Perioperative blood management of a patient with coagulation factor Ⅴ deficiency and literature review / 中国输血杂志

【Objective】 To explore the perioperative blood management in patients with pancreatic pseudocyst combiend with coagulation factor Ⅴ(FⅤ) deficiency. 【Methods】 Preoperative: In order to determine the effect of cryoprecipitated antihemophilic factor and fresh frozen plasma (FFP) on the elevation level of factor Ⅴ, we alternately infused cryoprecipitate and FFP in the resting state. TEG, coagulation function and coagulation factor activity were monitored before and 1 h, 24 h and 48 h after infusion, and intraoperative and postoperative blood transfusion strategies were formulated. FFP 600 mL and cryoprecipitate 10 U were supplemented preoperatively. Intraoperative: The operation procedure was performed for 7 hours with an infusion of 600 mL FFP without significant bleeding. Postoperative: FFP was infused. 【Results】 Preoperative: The coagulation factor Ⅴ activity on pre-operation was 1.9% and 1.8%. After alternating infusion cryoprecipitate 10 U and FFP 1 200 mL, the FⅤactivity increased to 5.1% and 6.0%, respectively. There was no significant difference in TEG parameters, PT and ATPP results were decreased to varying degrees. Intraoperative: The operation was successful without obvious bleeding. Postoperative: FFP 500 mL was infused 2 h after operation, and FFP 250-500 mL was injected daily from 1 to 7 days after surgery. No significant bleeding was observed in the wound, the results of TEG, PT, APTT and hemoglobin (Hb) did not change significantly compared with those before surgery. The patient was discharged successfully 12 days after surgery. The genetic test results showed that he had inherited coagulation factor Ⅴ deficiency, which was a compound heterozygous variation. 【Conclusion】 Perioperative blood management in patients with FⅤ deficiency combined with surgical disease, requiring pre-transfusion evaluation and post-transfusion evaluation in combination with laboratory investigations and clinical manifestations, cryoprecipitate and fresh frozen plasma can be effective in supplementing coagulation factors. The TEG seems to be better than the Seven items of coagulation function in judging the clotting status of patients with FⅤ deficiency.

Application of thrombelastogram in blood transfusion for patients in early stage of severe trauma / 中国输血杂志

【Objective】 To explore the value of thrombelastogram(TEG) on monitoring the coagulation function and guiding blood transfusion in admitted patients in early stage of severe trauma. 【Methods】 A total of 96 patients in early stage of severe trauma were selected from Ezhou Central Hospital, and were divided into two groups using a random number table method, with 48 patients in each group. The control group was guided by four routine coagulation tests for blood transfusion, while the observation group was guided by TEG.The detection rate of trauma-induced coagulopathy, detection duration, blood infusion volume within 24 hours of admission, coagulation index levels at different time points after blood transfusion, length of hospital stay, ICU stay, and mortality rate between the two groups were compared. 【Results】 The detection rate of trauma-induced coagulopathy was 72.9% in the control group and 93.8% in the observation group(P<0.05). The transfusion volume of fresh frozen plasma (U) and red blood cell (U) in the observation group within 24 hours of admission were significantly lower than those in the control group, which were (35.13±4.75) vs (45.17±6.54), (5.19±1.41) vs (7.08±1.32) (P<0.05); the tranfusion volume of cryoprecipitate (U) and the rate of platelet transfusion in the observation group were significantly higher than those in the control group, which were (36.78±2.49) vs (24.84±3.92), 79.2% vs 22.9%(P<0.05). The APTT(s), PT(s), TT(s), R(min), and K(min) in the observation group 8 hours after blood transfusion were significantly lower than those in the control group, which were (58.16±10.39) vs (70.83±14.99), (15.44±3.22) vs (17.32±2.89), (21.39±4.51) vs (25.18±4.73), (13.03±3.29) vs (14.95±4.57), and (8.07±3.65) vs (10.54±5.14) (P<0.05), while FIB(g/L), MA(mm), α(°), and Plt (×109/L) were higher than those in the control group, which were (2.02±0.46) vs (1.09±0.27), (35.56±11.88) vs (29.57±9.25), (40.07±13.34) vs (27.23±10.87), and (135.87±59.13) vs (108.17±52.08) (P<0.05). 【Conclusion】 TEG can help monitoring the coagulation function in patients in early stage of severe trauma and guide the blood transfusion.

Relationship between the incidence of acute kidney injury and postoperative changes of coagulation function in adult recipients after liver transplantation / 器官移植

Objective To evaluate the effect of coagulation function changes on the incidence of acute kidney injury (AKI) after liver transplantation. Methods Clinical data of 245 liver transplant recipients who met the inclusion and exclusion criteria were retrospectively analyzed. According to the incidence of AKI after liver transplantation, all recipients were divided into the AKI group (n=99) and non-AKI group (n=146). The incidence of AKI after liver transplantation was summarized. Perioperative parameters of the recipients were collected. The risk factors of AKI after liver transplantation were assessed by univariate and multivariate analysis. Results Among 245 recipients undergoing liver transplantation, 99 cases developed AKI after operation with an incidence rate of 40.4%. Preoperative serum creatinine levels of the recipients and the in-hospital fatality were relatively high in the AKI group (all P < 0.05). Compared with the recipients in the non-AKI group, those in the AKI group presented with significantly higher liver function parameters within postoperative 24 h, significantly decreased levels of stage Ⅱ coagulation parameters including coagulation factorsⅤ, Ⅶ, Ⅸ, Ⅹ, Ⅻ and protein S, protein C and antithrombin Ⅲ, evidently elevated prothrombin time international normalized ratio (PT-INR), remarkably increased stage Ⅲ coagulation parameters including D-dimer and fibrin degradation product (FDP) levels and considerably decreased fibrinogen (FIB) level (all P < 0.05). Thrombelastogram showed that the R value was increased, the α angle was decreased and the coagulation time was prolonged in the AKI group (all P < 0.05). Logistic regression analysis demonstrated that the increased R value of postoperative thrombelastogram [odd ratio (OR) 1.116, 95% confidence interval (CI) 1.018-1.223, P=0.019], and decreased levels of antithrombin Ⅲ (OR 0.974, 95%CI 0.955-0.993, P=0.007) were the independent risk factors of incidence of AKI after liver transplantation. Conclusions The incidence of AKI after liver transplantation is high, which is associated with the coagulation function changes of the recipients. Decreased coagulation factor activity (increased R value) and declined antithrombin Ⅲ level are the independent risk factors of AKI in liver transplantat recipients.

Analysis of guiding value and effect of TEG in clinical application of cryoprecipitation / 中国输血杂志

【Objective】 To retrospectively analyze the guiding significance and effect of thromboelogram (TEG) in the clinical use of cryoprecipitation. 【Methods】 A total of 289 patients with fibrinogen reduction, admitted to our hospital between January 2018 and December 2021, were collected. They was divided into control group (using coagulation examination and clinical feature as the transfusion criteria) and observation group (above parameters plus TEG). The TEG index in the observation group before and after transfusion and Fg, APTT, PT, and TT in 2 groups of patients before and after transfusion were monitored. The efficacy and prognosis of different blood products and cryoprecipitate were compared between 2 groups of patients.) 【Results】 The efficacy of choprecipitate transfusion was better in the observation group than the control[Fg index after transfusion (g / L) 1.92±0.92 vs 1.80±1.00, P<0.05]. And less blood products were used in observation group as compared with the control[ RBC(U) 1.93±2.69 vs 2.81±3.25 (P<0.05); FFP(mL) 667±378 vs 879±455(P<0.05)]. No differences were noticed by hospital stay between the two groups, but the prognosis in the observed group was significantly better than that in the control. 【Conclusion】 It’s scientific and reasonable to apply TEG to guide the clinical transfusion of cryoprecipitate, so as to save blood resources and improve the prognosis.

Coagulation functions in a large-dose blood loss/transfusion model by different protocols in vitro / 中国输血杂志

【Objective】 To evaluate common laboratory items in a large-dose blood loss model in vitro using thromboelastogram (TEG), to provide a reasonable infusion solution for clinical massive transfusions. 【Methods】 On March 2nd, 2017, eight healthy blood donors who participated in voluntary blood donation in the Department of Blood Transfusion Medicine of the First Medical Center of the PLA General Hospital were selected to undergo phlebotomy, and an in vitro dilution model of massive blood loss was established based on the previous research, namely Model 1 (M1, given massive transfusion protocol) and Model 2 (M2, given packed red blood cells and plasma) were established. Then blood routine, routine coagulation function, clotting factor activity, TEG of each model were tested. 【Results】 The platelet count in the M1 model was 61.00±10.24 (×109/L), and reduced to 28.83±10.36(×109/L) in M2 (P<0.01). The MA value (mm) of two groups detected by TEG was 29.35±2.37 vs 20.53± 2.76 (P<0.01). In M1 and M2 model, The activities of primary clotting factors respectively decreased to about 40% and 30% to original in M1 and M2. The R value of TEG prolonged to (6.32±0.85) min and (7.27±0.63) min respectively, still within the normal range(baseline 4.97±1.04). The fibrinogen concentration in the M1 and M2 model decreased to (1.10±0.08) g/L and (0.81±0.10) g/L(P<0.01), which had the same variation tendency to Alpha angle of TEG (25.65±4.95 vs 16.63±3.94, P>0.05). 【Conclusion】 MTP with blood components supplemented such as platelet and cryoprecipitate in time has effectively improved the Plt and Fib in vitro large-dose blood loss/transfusion model.

Prognostic analysis of critically ill patients with coagulation dysfunction by thrombelastogram and coagulation 4 items combined APACHEⅡ score / 中国输血杂志

【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (PP4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.

TEG evaluation and blood transfusion prediction model for patients with upper gastrointestinal bleeding / 中国输血杂志

【Objective】 To establish a blood transfusion outcome prediction model for comprehensivel evaluation of coagulation function of patients with upper gastrointestinal bleeding by thrombelastogram (TEG) and blood coagulation indicators. 【Methods】 The data of 101 patients with upper gastrointestinal hemorrhage, admitted to the Department of Gastroenterology of Zhejiang Provincial People′s Hospital and its Chun′an Branch from June 2018 to June 2021, were collected through Tongshuo blood transfusion management system and His system. Those patients were divided into blood transfusion group (n=56) and non-transfusion group (n=45), and into cirrhosis group (n=74) and non-cirrhosis group (n=27), and 40 patients, with non-upper gastrointestinal bleeding, were enrolled as the control. The results of TEG indicators (R, K, α, MA), coagulation function (PT, INR, APTT, TT, Fib), blood routine (Hb, Plt, WBC, NEUT%) and biochemical detection(Alb, SCr, ALT, AST, GGT) before transfusion were compared between groups and the correlation between TEG indicators and traditional coagulation parameters was analyzed. Single-factor and multi-factor analysis were used to screen blood transfusion-related factors to establish a predictive model. 【Results】 The comparisons of paremeters between transfusion and non-transfusion group were as follows, K (min), α (°), and MA (mm) was 3.86±3.12 vs 2.50±1.47, 54.00±14.08 vs 61.05±10.88, and 51.12±13.37 vs 58.26±11.08, respectively (P<0.01); PT (s) and Fib (g) was 16.36±7.45 vs 13.44±1.50 and 1.59±0.87 vs 2.35±1.09 (P<0.01); NEUT% and Hb (g/L) was 0.75 ±0.13 vs 0.66±0.15 and 68.04±14.49 vs 100.73±22.92 (P<0.01); Alb (g/L) and SCr (nmol/L) was 29.73±6.08 vs 33.73±7.19 and 99.50±53.55 vs 76.25±19.28 (P<0.01). Correlation analysis showed that APTT was positively correlated with R and K values, and negatively correlated with α and MA. Fib was negatively correlated with K values, and positively correlated with α and MA. Plt was negatively correlated with K values, and positively correlated with α and MA (P<0.01). Eight pre-transfusion indicators as K, MA, PT, Fib, NEUT%, Hb, Alb, and SCr were subjected to Logistic regression to establish a blood transfusion prediction model. The optimal ROC curve of blood transfusion threshold (blood transfusion predictive value of patients), sensitivity, specificity and AUC were 0.448, 92.9%, 88.9%, and 0.969, respectively. 【Conclusion】 The establishment of Logistic regression model by integrating detection indicators of TEG, coagulation function, blood routine and biochemistry in patients with upper gastrointestinal bleeding have showed significant correlation with blood transfusion prediction, and good clinical practicability.

Predictive value of thrombelastogram on venous thromboembolism in elderly patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the predictive value of thrombelastogram (TEG) on venous thromboembolism in elderly patients undergoing cardiac surgery. Methods    A total of 64 patients with venous thromboembolism after cardiac surgery in our hospital from March 2014 to March 2018 were selected as a pathogenesis group, including 38 males and 26 females, aged 61-73 (67.3±5.8) years. And 158 patients without venous thromboembolism who underwent cardiac surgery during the same period were selected as a control group, including 82 males and 76 females, aged 59-75 (65.9±7.1) years. Routine coagulation parameters such as plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and various indicators of TEG were measured in two groups. The correlation analysis was performed on the obtained results, and the specificity and sensitivity of conventional coagulation indicators and TEG indicators for venous thromboembolism were analyzed and compared. Results    There were significant differences between the two groups in routine coagulation parameters and TEG (P<0.05). The area under the receiver operating characteristic (ROC) curve for each indicator was >0.5, which was of diagnostic significance. When the sensitivity>90%, the highest specificity value was also selected. The sensitivity and specificity of each indicator of TEG were greater than those of conventional coagulation indicators. The reaction time (R) was positively correlated with APTT in all indicators of TEG, and coagulation speed (K) was negatively correlated with Fib and PLT. Maximum thrombus intensity (MA) and Angle were positively correlated with Fib and PLT (all P<0.05). There was no correlation between TEG indicators and D-D. Conclusion    The TEG has higher predictive value for postoperative venous thromboembolism in elderly patients undergoing cardiac surgery than conventional coagulation tests. However, D-D level tests have unique diagnostic value in the diagnosis of venous thromboembolism.

Correlation study between platelet function and immune parameters in septic patients / 中国综合临床

Objective To explore the correlation between platelet function and immunity index in patients with sepsis. Methods The platelet function and immune indexes of one hundred and one patients with sepsis treated in Shanxi Dayi Hospital from July 1st, 2016 to October 31st, 2017 were analyzed retrospectively. According to their shock,they were divided into shock group (34 cases) and non shock group (67 cases). Another 50 healthy people in the same period in our hospital were selected as control group. The relationship between platelet function and immune indexes was compared. Results ( 1) the incidence of maximum blood block intensity decreased in the thrombus map of the septic shock group was higher than that in the non shock group, and the difference was statistically significant ( 65. 67%( 44/67 ) vs. 23. 53%(8/34),χ2＝41. 28,P＜0. 05); (2) the CD4+T lymphocyte and C3 in the septic shock group were all lower than those in the non shock group ((47. 28%±7. 78) vs. (54. 93%±11. 26),t＝3. 554,P＜0. 05; (0. 42 ±0. 23) g/L vs. (0. 75±0. 19) g/L,t＝－3. 057,P＜0. 05),the ratio of CD4+/CD8+T lymphocyte was higher than that in non shock group ((2. 68±0. 18) vs. (2. 45±0. 07),t＝7. 18,P＜0. 001)). (3) the maximum intensity of blood clots was correlated with the percentage of CD4+T lymphocyte,CD4+/CD8+T lymphocyte ratio,complement C3,acute physiology and chronic health status score system II score,and sequential organ failure score ( r ＝ 0. 617, 0. 411, 0. 563,－ 0. 631,－ 0. 547, P＜ 0. 01, or P＜ 0. 05 ) . Conclusion Thrombocytopenia is present in septic patients,which is correlated with changes in immune indices.

Incidence of Lower Limb Deep Venous Thrombosis and Coagulation Status in Severe Patients after Thoracic Surgery / 中国肺癌杂志

BACKGROUND@#The aim of this study was to analyze the incidence of lower limb deep venous thrombosis (DVT) and the corresponding coagulation status in severe patients after thoracic surgery.@*METHODS@#Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016 and June 2018 were analysed retrospectively. Their general information, disease species, surgical treatment, and coagulation index were reviewed.@*RESULTS@#Fifty patients were finally included. There were 34 male and 16 female, aging from 22 to 80 years. The incidence of DVT was 22.0%, all of them were isolated calf DVT. The incidence was 29.4% in male patients, while 6.3% in female; 23.5% in malignant diseases and 18.6% in benign. All coagulation index presented no statistical difference between patients with and without DVT, except activated partial thromboplastin time (APTT).@*CONCLUSIONS@#Even on the basis of adequate mechanical prophylaxis, lower limb DVT is common in severe patients after thoracic surgery. Meanwhile, male patients and malignant diseases are more suscepted.

Predicative value of thrombelastogram in aSAH with delayed cerebral ischemia / 中国神经精神疾病杂志

Objective To investigate the clinical value of thrombelastogram (TEG) in prediction for the cause of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods In this study, there were 30 patients with DCI (group DCI) and 45 patients without DCI (group No-DCI). TEG was performed in all the patients at post-bleeding day 1, 5, 10 and 15 after aSAH(PBDn, n=1,5,10,15). The changes of reaction time (R value), coagulation time (K value),coagulation angle (α value),maximum thrombus consistency (MA value) and coagulation index (CI value) were examined at different time points after aSAH. Results Thirty of 75 aSAH patients developed DCI and the incidence of DCI was 40 percent. According to linear mixed model, both MA value and CI value were significantly statistical different at different time points within each group (P<0.05,for all) as well as between No-DCI group and DCI group.MA value and CI were significantly statistical different at same time point (P<0.05,for all). The results of logistic regression analysis showed that modified Fisher levelⅢ-Ⅳ,△MA5-1(OR=1.124,P=0.024,95% CI=1.015~1.244), PBD5 MA>70(OR=5.605,P=0.011,95% CI=1.464~21.457)were the independent risk factors of DCI.By using ROC curve to define a threshold for prediction of the occurrence of DCI,the rate of DCI was significantly increased when △MA5-1>3.05.Conclusion aSAH Patients, especially those with DCI have severe hypercoagulation. The MA value in PBD5 has an important predictive value for DCI.

Impact of aspirin resistance on recurrence of artery atherosclerotic cerebral infarction and risk factors of aspirin resistance / 实用医学杂志

Objective To study the impact of aspirin resistance(AR)on the recurrence of artery athero-sclerotic cerebral infarction,and analyze the risk factors of AR. Methods According to TOSAT classification, newly diagnosed cerebral infarction patients with artery atherosclerotic cerebral infarction were selected into groups,and aspirin enteric-coated tables(ASP)was used to prevent platelet aggregation.One week later,the inhi-bition rate of platelet was detected by thrombelastogram(TEG),and the patients were divided into aspirin sensi-tive(AS)group and AR group,and were followed-up for at least 6 months.According to whether they were recur-rent cerebral infarction,the patients were divided into recurrent group and non-recurrent group. Then,statistical analysis was conducted.Results The incidence rate of AR in recurrent group was significantly higher than that in non-recurrence group(P < 0.05);the recurrence rate of cerebral infarction in AR group was significantly higher than that in AS group(P<0.05).When compare the clinical indexes between the recurrence group and non-recur-rence group,age,diabetes,TC,Hcy,Apo-a in the two groups were different(P<0.05).In recurrent group,the distribution of diabetes,LDL-C and Hs-CRP were different between AR and AS group(P<0.05).Age,gender, hypertension,diabetes,Hs-CRP and TC were risk factors for AR.Conclusions AR plays an important role in the relapse of artery atherosclerotic cerebral infarction and it is more likely to occur especially accompanied by adverse factors such as underlying diseases. TEG can be used to detect AR rapidly and conveniently,which has practical significance in preventing recurrent cerebral infarction.

Investigation of Correlation between Parameters of Thrombelastogram and Platelet Count in Perioperative Patients / 现代检验医学杂志

Objective To investigate thrombelastogram (TEG) correlation between parameters and platelet count in perioperative period patients.Methods Selected 139 patients,69 cases with thrombocytopenia,35 cases with normal platelet number and 35 cases with thrombocytosis from 2012 January to 2014 May,monitored TEG,blood coagulation function and the change of blood routine during perioperative period.Spearman test was used to analyze the different level of platelet count and other coagulation parameters.Results The positive correlation between platelet count and TEG parameters were:MA (r=0.57,P＜0.57),Angle (r=0.54,P＜0.000 1),CI (r=0.57,P＜0.000 1),and R was negatively correlated with platelet count (r=-0.27,P＜0.000 1).There was no significant correlation between PT,APTT and platelet count.In mild lack of platelet group [(87.34 ± 10.43) × 109/L] and normal group [(198.47 ± 45.30) × 109/L],platelet count was positively correlated with MA and Angle.In severe lower [(39.33±10.63) × 109/L] and higher group [(330.34±35.43) × 109/L],there was no correlation between platelet platelet count with MA or Angle.Conclusion Platelet count was significantly correlated with CI,Angle and MA,but in patients with moderately severe lower platelet and platelet increase the platelet count do not reflect the aggregation function,MA is more sensitive response to platelet function.

The study of application of thrombus elastograph in evaluating coagulation function of patients with acute ischemic stroke / 国际检验医学杂志

Objective To evaluate the role of thrombus elastograph (TEG) in evaluating the coagulation function of patients with acute ischemic stroke.Methods Totally 116 cases of patients with acute ischemic stroke and 116 cases of health physical examination people from our hospital were selected as case group and control group.The blood clotting index and thrombelastogram index of the groups were detected.Results In case group of acute phase,fibrinogen (FIB),two D-dimer (D-D),maximum blood clot strength (MA),0.5 h blood clot reduction rate of MA (LY30),alpha angle,integrated coagulation index (CI) and blood clot strength (G) were significantly higher than those of control group and the recovery period group.The difference was statistically significant(P＜0.01).In cases of acute phase,activated partial thromboplastin time (APTT),prothrombin time (PT),PT-INR,reaction time (R),clot formation time (K value) were significantly lower than those in the healthy control group and the recovery period cases,the difference was statistically significant (P＜0.01).MA,LY30,α Angle and CI were negatively correlated with PT,APTT,PT-INR,and were positively correlated with FIB,D-D(P＜0.05);R value,K value were positively correlated with PT,APTT,PT-INR,and were negatively correlated with FIB,D-D(P＜ 0.05).Conclusion TEG plays a significant role in monitoring and evaluating coagulation function in patients with acute ischemic stroke,and has important evaluation effect on the prognosis of disease.It is worthy of clinical application.

Correlation analysis between thrombelastogram and coagulation test and platelet count in patients with malignant tumor / 国际检验医学杂志

Objective To analyze the correlation between thrombelastography(TEG)and coagulation, platelet count(PLT)in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 241 cases with tumor who were performed TEG,coagulation and blood test in the same day in Chongqing Cancer Institute from November 2016 to March 2017.Linear correlation and regression were carried out to an-alyze relationship among the parameters.The number of patients with positive blood clotting,PLT and TEG parameters were counted,and the χ2test was used to compare the difference between them.Using Mann-Whit-ney U test to compare the differences between multiple parameters of liver cancer,breast cancer,and pancreatic cancer.Results The R value of TEG parameters in patients with malignant tumor was positively correlated with APTT,negatively correlated with TT,DD and FDPs.K was positively correlated with APTT and TT, and negatively correlated with FIB and PLT.The relationship between α and FIB,PLT were positive,between APTT and TT were negative.MA was positively correlated with FIB and PLT,negatively correlated with TT, CI was positively correlated with FIB and PLT,and negatively correlated with APTT(P<0.05).The correla-tion between FIB,PLT and MA was the highest.And the linear regression equation of TEG parameters and coagulation indexes was obtained.The positive rate of TEG was lower than that of coagulation(P<0.05). Same certain differences of TEG and coagulation parameters were existed in liver cancer,breast cancer and pancreatic cancer patients.Conclusion TEG is significantly associated with PLT and conventional coagulation test,and the results of TEG and conventional coagulation test are consistent to a certain degree,but the overall agreement is generally not interchangeable.TEG might be play a complementary role with coagulation tests and platelet counts.And the TEG of different cancer types is not exactly the same as the coagulation parameters.

Study on the related factors with clopidogrel resistance of patients with acute cerebral infarction / 中国综合临床

Objective To study the effect of clopidogrel on different CYP2C19 genotypes and platelet reactivity in acute cerebral infarction patients with antiplatelet aggregation.Methods Four hundred and seventy-four cases of cerebral infarction patients in Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2015 to April 2016 were collected.CYP2C19 genotype was determined,and the genotype was divided into the wild type group,the heterozygous type group and the mutant homozygous group.Platelet aggregation inhibition rate(ADP%) and platelet reactivity index induced by ADP were detected.Patients were divided into clopidogrel resistance group(group CR) and non resistant group according to whether ADP% was less than 30.SPSS 16.0 statistical software was used for statistical analysis,the comparison between groups using independent samples t test,chi square test and multivariate analysis using Logistic regression analysis,when P<0.05 difference was statistically significant.Results Among the 474 patients,204 cases(43.04%) were divided into wild-type group,and 204(43.04%) and 66(13.92%) were divided into the mutant heterozygous group and mutant homozygous group.In Chi square test analysis,clopidogrel resistance group and non resistance group CYP2C19 genotype distribution was significantly different(χ2=6.658,P=0.036).CR group angle(α) values((68.87±5.47)°) and MA((66.77±6.25) mm) were higher than that of CS group ((66.55±6.05)° and (63.30±5.66) mm,t=2.199,3.387,P=0.029,0.001).The multivariate logistic regression analysis showed that OR of angle level was 1.028,95%CI was 0.929-1.137 (P=0.595);OR of Ma level was 1.561,95%CI was 0.785-0.970 (P=0.012).Conclusion The effect of clopidogrel on platelet aggregation in patients with acute cerebral infarction is decreased by CYP2C19 gene mutation.CYP2C19 mutant allele is a risk factor for clopidogrel resistance.Angle (α) value and MA value are the risk factors for the diagnosis of CR in the patients with acute cerebral infarction,and the risk of clopidogrel resistance increased when the patients′ Angle (α) value and the value of MA increased.MA value as a predictor of CR and the screening tool has a certain value.

Application of thrombelastogram in choosing antiplatelet drug for patients with cerebral arterial thrombosis / 中国医学装备

Objective:To investigate the application value of thromboelastography (TEG) in choosing antiplatelet drug for patients with cerebral arterial thrombosis.Methods: 100 new patients with cerebral arterial thrombosis, who received single antiplatelet therapy after received dual antiplatelet therapy (aspirin and clopidogrel) in acute stage (14d), were randomly divided into observation group (50cases)and control group (50cases). According to different method of choosing drug, patients of control group randomly were implemented different single antiplatelet drug, while patients of observation group received more sensitive antiplatelet drug based on TEG results. The follow-up observation about recurrent situation of cerebral arterial thrombosis for the two groups were carried out in further study.Results: In one year, the recurrence rate of cerebral arterial thrombosis of observation group (6%, 3/50) was significantly lower than that of control group (20%, 10/50) (x2=4.332,P<0.05). The differences of recurrence rate between different antiplatelet drug in intra-group were not statistically significant.Conclusion: TEG can efficiently evaluate the therapeutic effect of antiplatelet drug, and guide the selection for drug so as to reduce the recurrence rate of cerebral arterial thrombosis.

Establishment of reference range for thromboelastography in pregnancy / 中国输血杂志

Objective To establish a reference range for the normal value of thromboelastography (TEG) in pregnant females.Methods According to the results of pregnancy and physical examination,166 pregnant females and 64 healthy females without pregnancy were selected as the pregnant group and the non-pregnant control group,respectively.The TEG value and the traditional coagulation index were measured.The TEG parameters of the two groups were compared and analyzed,establishing a reference range for the parameters.We further analyzed the effect of full-term pregnancy on TEG results and the correlation between traditional coagulation index and TEG test results.Results The traditional coagulation index and TEG test results of the pregnant females andthe non-pregnant females were significantly different.According to the results,a new TEG reference range was established:R 3.9-7.5 min,K 1.0-2.4 min,α 57.6°-74.9°,MA 55.7-75.7 mm,LY30 0-0.56％,CI(-0.97)-3.6.Full-term pregnancy had no significant effect on TEG results.In addition to LY30,other parameters of TEG had some correlation with the traditional coagulation index.Conclusions The general TEG reference range does not apply to pregnant females and established TEG normal reference range for pregnant females can be applied for clinical use.

Clinical application value of thrombela-stogram for anticoagulant therapy to prevent deep venous thrombosis in perioperative period of Orthopedics Department / 中国综合临床

Objective To research the clinical application effect of thrombela-stogram(TEG) for anticoagulant therapy to prevent deep venous thrombosis(DVT) in perioperative period of Orthopedics Department.Methods Sixty-eight cases of fracture patients treated with surgery in the Orthopedicsin Department of Jiangning Hospital of Nanjing were selected as the research subjects,and 42 healthy volunteers for a physical examination at the same period were selected as the control group.All fracture patients were treated with anticoagulant therapy after surgery,according to the different anticoagulants,the fracture patients were divided into the low molecular weight heparin(LWMH) group and the rivaroxaban group.On the day of the investigation,the control group was detected by TEG,and the TEG test was performed on all the patients during the perioperative period.Results There was no significant difference on the TEG test results between fracture patients and the control group(P>0.05),the TEG test results of fracture patients were normal,and the blood was not in the high coagulation state.On the 7th d of anticoagulant therapy and the end of anticoagulant therapy,the R value in the LWMH group and in the rivaroxaban group were the highest positive rate,were all more than 50%.At the end of the anticoagulant therapy,the abnormal detection rate of α angle,maximum thrombus(MA) and integrated coagulation index(CI) in the rivaroxaban group were 35.29%,32.35%,41.76%,respectively,were significantly higher than those in the LWMH group(8.82%,17.65%,11.76%),the differences were statistically significant(χ2=6.9283,5.7566,7.5556,P<0.05).After the end of the anticoagulant therapy for Doppler ultrasound,9 cases were diagnosed as DVT,and the incidence rate was 14.06%.Compared and founded,at the end of the anti coagulation therapy,the great value of the diagnostic indicators were α angle,MA and CI,the sensitivity was 64.71%,76.47%,73.53% respectively,and the specificity was 79.41%,73.53%,82.35% respectively.Conclusion After fracture surgery,the coagulation function of the patients are changed,using TEG dynamic detection can accurately understand the change of blood state in real time,and it has important reference value for the evaluation of blood coagulation function.With MA was equal to 68.35 mm as a clinical diagnosis of critical point.

Correlative study on thrombelastogram and hemorrhagic transformation after acute ischemic stroke / 国际检验医学杂志

Objective To investigate the correlation between indexes of thrombelastogram (TEG) and hemorrhagic transformation (HT) after acute ischemic stroke.Methods The cases of acute ischemic stroke but not receiving early reperfusion therapy were recruited in our hospital from January to November 2016,and were divided into HT group and non-HT group.Their general clinical characteristics and TEG indexes were retrospectively analyzed,and comparison between two groups and multivariate Logistic regression analysis were performed.Results A total of 71 cases were enrolled and 11 of them were divided into HT group.The percentages of massive cerebral infarction and cardio-embolic stroke were significantly higher in HT group than those in non-HT group (P<0.05),whereas the levels of CI in HT group were significantly lower than thoes in non-HT group(P<0.05).Multivariate Logistic regression analysis showed that massive cerebral infarction (OR=13.172,95%CI:1.414-122.671) and CI(OR=0.554,95%CI:0.321-0.956) were independently correlated with HT(P<0.05).Conclusion CI is independently correlated with HT after acute ischemic stroke,and may be a potential predictor of HT.