropriate intervention. They rely on instruments able to determine blood clot formation in whole blood samples upon activation of coagulation with specific reagents, and activation of platelets upon exposure to different drugs. The present review proposes an overview of both the available Point-of-Care tests such as Thrombelastography, for the assessment of blood clot formation, Impedance Aggregometry, for the function of platelets, and those still under improvement or missing entirely.
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Vetrile, S. T., R. G. Zakharin', A. I. Bernakevich', S. A. Vasil'ev, A. A. Kuleshov, S. T. Vetrile, R. G. Zakharin, A. I. Bernakevich, S. A. Vasil'ev, and A. A. Kuleshov. "Coagulation Hemostasis in Surgical Treatment of Scoliosis." N.N. Priorov Journal of Traumatology and Orthopedics 10, no. 4 (December 15, 2003): 64–68. http://dx.doi.org/10.17816/vto200310464-68.
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In 95 patients, operated on for scoliosis, coagulation status was studied using standard tests (activated partial thromboplastin time, prothrombin decrease by Quick, normolized prothrombin ratio, antithrombin III, ethanol and orthophenothroline tests, ХП-a dependent fibrinolysis) pre-, intra- and postoperatively. It was shown that coagulation disturbances developed already during the hemodilution process. Consumption of coagulation factors took place during operation and at early postoperative period. Blood loss by drainage was marked during 48 hours after operation. Maximum changes of coagulation indices were registered on 2-5 day after operation. Use of fresh-frozen plasma, e-aminocaproic acid to decrease of blood grainage loss was grounded.
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Banković Radovanović, Patricija, Tanja Živković Mikulčić, and Jasmina Simović Medica. "Unexpected abnormal coagulation test results in a 2-year-old child." Biochemia medica 30, no. 1 (February 15, 2020): 158–63. http://dx.doi.org/10.11613/bm.2020.011002.
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Rejection of the sample with repeated blood withdrawal is always an unwanted consequence of sample nonconformity and preanalytical errors, especially in the most vulnerable population – children. Here is presented a case with unexpected abnormal coagulation test results in a 2-yearold child with no previously documented coagulation disorder. Child is planned for tympanostomy tubes removal under the anaesthesia driven procedure, and preoperative coagulation tests revealed prolonged prothrombin time, activated partial thromboplastin time and thrombin time, with fibrinogen and antithrombin within reference intervals. From the anamnestic and clinical data, congenital coagulation disorder was excluded, and with further investigation, sample mismatch, clot presence and accidental ingestion of oral anticoagulant, heparin contamination or vitamin K deficiency were excluded too. Due to suspected EDTA carryover during blood sampling another sample was taken the same day and all tests were performed again. The results for all tests were within reference intervals confirming EDTA effect on falsely prolongation of the coagulation times in the first sample. This case can serve as alert to avoid unnecessary loss in terms of blood withdrawal repetitions and discomfort of the patients and their relatives, tests repeating, prolonging medical procedures, and probably delaying diagnosis or proper medical treatment. It is the responsibility of the laboratory specialists to continuously educate laboratory staff and other phlebotomists on the correct blood collection as well as on its importance for the patient’s safety.
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Batarseh, Mahed, Jose Rafael Guzman-Sepulveda, Ruitao Wu, William M. DeCampli, and Aristide Dogariu. "Passive Coagulability Assay Based on Coherence-Gated Light Scattering." Hemato 1, no. 2 (October 20, 2020): 49–59. http://dx.doi.org/10.3390/hemato1020009.
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Coagulation monitoring relies on in vitro tests where the clot formation is induced using external stimuli. We report an optical method capable of revealing the propensity of coagulation based solely on the natural dynamics of erythrocytes in whole blood. In contrast to traditional techniques, our approach provides means to assess the blood coagulability without the need to chemically trigger the coagulation. Results of correlations with standard clinical methods suggest that this optical assay could be used for continuous management of blood coagulation during clinical procedures.
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Tanaka, Kenichi, and Daniel Bolliger. "Point-of-Care Coagulation Testing in Cardiac Surgery." Seminars in Thrombosis and Hemostasis 43, no. 04 (March 30, 2017): 386–96. http://dx.doi.org/10.1055/s-0037-1599153.
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AbstractBleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on coagulation intervention(s). The most common POC coagulation testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC coagulation testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.
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Oberhardt, Bruce J., Patrick D. Mize, and Cynthia G. Pritchard. "Point-of-care fibrinolytic tests: the other side of blood coagulation." Clinical Chemistry 43, no. 9 (September 1, 1997): 1697–702. http://dx.doi.org/10.1093/clinchem/43.9.1697.
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Abstract Point-of-care (POC) coagulation tests with paramagnetic iron oxide particles have provided alternatives to testing previously done only in the laboratory. With this technology, POC fibrinolytic tests have followed quietly the trail blazed by POC clotting tests and have found specific applications. These include rapid verification of in vivo thrombolytic drug action by in vitro testing with subsequent quantitative drug monitoring of the systemic lytic state, and also the determination of in vitro thrombolytic drug response before the drug is actually administered, to individualize therapy by selection of the most appropriate drug. Other applications include POC coagulation factor assays associated with fibrinolysis, and most recently the POC screening of patients with fibrinolytic defects. In this latter application, plasma from cardiac catheterization (n = 19) and venous thrombosis (n = 47) patient groups were tested. Controls consisted of two independent donor pools (n = 10, n = 21) as negatives and two plasma samples with known genetic defects in the fibrinogen molecule (Aα554 Arg → Cys) as positives.
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Alberts, Karl Akke, Ingrid Norén, Margareta Rubin, and Staffan Törngren. "Respiratory distress following major trauma: Predictive value of blood coagulation tests." Acta Orthopaedica Scandinavica 57, no. 2 (January 1986): 158–62. http://dx.doi.org/10.3109/17453678609000892.
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SAMAMA, M. "LOW DOSE HEPARIN IN GYNAECOLOGICAL SURGERY: EFFECT ON BLOOD COAGULATION TESTS." Scandinavian Journal of Haematology 24, S36 (April 24, 2009): 101–11. http://dx.doi.org/10.1111/j.1600-0609.1980.tb02518.x.
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Görög, P., and I. B. Kovacs. "Coagulation of flowing native blood: Advantages over stagnant (tube) clotting tests." Thrombosis Research 64, no. 5 (December 1991): 611–19. http://dx.doi.org/10.1016/s0049-3848(05)80010-6.
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Görög, P., and I. B. Kovacs. "Coagulation of flowing native blood: Advantages over stagnant (tube) clotting tests." Thrombosis Research 65, no. 5 (December 1991): 611–19. http://dx.doi.org/10.1016/0049-3848(91)90335-t.
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Wu, John K., Janet C. McGeer, and James E. Carter. "Central venous line blood sampling for coagulation tests in hemodialysis patients." Pediatric Nephrology 10, no. 1 (February 1996): 128. http://dx.doi.org/10.1007/bf00863466.
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Subbarayan, Devi, Chidambharam Choccalingam, and Chittode Kodumudi Anantha Lakshmi. "The Effects of Sample Transport by Pneumatic Tube System on Routine Hematology and Coagulation Tests." Advances in Hematology 2018 (July 2, 2018): 1–4. http://dx.doi.org/10.1155/2018/6940152.
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Background. Automation helps improve laboratory operational efficiency and reduce the turnaround time. Pneumatic tube systems (PTS) automate specimen transport between the lab and other areas of the hospital. Its effect on complete blood count (CBC) and coagulation is still controversial.Aim. To study the effects of pneumatic tube system sample transport on complete blood count and coagulation parameters to compare them with hand delivered samples.Methods. 75 paired samples for complete blood count and 25 paired samples for coagulation analysis were compared between samples sent via pneumatic tube system and hand delivered system.Results. PTS showed significant decrease in red cell indices such as MCV and RDW and increase in MCHC. Other red cell parameters and WBC parameters showed no statistical significant difference. Statistically significant increase in platelet count was observed with PTS samples. However, these differences were clinically insignificant. No significant effect of PTS was found in PT and APTT samples compared to the hand delivered samples.Conclusion. Despite statistically significant changes in RBC parameters such as MCV, RDW, and MCHC and platelet count, these changes were clinically insignificant. Hence, blood samples for CBC and coagulation assay can safely be transported via our hospital’s PTS. However, further studies on platelet count are warranted to ensure safe transport and accuracy of the results.
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Brahimi, Mohamed, Farah Bouamama, Assia Alem, Amel Mihoubi, and Mohamed Amine Bekadja. "Les examens de laboratoire en hématologie." Batna Journal of Medical Sciences (BJMS) 2, no. 2 (December 30, 2012): 172–76. http://dx.doi.org/10.48087/bjmstf.2015.2216.
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Complete blood cell count (CBC) and coagulation screening tests are the most performed laboratory tests. These two assays must be done systematically in various occasions since many blood disorders can be pauci or asymptomatic, and every illness may lead to their disturbance. For these reasons these tests are described in this paper. Nowadays, the majority of CBCs are performed using eighteen parameters automatic counters. For pedagogic reasons, this load of parameters is divided into three parts: red blood cells (RBCs), white blood cells (WBCs) and platelets parameters and the alteration of each of these later are highlighted hereafter. Standard coagulation assays (aPPT, PT, and fibrinogen) are described and the clinical approach explained in this monograph.
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Despotis, George J., J. Heinrich Joist, and Lawrence T. Goodnough. "Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes." Clinical Chemistry 43, no. 9 (September 1, 1997): 1684–96. http://dx.doi.org/10.1093/clinchem/43.9.1684.
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Abstract Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Strategies to optimize administration of heparin and protamine and the assessment of their effects on coagulation are evolving in cardiac surgical patients. Two recent evaluations have focused on the use of multiple point-of-care (POC) coagulation assays for patient-specific adjustment of heparin and protamine dosage. These studies indicate that blood loss and transfusion requirements in cardiac surgical patients may be reduced with more accurate control of heparin anticoagulation and its reversal. Blood component administration in patients with excessive post-CPB bleeding is generally empiric in part, related to turnaround times of laboratory-based tests. Methods are now available for rapid, POC assessment of coagulation to allow appropriate, targeted therapy for acquired hemostatic abnormalities. Recent studies indicate that a rapid evaluation of thrombocytopenia and coagulation factor deficiencies with POC tests can facilitate the optimal administration of pharmacologic and transfusion-based therapy in patients who exhibit excessive bleeding after CPB. POC tests that assess platelet function have been developed, and their use may facilitate identification of which patients at risk for excessive blood loss may respond to pharmacologic interventions such as desmopressin acetate or antifibrinolytic agents.
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Vlot, Eline A., Eric P. A. van Dongen, Laura M. Willemsen, Jur M. ten Berg, Christian M. Hackeng, Stephan A. Loer, and Peter G. Noordzij. "Association of Plasma Fibrinogen and Thromboelastography With Blood Loss in Complex Cardiac Surgery." Clinical and Applied Thrombosis/Hemostasis 27 (January 1, 2021): 107602962110165. http://dx.doi.org/10.1177/10760296211016541.
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Postoperative coagulopathic bleeding is common in cardiac surgery and is associated with increased morbidity and mortality. Ideally, real-time information on in-vivo coagulation should be available. However, up to now it is unclear which perioperative coagulation parameters can be used best to accurately identify patients at increased risk of bleeding. The present study analyzed the associations of perioperative fibrinogen concentrations and whole blood viscoelastic tests with postoperative bleeding in 89 patients undergoing combined cardiac surgery procedures. Postoperative bleeding was recorded until 24 hours after surgery. Regression analyses were performed to establish associations between blood loss and coagulation parameters after cardiopulmonary bypass including a prediction model with known confounding factors for bleeding. Coagulation tests show large changes over the perioperative course with the strongest coagulopathic deviations from baseline after cardiopulmonary bypass. After adjustment for multiple confounders, viscoelastic clot strength instead of fibrinogen concentration showed a similar performance for 24 hour blood loss and a better performance for 6 hour blood loss. This makes intraoperative viscoelastic testing a useful tool to strengthen early clinical decision-making with the potential to reduce perioperative blood transfusions.
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Weatherby, H., V. Woolner, L. Chartier, S. Casey, C. Ong, and E. Gaylord. "LO37: Reducing hemolysis of coagulation blood samples in the emergency department." CJEM 22, S1 (May 2020): S20. http://dx.doi.org/10.1017/cem.2020.92.
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Background: Hemolysis of blood samples is the leading cause of specimen rejection from hospital laboratories. It contributes to delays in patient care and disposition decisions. Coagulation tests (prothrombin time/international normalized ratio [PT/INR] and activated partial thromboplastin time [aPTT]) are especially problematic for hemolysis in our academic hospital, with at least one sample rejected daily from the emergency department (ED). Aim Statement: We aimed to decrease the monthly rate of hemolyzed coagulation blood samples sent from the ED from a rate of 2.9% (53/1,857) to the best practice benchmark of less than 2% by September 1st, 2019. Measures & Design: Our outcome measure was the rate of hemolyzed coagulation blood samples. Our process measure was the rate of coagulation blood tests sent per 100 ED visits. Our balancing measure was the number of incident reports by clinicians when expected coagulation testing did not occur. We used monthly data for our Statistical Process Control (SPC) charts, as well as Chi square and Mann-Whitney U tests for our before-and-after evaluation. Using the Model for Improvement to develop our project's framework, we used direct observation, broad stakeholder engagement, and process mapping to identify root causes. We enlisted nursing champions to develop our Plan-Do-Study-Act (PDSA) cycles/interventions: 1) educating nurses on hemolysis and coagulation testing; 2) redesigning the peripheral intravenous and blood work supply carts to encourage best practice; and 3) removing PT/INR and aPTT from automatic inclusion in our electronic chest pain bloodwork panel. Evaluation/Results: The average rate of hemolysis remained unchanged from baseline (2.9%, p = 0.83). The average rate of coagulation testing sent per 100 ED visits decreased from 41.5 to 28.8 (absolute decrease 12.7 per 100, p < 0.05), avoiding $4,277 in monthly laboratory costs. The SPC chart of our process measure showed special cause variation with greater than eight points below the centerline. Discussion/Impact: Our project reduced coagulation testing, without changing hemolysis rates. Buy-in from frontline nurses was integral to the project's early success, prior to implementing our electronic approach – a solution ranked higher on the hierarchy of intervention effectiveness – to help sustainability. This resource stewardship project will now be spread to a nearby institution by utilizing similar approaches.
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Uhrikova, I., P. Scheer, J. Hlozkova, P. Suchy Jr, and M. Sepsi. "Effects of acetylsalicylic acid on coagulation tests and haptoglobin concentrations in rabbits with permanent transvenous pacing." Veterinární Medicína 61, No. 9 (September 13, 2016): 528–32. http://dx.doi.org/10.17221/22/2016-vetmed.
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The aim of this study was to evaluate changes in coagulation tests, haptoglobin concentrations and leukocyte counts in rabbits with right-ventricle pacing medicated with acetylsalicylic acid (ASA). Blood was collected from 35 non-anaesthetised males from the jugular vein at baseline, one and two months after pacemaker implantation. Animals were divided into two groups: non-medicated and medicated with ASA. Total leukocyte and platelet counts were measured on an automatic veterinary flow cytometry haematological analyser. Prothrombin time, activated partial thromboplastin time, fibrinogen levels and D-dimers were determined from citrated blood. We found significantly elevated activated partial thromboplastin times and prothrombin times in ASA in comparison to the control group, but not within the ASA group over time. We also observed a decrease in platelet counts in the control group over time, but not in comparison to the ASA group. No significant changes in total leukocyte counts and haptoglobin concentrations were detected. Medication with ASA may alter coagulation profiles in rabbits with permanent transvenous pacing.
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Kumura, Takeo, Masayuki Hino, Takahisa Yamane, and Noriyuki Tatsumi. "Hirudin as an anticoagulant for both haematology and chemistry tests." Journal of Automated Methods and Management in Chemistry 22, no. 4 (2000): 109–12. http://dx.doi.org/10.1155/s1463924600000158.
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Hirudin, an extract from the leech, has powerful antithrombin activity affecting the blood coagulation pathway. We evaluated the usefulness of hirudin in anticoagulating specimens for routine laboratory tests. Results using blood anticoagulated with hirudin corresponded well with results with blood treated with ethylenediamine tetraacetic acid (EDTA) in the complete blood count (CBC), including white blood cell (WBC) differential count and morphology of blood cells, when CBC was performed within 2 h of blood collection. Clinical chemistry results from hirudin-treated samples were similar to results obtained with serum specimens. Thus, hirudin may be a useful anticoagulant for emergency laboratory medicine.
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Zhou, Min, Xiaobo Luo, Qing Zhang, Xiaolan Yang, Xiaojing Li, and Renchi Yang. "Age-Associated Changes of Coagulation Test and Coagulation Factor Activities in Healthy Chinese Children." Blood 134, Supplement_1 (November 13, 2019): 4924. http://dx.doi.org/10.1182/blood-2019-123175.
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Background: The concept of developmental hemostasis has been universally accepted. Plasma concentrations of many coagulation factors in childhood are significantly different from adults for both mean values and ranges of normal. Thus, an understanding of developmental hemostasis and the development of appropriate age-dependent reference ranges are pivotal for prevention, diagnosis, and treatment of hemostatic problems during childhood. However, no data of developmental hemostasis are available in healthy Chinese children. Methods: Coagulation data from children aged 0-18 years old receiving minor elective surgery in Chengdu Women and Children's Central Hospital, from Sep. 2017 to Feb. 2019 was collected, and patient medical records were reviewed. Ethical approval was obtained from the parents of all children and the study was approved by the Ethics Review Committee at Chengdu Women and Children's Central Hospital. To qualify for the study, enrolled subjects had to meet the following criteria: (1) Children aged 0-18 years receiving minor elective surgery.(2) No history of bleeding problems.(3)No family history of bleeding nor thrombosis .(4) No history of heart, lung, liver or kidney diseases, normal physical examination. (5) Normal blood routine test. Normal liver function and kidney function, (6)No history of medication use for at least two weeks prior to specimen collection.(7) The operation gone successfully, and postoperative recovery was well. Blood samples (3 mL) were obtained by venipuncture into plastic tube containing 3.2% (109 mmol/L) buffered sodium citrate (1 part citrate:9 parts blood). The specimens were centrifuged immediately at 2500 g for 15 min at room temperature to prepare platelet-poor plasma (PPP) for the preoperative coagulation screening tests, consisting of activated partial thromboplastin time (APTT), prothrombin time (PT)), international normalized ratio (INR), thrombin time (TT) and fibrinogen. Activity of coagulation factors VIII, IX, XI, XII,Ⅱ,Ⅴ,Ⅶ,Ⅹ were determined using one-stage clotting methods with respective factor-deficient plasma. Results: A total of 82 samples were collected, while only 67 met the enrollment criteria. Specimens with inappropriate ratio of blood to anticoagulant, hemolysis or abnormal values of coagulation tests (APTT, PT, TT, fibrinogen) were excluded from analysis. The total of 67 children (40 Male 27 female), with a median age of 2.0 years (range: 1month -14 years) were divided into three groups according to the age: <1y group 15 cases, 1-5y group 45 cases, and >6y group 7cases. (1) The values of APTT, PT, TT, and fibrinogen were (36.1±5.2) seconds, (11.1±0.85) seconds, (20.3±1.6) seconds, (2.4±0.89) g/L respectively. No significant differences were found between groups. (2) In all children ,the activities of factor VIII、IX、XI、XII、vWF、II、V、VII、X were(123.6±48.3)%、(75.9±16.9)%、(95.9±24.3)%、(43.7±16.3)%、(111.3±50.4)%、(90.2±14.0)%、(104.7±21.1)%、(81.6±19.1)%、(93.0±21.8)% respectively. Factor VIII and vWF activities were significantly higher than other factors, while factor XII activities were significantly lower than others. (3)Mean values of FII:C, FVIII:C, FIX:C, FXI:C were significantly lower in children below <1year old group than those in 1-5y group. No significant difference were seen in FVII:C, FV:C, FX:C, FXII:C, vWF:C among three groups. Conclusions: Coagulation test is just a simple and easy screening test. Coagulation factor activities changed dynamically with age during childhood, especially the FII:C, FVIII:C, FIX:C and FXI:C. Physiological reference ranges for coagulation factor activities in Chinese children of different ages should be established in order to evaluate the children with congenital or acquired bleeding diseases correctively. Table Disclosures No relevant conflicts of interest to declare.
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Helmond, Noud van, Blair D. Johnson, Timothy B. Curry, Andrew P. Cap, Victor A. Convertino, and Michael J. Joyner. "Coagulation changes during lower body negative pressure and blood loss in humans." American Journal of Physiology-Heart and Circulatory Physiology 309, no. 9 (November 2015): H1591—H1597. http://dx.doi.org/10.1152/ajpheart.00435.2015.
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We tested the hypothesis that markers of coagulation activation are greater during lower body negative pressure (LBNP) than those obtained during blood loss (BL). We assessed coagulation using both standard clinical tests and thrombelastography (TEG) in 12 men who performed a LBNP and BL protocol in a randomized order. LBNP consisted of 5-min stages at 0, −15, −30, and −45 mmHg of suction. BL included 5 min at baseline and following three stages of 333 ml of blood removal (up to 1,000 ml total). Arterial blood draws were performed at baseline and after the last stage of each protocol. We found that LBNP to −45 mmHg is a greater central hypovolemic stimulus versus BL; therefore, the coagulation markers were plotted against central venous pressure (CVP) to obtain stimulus-response relationships using the linear regression line slopes for both protocols. Paired t-tests were used to determine whether the slopes of these regression lines fell on similar trajectories for each protocol. Mean regression line slopes for coagulation markers versus CVP fell on similar trajectories during both protocols, except for TEG α° angle (−0.42 ± 0.96 during LBNP vs. −2.41 ± 1.13°/mmHg during BL; P < 0.05). During both LBNP and BL, coagulation was accelerated as evidenced by shortened R-times (LBNP, 9.9 ± 2.4 to 6.2 ± 1.1; BL, 8.7 ± 1.3 to 6.4 ± 0.4 min; both P < 0.05). Our results indicate that LBNP models the general changes in coagulation markers observed during BL.
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Kim, Jinju, Yejin Song, Hyun-Jeong Kim, Mi-Sook Yang, and Jaewoo Song. "Relative Interfering Effects of In Vivo Direct Oral Anticoagulants on Routine Coagulation Tests." Blood 138, Supplement 1 (November 5, 2021): 4238. http://dx.doi.org/10.1182/blood-2021-152088.
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Abstract Background: The interfering effects of DOACs on the screening coagulation tests, such as prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen assay, have been shown mainly by in vitro spiking experiments. However, the effects of DOACs on coagulation tests in real-world samples from anticoagulated patients are unknown because of the difficulty in selectively eliminating DOAC from blood samples already containing DOACs. Method: Citrated blood samples were drawn from patients on anticoagulation therapy (rivaroxaban and edoxaban). In addition, blood samples from patients not on anticoagulation were collected. PT INR and APTT were measured from those samples by coagulometers from two manufacturers (Roche t711, Swiss and ACL-TOP, USA). We also measured DOAC levels from the same samples by anti-FXa activity (Hyphen Biomed, France). Then, we compared the test results in relation to the DOAC levels. Results: The PT INR, APTT, and fibrinogen assay results from non-anticoagulated patients measured by the two coagulometers were comparable (PT INR: y = -3.353 + 1.029 x; APTT: y = -6.276 + 1.101x; fibrinogen: y = -3.353 + 1.029 x; Passing Bablok). We included blood samples from 61 patients on rivaroxaban and 75 patients on edoxaban. From the rivaroxaban samples we observed the regression line change for PT INR (y = 0.6303 + 0.3712x) and for APTT (y = -10.71+1.358x). The comparability of fibrinogen assay was not affected significantly (y = -17.39+1.01x). From the edoxaban samples we also observed the similar change of the regression line (PT INR: y = 0.4728 + 0.5661x; APTT: y = -133.07+2.014x). Fibrinogen levels were comparable (y = -28.95+1.082x). Conclusion: The susceptibility of screening coagulation tests to the interfering effects of in vivo DOAC is dependent on the reagents and coagulometers. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Fries, D. "Coagulation management in massive transfusion." Hämostaseologie 26, S 02 (2006): S15—S20. http://dx.doi.org/10.1055/s-0037-1617077.
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SummaryWhen no fresh frozen plasma is available, acute major blood loss is compensated above all with crystalloids, colloids and red blood cell concentrates, meaning that all plasma clotting factors are diluted. So far, consumption coagulopathy is almost always accompanied by dilutional coagulopathy. Formulas for calculating critical blood loss and standard coagulation tests are often not helpful in the case of massive transfusion. On the other hand, systems suitable for point of care, such as thrombelastography, have important advantages. In the case of consumption and dilutional coagulopathy plasma coagulation is disturbed and critical values are first seen for fibrinogen. Not only is fibrin polymerization impaired by the bleeding-induced loss and dilution of fibrinogen, but also by interaction with artificial colloids, particularly hydroxyethyl starch and gelatin preparations. Neither fresh frozen plasma therapy nor treatment with clotting factor concentrates has been the subject of detailed clinical study. Large scaled studies are needed to work out guidelines for coagulation management in the case of massive blood loss.
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Aronniemi, Johanna, Satu Långström, Katariina A. Mattila, Anne Mäkipernaa, Päivi Salminen, Anne Pitkäranta, Johanna Pekkola, and Riitta Lassila. "Venous Malformations and Blood Coagulation in Children." Children 8, no. 4 (April 20, 2021): 312. http://dx.doi.org/10.3390/children8040312.
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Introduction: Venous malformations (VMs) are congenital low-flow lesions with a wide spectrum of clinical manifestations. An increasing number of studies link VMs to coagulation abnormalities, especially to elevated D-dimer and decreased fibrinogen. This condition, termed localized intravascular coagulopathy (LIC), may pose a risk for hemostatic complications. However, detailed data on the laboratory variables for coagulation and fibrinolytic activity in VM patients are limited. We addressed this question by systematically analyzing the coagulation parameters in pediatric VM patients. Methods: We included 62 patients (median age 11.9 years) with detailed laboratory tests for coagulation and fibrinolytic activity at a clinically steady phase. We assessed clinical and imaging features of VMs and their correlations with coagulation and fibrinolysis variables using patient records and MRI. Results: D-dimer was elevated in 39% and FXIII decreased in 20% of the patients, as a sign of LIC. Elevated D-dimer and decreased FXIII were associated with large size, deep location, and diffuse and multifocal VMs. FVIII was elevated in 17% of the patients and was associated with small VM size, superficial and confined location, discrete morphology, and less pain. Surprisingly, antithrombin was elevated in 55% of the patients but without associations with clinical or other laboratory variables. Conclusions: LIC was common in pediatric patients with VMs. Our results provide a basis for when evaluating the risks of hemostatic complications in children with VMs. Further research is warranted to explore the mechanisms behind coagulation disturbances and their relation to clinical complications.
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Kunz, F., C. Pechlaner, M. Tabarelli, E. Solder, and W.-D. Zwierzina. "Influence of oral contraceptives on coagulation tests in native blood and plasma." International Journal of Gynecology & Obstetrics 35, no. 1 (May 1991): 89. http://dx.doi.org/10.1016/0020-7292(91)90071-c.
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Kunz, Friedebert, Christoph Pechlaner, Marco Tabarelli, Elisabeth Solder, and Wolf-Dieter Zwierzina. "Influence of oral contraceptives on coagulation tests in native blood and plasma." American Journal of Obstetrics and Gynecology 163, no. 1 (July 1990): 417–20. http://dx.doi.org/10.1016/0002-9378(90)90593-v.
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Bercovitz, Rachel Sara. "An introduction to point-of-care testing in extracorporeal circulation and LVADs." Hematology 2018, no. 1 (November 30, 2018): 516–21. http://dx.doi.org/10.1182/asheducation-2018.1.516.
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Abstract There is a delicate balance between bleeding and clotting in patients on circuits such as ventricular assist devices or extracorporeal membrane oxygenation. Traditional coagulation tests, prothrombin time, activated partial thromboplastin time, and anti-factor Xa levels, are used to monitor patients on these devices. However, turnaround times and inability to assess global hemostasis, including platelets and fibrinogen have contributed to a recognition that faster, accurate, and more informative coagulation tests are needed. Activated clotting time is used to monitor heparin in patients on circuits and has the advantages of being a near-patient point-of-care test. However, its utility is limited to heparin monitoring. Viscoelastic tests (thromboelastometry and thromboelastography) are global, whole-blood coagulation tests, and whole-blood platelet aggregometry evaluates platelet function. Ideally, these tests can ensure that patients are within the therapeutic range of their antithrombotic medications, identify patients at risk for hemorrhagic or thrombotic complications, and guide management of acute bleeding complications. This ideal is currently hampered by a lack of studies that delineate clear ranges that are clinically relevant. Future research is needed to better understand the optimal use of point-of-care coagulation testing in patients on extracorporeal circuits and ventricular assist devices.
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Wedasingha, Supun, Geoffrey Isbister, and Anjana Silva. "Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite." Toxins 12, no. 9 (September 10, 2020): 583. http://dx.doi.org/10.3390/toxins12090583.
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Venom-induced consumption coagulopathy is the most important systemic effect of snake envenoming. Coagulation tests are helpful to accurately and promptly diagnose venom-induced consumption coagulopathy and administer antivenom, which is the only specific treatment available. However, bedside clotting tests play a major role in diagnosing coagulopathy in low-income settings, where the majority of snakebites occur. We conducted a literature search in MEDLINE® from 1946 to 30 November 2019, looking for research articles describing clinical studies on bedside coagulation tests in snakebite patients. Out of 442 articles identified, 147 articles describing bedside clotting assays were included in the review. Three main bedside clotting tests were identified, namely the Lee–White clotting test, 20-min whole blood clotting time and venous clotting time. Although the original Lee–White clotting test has never been validated for snake envenoming, a recently validated version has been used in some South American countries. The 20-min whole blood clotting time test is the most commonly used test in a wide range of settings and for taxonomically diverse snake species. Venous clotting time is almost exclusively used in Thailand. Many validation studies have methodological limitations, including small sample size, lack of case-authentication, the inclusion of a heterogeneous mix of snakebites and inappropriate uses of gold standard tests. The observation times for bedside clotting tests were arbitrary, without proper scientific justification. Future research needs to focus on improving the existing 20-min whole blood clotting test, and also on looking for alternative bedside coagulation tests which are cheap, reliable and quicker.
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Wiegand, Cornelia, Martin Abel, Uta-Christina Hipler, Peter Elsner, Michael Zieger, Julia Kurz, Hans P. Wendel, and Sandra Stoppelkamp. "Hemostatic wound dressings: Predicting their effects by in vitro tests." Journal of Biomaterials Applications 33, no. 9 (February 21, 2019): 1285–97. http://dx.doi.org/10.1177/0885328219831095.
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Background Application of controlled in vitro techniques can be used as a screening tool for the development of new hemostatic agents allowing quantitative assessment of overall hemostatic potential. Materials and methods Several tests were selected to evaluate the efficacy of cotton gauze, collagen, and oxidized regenerated cellulose for enhancing blood clotting, coagulation, and platelet activation. Results Visual inspection of dressings after blood contact proved the formation of blood clots. Scanning electron microscopy demonstrated the adsorption of blood cells and plasma proteins. Significantly enhanced blood clot formation was observed for collagen together with β-thromboglobulin increase and platelet count reduction. Oxidized regenerated cellulose demonstrated slower clotting rates not yielding any thrombin generation; yet, led to significantly increased thrombin-anti-thrombin-III complex levels compared to the other dressings. As hemostyptica ought to function without triggering any adverse events, induction of hemolysis, instigation of inflammatory reactions, and initiation of the innate complement system were also tested. Here, cotton gauze provoked high PMN elastase and elevated SC5b-9 concentrations. Conclusions A range of tests for desired and undesired effects of materials need to be combined to gain some degree of predictability of the in vivo situation. Collagen-based dressings demonstrated the highest hemostyptic properties with lowest adverse reactions whereas gauze did not induce high coagulation activation but rather activated leukocytes and complement.
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Marsden, Nicholas J., Martin Van, Samera Dean, Ernest A. Azzopardi, Sarah Hemington-Gorse, Phillip A. Evans, and Iain S. Whitaker. "Measuring coagulation in burns: an evidence-based systematic review." Scars, Burns & Healing 3 (January 1, 2017): 205951311772820. http://dx.doi.org/10.1177/2059513117728201.
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Introduction: Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based. Objectives: Establishing the role of different coagulation markers in burn patients, diagnosing coagulopathy, tailoring blood product administration and indicating prognosis. Methods: Literature during 2004–2017 from the Cochrane Library, PubMed, Scopus, Medline and Embase was reviewed. Eligibility criteria included randomised controlled trials, systematic reviews, multi-/single-centre study and meta-analyses. Keywords searched were ‘burns’, ‘blood coagulation disorders’, ‘rotem’, ‘blood coagulation’ and ‘thromboelastography’. The PRISMA flow system was used for stratification and the CASP framework for appraisal of the studies retrieved. Results: In total, 13 articles were included after inclusion/exclusion criteria had been applied to the initial 79 studies retrieved. Hypercoagulation increases in proportion to the severity of thermal injury. Whole blood testing, using thrombelastography (TEG) and rotation thromboelastometry (ROTEM), was superior to standard plasma based tests, including prothrombin time (PT) and activated partial thromboplastin time (APTT) at detecting burn-related coagulopathies. Conclusions: Routine laboratory markers such as PT/APTT are poor indicators of coagulation status in burns patients. Viscoelastic tests, such as TEG and ROTEM, are efficient, fast and have a potential use in the management of burn patients; however, strong evidence is lacking. This review highlights the need for more randomised controlled trials, to guide future practice.
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Yazar, Hayrullah, Fatma Özdemir, and Elif Köse. "Effect of Centrifuge Temperature on Routine Coagulation Tests." Acta Haematologica 139, no. 3 (2018): 158–63. http://dx.doi.org/10.1159/000486271.
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Background: This study investigated the effects of cooled and standard centrifuges on the results of coagulation tests to examine the effects of centrifugation temperature. Methods: Equal-volume blood samples from each patient were collected at the same time intervals and subjected to standard (25°C) and cooled centrifugation (2–4°C). Subsequently, the prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer values were determined in runs with the same lot numbers in the same coagulation device using the Dia-PT R (PT and INR), Dia-PTT-liquid (aPTT), Dia-FIB (fibrinogen), and Dia-D-dimer kits, respectively. Results: The study enrolled 771 participants. The PT was significantly (p < 0.018) higher in participants on anticoagulant therapy. The respective median values of the test parameters determined using the standard and cooled centrifuges were as follows: PT 10.30 versus 10.50 s; PT (INR) 1.04 versus 1.09 s; APTT 28.90 versus 29.40 s; fibrinogen 321.5 versus 322.1 mg/dL; and D-dimer 179.5 versus 168.7 µg FEU/mL. There were significant differences (p < 0.001) in the parameters between the values obtained with the standard and cooled centrifuges. Conclusions: Centrifuge temperature can have a significant effect on the results of coagulation tests. However, broad and specific disease-based studies are needed.
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Sweeney, D., and V. Williams. "The Effect of Halothane General Anaesthesia on Platelet Function." Anaesthesia and Intensive Care 15, no. 3 (August 1987): 278–81. http://dx.doi.org/10.1177/0310057x8701500306.
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Major craniofacial surgery has the potential for very large blood loss, frequently greater than one blood volume. In order that an assessment could be made of any deficiencies of platelet function or coagulation, tests were performed at intervals during the operation. None of the coagulation parameters showed variation below normal limits during the operation, but in vitro platelet aggregation showed significant decreases to several agonists.
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Janko, Natasha, Ammar Majeed, William Kemp, and Stuart K. Roberts. "Viscoelastic Tests as Point-of-Care Tests in the Assessment and Management of Bleeding and Thrombosis in Liver Disease." Seminars in Thrombosis and Hemostasis 46, no. 06 (September 2020): 704–15. http://dx.doi.org/10.1055/s-0040-1715475.
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AbstractViscoelastic point-of-care (VET POC) tests provide a global assessment of hemostasis and have an increasing role in the management of bleeding and blood component delivery across several clinical settings. VET POC tests have a rapid turnaround time, provide a better overall picture of hemostasis, predict bleeding more accurately than conventional coagulation tests, and reduce blood component usage and health care costs. Despite commonly having abnormal conventional coagulation tests, most patients with chronic liver disease have a “rebalanced” hemostasis. However, this hemostatic balance is delicate and these patients are predisposed to both bleeding and thromboembolic events. Over recent years, VET POC tests have been increasingly studied for their potential as better functional tests of hemostasis in liver disease patients. This review provides a background on the most common VET POC tests (thromboelastography and rotational thromboelastometry) and discusses the current evidence for these tests in the prediction and management of bleeding and thrombosis in patients with chronic liver disease, and in liver resection and transplant. With the recent publication of several randomized controlled trials, there is growing evidence that VET POC tests may be used to improve bleeding risk assessment and reduce blood product use in liver disease patients outside of the transplant setting. However, consensus is still lacking regarding the VET POC tests' thresholds that should be used to trigger blood product transfusion. VET POC tests also show promise in predicting thrombosis in patients with liver disease, but further research is needed before they can be used to guide anticoagulant therapy.