Efecto de las diferentes drogas anticoagulantes sobre el ensayo de fibrinógeno derivado del tiempo de protrombina / Effect of different anticoagulant drugs on the prothrombin time-derived fibrinogen assay

Resumen El objetivo de este trabajo fue comparar los niveles de fibrinógeno (FBG) obtenidos por el método de Clauss con los obtenidos por el método de fibrinógeno derivado del tiempo de protrombina (FBG PT-d), con dos tromboplastinas, en pacientes anticoagulados con distintas drogas. Se estudiaron pacientes anticoagulados consecutivos: 105 con antagonistas de la vitamina K (AVK), 55 con heparina no fraccionada (HNF), 58 con heparina de bajo peso molecular (HBPM), 60 con rivaroxabán, 45 con apixabán, 60 con dabigatrán y 100 controles normales (CN). El FBG se determinó por el método de Clauss y FBG PT-d utilizando tromboplastina de cerebro de conejo o recombinante humana; los niveles de heparina, rivaroxabán y apixabán por método cromogénico anti Xa; el dabigatrán con el ensayo de tiempo de trombina diluido. Existió un sesgo positivo (p<0,001) al comparar el FBG PT-d vs. FBG por Clauss: CN: 13,7%, AVK: 31,8%, rivaroxabán: 34,8% y apixabán: 20,0% cuando se utilizó tromboplastina de conejo. En el caso de las muestras que contenían HBPM se observó este desvío con ambas tromboplastinas. El sesgo porcentual en presencia de dabigatrán y heparina no fraccionada no fue estadísticamente distinto del obtenido en el grupo control. El ensayo de FBG PT-d no debe utilizarse en pacientes anticoagulados con rivaroxabán, apixabán, HBPM o AVK, ya que sobreestima los niveles de FBG. El porcentaje de sesgo depende del tipo de tromboplastina utilizado y fue mayor con la de cerebro de conejo en el sistema de detección utilizado.

Abstract The aim of this study was to compare fibrinogen (FBG) results obtained by Clauss method (FBG-C) and by the prothrombin time-derived fibrinogen assay (FBG PT-d) with two thromboplastins in patients under anticoagulation. Consecutive anticoagulated patients were studied: 105 vitamin-K antagonist (VKA), 55 unfractioned heparin, 58 LMWH, 60 rivaroxaban, 45 apixaban and 60 dabigatran, and 100 healthy controls (NC). FBG-C was performed by Clauss and FIB PT-d with rabbit brain and human recombinant thromboplastins, respectively. Heparins, rivaroxaban and apixaban levels were measured by antiXa; dabigatran by thrombin diluted assay. A positive bias of FBG PT-d vs. FBG-C with both thromboplastins were seen in NC (13.7 and 19.0 % for HS and RP, respectively), but bias with HS in rivaroxaban, apixaban and VKA patients were significantly higher compared to NC: 34.8%, 20.0 % and 31.8 %, respectively. LMWH presented higher BIAS compared to NC with both thromboplastins. Samples with unfraction heparin and dabigatran presented similar bias to NC. FBG PT-d should not be used in patients under anticoagulant treatment because of an important overestimation of FBG could be obtained in these patients. The percentage of bias depends on the type of thromboplastin used; it was higher with rabbit brain thromboplastin in the detection system used.

Resumo O objetivo deste trabalho foi comparar os níveis de fibrinogênio (FBG) obtidos pelo método de Clauss com aqueles obtidos pelo método do fibrinogênio derivado do tempo de protrombina (FBG PT-d), com duas tromboplastinas, em pacientes anticoagulados com diferentes drogas. Pacientes anticoagulados consecutivos foram estudados: 105 com antagonista da vitamina K (AVK); 55 com heparina não fracionada (UFH); 58 com heparina de baixo peso molecular (HBPM), 60 com rivaroxabana, 45 com apixabana, 60 com dabigatrana e 100 controles normais (CN). FBG foi determinado pelo método de Clauss e FBG PT-d usando tromboplastina de cérebro de coelho ou tromboplastina humana recombinante; níveis de heparina, rivaroxabana e apixabana pelo método cromogênico anti-Xa; dabigatrana com ensaio de tempo de trombina diluída. Há um viés positivo (p<0,001) ao comparar o FBG PT-d vs FBG de Clauss: CN: 13,7%; AVK: 31,8%, rivaroxabana: 34,8% e apixabana 20,0% quando foi utilizada tromboplastina de coelho. No caso das amostras contendo HBPM, esse desvio foi observado com ambas as tromboplastinas. O viés percentual na presença de dabigatrana e heparina não fracionada não foi estatisticamente diferente daquela obtida no grupo controle. O ensaio de FBG PT-d não deve ser usado em pacientes anticoagulados com rivaroxabana, apixabana, LMWH ou VKA, pois superestima os níveis de FBG. A porcentagem de viés depende do tipo de tromboplastina utilizado e foi maior com a de cérebro de coelho, no sistema de detecção utilizado.

Changes in hemostasis and clinical significance of coagulation function test in patients with liver cirrhosis / 临床肝胆病杂志

The liver plays an important role in procoagulant and anticoagulant mechanisms in human body. There are complex changes in hemostasis in patients with liver cirrhosis, with the presence of interaction between the portal venous system and the peripheral system and differences in etiology, and such patients have a dual trend of hemorrhage and thrombosis. At present, there are certain limitations in coagulation function tests commonly used in clinical practice. The primary etiology and results of various coagulation tests should be considered before initiation of anticoagulant therapy for patients with liver cirrhosis, so as to make the best clinical decisions for patients.

Efficacy of the 20-minute whole blood clotting test (WBCT20) in the diagnosis of coagulation alteration related to snakebites in a Western Brazilian Amazon hospital

Abstract Introduction: The efficacy of 20-minute whole blood clotting (WBCT20) and the Lee-White clotting time (LWCT) tests in diagnosing coagulation alterations from snakebites were compared. Methods: We evaluated 89 snakebite cases treated at the Hospital Regional do Juruá em Cruzeiro do Sul, Acre, Brazil. Results: WBCT20 results were normal in 33.7% and unclottable in 66.3% of cases, while LWCT results were normal in 23.6% and altered (prolonged or unclottable) in 76.4% of cases, with no significant differences. Conclusions: The WBCT20 is important for rapidly diagnosing coagulation alterations from snakebites. Furthermore, it is efficient, inexpensive, and can be deployed in isolated hospitals.

A Retrospective Study on Unfractionated Bovine Heparin Safety in On-Pump Cardiac Surgery

Abstract Background: Heparin decreases the risks of thrombotic phenomena in extracorporeal circulation. However, it must present a robust safety profile itself, especially for bleeding. Contamination of porcine heparin demands an alternative source and consequent assessment of safety. Objective: To evaluate the safety of unfractionated bovine heparin during on-pump cardiac surgery. Methods: Descriptive, retrospective study, evaluating medical records from all patients who had on-pump cardiac surgery over four years. We observed the occurrence of bleeding, thrombocytopenia, postoperative vasoplegia, activated clotting time values and any other coagulation phenomena as safety profile parameters. Results: We evaluated 204 medical records reporting the use of unfractionated bovine heparin. 66.18% of the patients presented thrombocytopenia, 1.04% presented bleeding of more than 2000 mL in the first 24 hours of the postoperative period. One patient presented clots in the surgical field. Median activated clotting time was 137 seconds at baseline, 803 seconds after the first dose of heparin and, after protamine, it returns to similar baseline values, that is, 149.5 seconds. Conclusion: Unfractionated bovine heparin did not present unusual adverse effects and can be considered safe for on-pump cardiac surgery.

Performance of HemosIL ReadiPlasTin, a Liquid Reagent for Prothrombin Time Measurement / 임상검사와정도관리

BACKGROUND: Prothrombin time (PT) measurement is an important test for screening blood coagulation disorders and monitoring anticoagulant therapy. In this study, we evaluated the analytical performance of HemosIL ReadiPlasTin (Instrumentation Laboratory, USA), a liquid reagent for PT measurement. METHODS: The precision of HemosIL ReadiPlasTin was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) EP5-A3 guidelines. Further, comparison with HemosIL RecombiPlasTin 2G (Instrumentation Laboratory, USA) was made according to the CLSI EP9-A3 guidelines. The reference intervals were established according to the CLSI C28-A3 guidelines. RESULTS: The coefficient of variation values for repeatability and total imprecision at two levels of control materials were lower than 1.1% and 3.4%, respectively. The performance of HemosIL ReadiPlasTin was comparable to that of HemosIL RecombiPlasTin 2G, with a high correlation (r=0.996). The reference interval for normal subjects was 10.4–13.3 seconds. CONCLUSIONS: HemosIL ReadiPlasTin showed an acceptable degree of imprecision and its performance showed high correlation with that of a conventional reagent. Therefore, it is expected to be useful for PT measurement in clinical laboratories.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery / 中国医师杂志

Objective@#To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery.@*Methods@#A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation.@*Results@#The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P<0.05), but there was no significant difference between group B and C (P>0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05).@*Conclusions@#Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery / 中国医师杂志

Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery.Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer,esophageal cancer,cardiac cancer) from February 2015 to October 2018.According to the Caprini risk assessment model,101 patients with high risk of deep venous thrombosis were randomly assigned to groups A,B and C.Control group A (34 cases) did not use low molecular weight heparin;group B (34 cases) used prophylactic low molecular weight heparin calcium after operation;group C (33 cases) used therapeutic low molecular weight heparin calcium after operation.The platelet count (PLT),fibrinogen (FIB),prothrombin time (PT),D-dimer (D-D),postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation.Results The incidence of deep venous thrombosis (DVT) was 11.76％ in group A,2.94％ in group B and 3.03％ in group C,with significant difference between group B and C and group A (P ＜ 0.05),but there was no significant difference between group B and C (P ＞ 0.05).The levels of FIB and D-D after operation were significantly higher than those before operation (P ＜ 0.05),but the levels of indexes in group B and C were significantly lower than those in group A (P ＜ 0.05).Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage,which is beneficial to improve the hypercoagulable state of patients and has good safety.However,the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index.

Comparación preoperatoria entre pruebas de coagulación y tromboelastografía en pacientes con cirrosis hepática sometidos a trasplante hepático / Thromboelastography and classical coagulation tests in the preoperative period of liver transplantation

Background: Compared to standard coagulation essays (SCE), such as international normalized ratio (INR), prothrombin activated partial thromboplastin time (aPTT), or platelet count, thromboelastograhy (TEG) offers precise and real-time information about hemostasis. TEG tests both platelet function and coagulation by assaying several parameters of clot formation dynamically in whole blood. Aim: To evaluate hemostasis in cirrhotic patients undergoing liver transplantation and determine the positive and negative predictive values of SCE for alterations of TEG. Material and Methods: Preoperative SCE and TEG were prospectively analyzed in 25 patients. Results were categorized as normal, laboratory alteration or clinical alteration. SCE results were compared with TEG parameters to determine positive (PPV) and negative predictive values (NPV). Results: Hemostasis was abnormal and laboratory abnormalities were observed in all patients. One patient had clinical signs of excessive bleeding. SCE were abnormal in all patients and TEG was normal in nine patients. The most common alteration in TEG was hypocoagulability, in some cases associated with hypercoagulability and hyperfibrinolysis. Two patients had solely hypercoagulability. PPV of INR, aPTT, platelet count and fibrinogenemia were 0, 0, 0.5 and 0.17 respectively. NPV of the same tests were 1, 1, 0.34 and 1 respectively. Conclusions: Hypocoagulability was the most common laboratory alteration, however, clinical signs of coagulopathy were rarely present. SCE had a poor predictive value to diagnose o discard hemostatic abnormalities.

Viscoelastic Coagulation Test Guided Therapy for a Strategy to Reduce Transfusions / 대한수혈학회지

Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.

Investigate on reference intervals of five indexes of blood coagulation tests among infants and children in Chongqing / 重庆医学

Objective To establish children's independent normal reference intervals of five coagulation indexes in Chongqing,in order to better provide references for clinic.Methods The plasma samples of 5 119 healthy children were collected and used to detecting prothrombin time (PT),activated partial thromboplastin time (APTT) and fibrinogen (FIB),thrombin time (TT) and D-Dimer (D-D) via Sysmex CS5100 and Sysmex CSA2000.According to ages,the children were divided into 6 groups:newborn (at 0 to less than 15 days of age),newborn (at 15 days to less than 1 month of age),infant (at 1 to less than 7 months of age),children (at 7 months to less than 3 years of age),children (at 3 to less than 7 years of age),children (at 7 to 15 years of age),and comparatively analysed.For normal distribution data,(x)± 1.96s was used to calculate the reference intervals;while for skewness distribution data,the reference intervals was calculated by 95 ％ reference interval according to the percentile of P2.5 and P97.5.Results The normal reference intervals of five coagulation indexes in this clinical laboratory were as follows:PT 11.1-20.2 s (at 0 to less than 15 days of age),10.7-15.8 s (at 15 days to less than 1 month of age),9.9-13.5 s (at 1 month to 15 years of age);APTT 28.8-91.6 s (at 0 to less than 15 days of age),33.3-64.2 s (at 15 days to less tha 1 month of age),24.0-53.2 s (at 1 to less than 7 months of age),21.2-39.2 s (at 7 months to less tha 15 years of age);FIB 1.45-3.52 g/L (at 0 to less than 3 years of age),1.50-3.52 g/L (at 3 to 15 years of age);TT 15.4-26.3 s (at 0 to less than 15 days of age),14.9-21.4 s (at 15 days to less than 7 months of age),14.7-20.1 s (at 7 months to less than 3 years of age),14.9-19.3 s (at 3 to 15 years of age);D-D 0.1-5.1 mg/L (at 0 to less than 15 days of age),0.2-2.2 mg/L (at 15 days to less than 1 month of age),0.1-1.1 mg/L (at 1 to less tha 7 months of age),0.1-1.4 mg/L (at 7 months to less than 3 years of age),0.1-1.3 mg/L (at 3 to less than 7 years of age),0-1.0 mg/L (at 7 to 15 years of age).Conclusion The normal reference intervals of five coagulation indexes,including PT,APTT,FIB,TT and D-D,are established,which provide more accurate references for the diagnosis of related diseases in infants and children in this area.

Evaluation of the targeted uncertainty in routine coagulation assay using EQA data / 中华检验医学杂志

Objective To establish the target measurement uncertainty(MU)of the routine coagulation assay according to the External Quality Assessment data(EQA)of routine coagulation assay. Methods Beijing Center for Clinical Laboratory(BCCL)established the target measurementuncertainty for routine coagulation assayswith the"up-down"methodon the basis of 93 clinical laboratoriesEQA datain BeijingThese assays includedActivated partial thromboplastine time(APTT), Fibrinogen(FBG), International Normalized Ratio(INR), Prothrombin time(PT), Thrombin time(TT)and D-dimer, Compared with CLIA′88,the proficiency of current coagulation assayswas observed.Results The MU of six routine coagulation assayscompared with CLIA ′88 showed that: The 90th percentile MU met the creteriain APTTof group B,FBG of group A&B&C,INR of group B and D-dimer of group B.The 75th percentile MU met the creteriainINR of group A&C,PT of group C.The medium met the creteriainAPTT of group A&C,PT of group A and INR of group D.Conclusions Target Measurement Uncertainty was establishedin routine coagulation assay by using EQA data only,whichcan simplify the procedure of determining MU and continuously update MU according to the frequency of EQA.It has good clinical practical value.However, the applicability of this method should also be considered.

Evidence based development and challenge of laboratory examination of thrombosis / 中华检验医学杂志

The clinical application of the laboratory examination with thrombosis can be divided into four categories,including risk assessment,diagnosis by exclusion,auxiliary diagnosis and therapic monitoring.Theevidence based parameters which subsumed into the international guidelines of thrombosis related clinical management,included the prothrombin time,activited partial thomboplastin time,anti-factor X a activity,D-dimer,coagulation factor Ⅷ,naturally occurring anticoagulants,antiphospholipid syndromeassociative parameters,heparin induced thrombocytopenia antibodies and platelet aggregation test,which provided the important evidence for clinical intervention and establishment of antithrombotic strategy.Theother thrombosis tests are still lack of sufficient evidence,therefore we need to participate in multicentric clinical randomized controlled study actively,and implementing the systematic review and meta-analysis forwardly,solving clinical questions based on PICO (Patients,Intervention,Comparision,Outcome),promoting the clinical application of laboratory parameters.

Investigation on the distribution of critical value limits in adult patients in Beijing / 中华检验医学杂志

Objective To investigate the distribution of critical values of adults in Beijing, to provide the evidence for the formulation of the Standardized Management Guideline in Critical Values, in order to promote the accurate management of critical values.Methods A total of 110 398 data of critical values from the tertiary and above medical institutions during January 1 to May 31 in 2015 in Beijing were collected by the way of on-site inspection, covering the disciplines of hematology, clinical chemistry, coagulation and blood gas analysis.Fristly, the selected critical values were classified by the factor of admission departments and disease types,then were analyzed by using Kruskal-Wallis test, to compare the differences in each group.Secondly,the combined groups were classified by the factor of gender then were analyzed by using Mann-Whithey U test, to compare the differences in each group.Finally, the stratification thresholds of critical values were established.Results Except for the upper limits of Ca, pH, pCO2, Hb and the lower limits of Glu, pH, the rest of thresholds of critical values had significant differences due to different admission departments and disease types and/or gender.Conclusion Depending on the different admission departmentsces disease types and/or gender, hierarchical limit values on each critical value were formulated.

Establishment of FMEA risk management procedures for blood coagulation tests in clinical laboratories / 中华检验医学杂志

Definiting the workflow and key link of the risk management in medical laboratory by FMEA.Identifying risk factors of the workflow and key link of blood coagulation test by the criteria for laboratory accreditation , such as ISO15189 recognition criteria and CAP laboratory accreditation inspection . Through the evaluation of the blood coagulation test , effective corrective actions and examining performance data periodically , the quality of the blood coagulation test can be improved continuously.

A Pigmented Bullous Maxillofacial Lesion in a Diabetic Patient: A Diagnostic Dilemma.

Diabetes mellitus (DM) can be complicated by a variety of cutaneous manifestations. Cutaneous manifestations, such as neuropathic foot ulcers are universally known and have predilection for the lower extremity. However, in the maxillofacial region diabetic lesion is not yet reported in the literature. It is because of enormous blood supply to the region. We present a case of 77-year-old female with pigmented bullous lesion in maxillofacial region as a result of uncontrolled DM, which was associated with reactive lymphadenitis due to infection from carious right mandibular first molar. The patient also had normocytic normochromic anemia secondary to progressive renal failure as a result of diabetic nephropathy (DN). The patient developed lesion due to trauma following fine-needle aspiration cytology and high sugar levels. She was successfully managed by good metabolic control, extraction of the offending tooth, antibiotic prophylaxis, and occlusive dressings. To the best of our knowledge, this clinical scenario has not been previously reported in the context of the diabetic lesion and, therefore, may be considered in the classification of dermatological lesions of diabetes.

Trastornos de la hemostasia en la enfermedad hepática crónica / Coagulation Disorders in Chronic Liver Disease

El mecanismo de la coagulación normal funciona sobre base la de un complicado balance entre mecanismos procoagulantes, anticoagulantes y sistema fibrinolítico, y el hígado juega un rol esencial en él. Se realizó una revisión con el objetivo de examinar aspectos relacionados con las alteraciones en la hemostasia en los pacientes con hepatopatía crónica, para ello se efectuó una búsqueda bibliográfica sobre el tema en Pubmed, EBSCO, Medline, e Hinari. Se abordaron las alteraciones plaquetarias cuantitativas y cualitativas, déficit en la síntesis de factores de la coagulación, disfibrinogenemia, alteraciones en la fibrinólisis, deficiencia de vitamina K y cambios compatibles con un estado de coagulación intravascular diseminada. Se concluyó que Las alteraciones de la hemostasia en el paciente cirrótico se relacionan con un estado avanzado de la enfermedad, con consecuencias clínicas que constituyen un espectro que incluyen tendencia al sangrado, o a fenómenos de trombosis, y que las pruebas de coagulación habituales no reflejan de manera adecuada las alteraciones de la hemostasia en el paciente con enfermedad hepática crónica. No obstante, los recientes avances en la exploración analítica de estos trastornos constituyen promisorias herramientas para su diagnóstico apropiado en el área clínica.

Normal haemostasis performs based on a complex balance between procoagulant, anticoagulant mechanisms and the fibrinolytic system, in which the liver exerts an important role. A review was performed aimed at examining aspects in relation with the hemostatic alterations in patients with chronic liver disease. A bibliographical review was done to accomplish that purpose in Pubmed, EBSCO, Medline, and Hinari database. Platelet quantitative and qualitative abnormalities and diminished synthesis of clotting factors were approached, as well as dysfibrinogenemia, fibrinolysis disorders, vitamin K deficiency, and a state compatible with disseminated intravascular coagulation. The following conclusions were made: the hemostatic disorders in the patient with cirrhosis are related to an advanced state of the disease, with clinical consequences which are in a wide spectrum from bleeding tendency to thrombosis, and that the standard coagulation tests do not appropriately reflect these phenomena. Nevertheless, recent advances in analytical techniques for the diagnosis of these abnormalities constitute promising tools for their proper identification in the clinical context.

Effect of hyperthermic intraperitoneal perfusion on blood coagulation in patients undergoing laparoscope-assisted radical surgery for gastric cancer / 中华麻醉学杂志

Objective To evaluate the effect of hyperthermic intraperitoneal perfusion on blood coagulation in patients undergoing laparoscope-assisted radical surgery for gastric cancer.Methods Forty patients of both sexes, aged 40-60 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective radical surgery for gastric cancer, were equally randomized into control group (group C) and hyperthermic intraperitoneal perfusion group (group HIP).The patients were treated with hyperthermic intraperitoneal perfusion for 1 h after the end of the radical surgery in group R.Before induction of anesthesia (T0) , immediately before hyperthermic intraperitoneal perfusion (T1), and at 1 h of hyperthermic intraperitoneal perfusion (T2) , venous blood samples were collected, blood coagulation was measured using thromboelastography, and the reaction time, coagulation time, α angle and maximal amplitude were recorded.Results Compared with group C, no significant change was found in blood coagulation parameters at T0 and T1 (P＞0.05), the reaction time and coagulation time were significantly increased, and α angle and maximal amplitude were decreased at T2 in group HIP (P＜0.05).Conclusion Hyperthermic intraperitoneal perfusion can improve blood coagulation in the patients undergoing laparoscope-assisted radical surgery for gastric cancer.

Blood-saving effect of prophylactic use of tranexamic acid in patients undergoing orthotopic liver transplantation / 中华麻醉学杂志

Objective To evaluate the blood-saving effect of prophylactic use of tranexamic acid in patients undergoing orthotopic liver transplantation.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 18-60 yr,weighing 45-80 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =30 each) using a random number table:prophylactic use group (group P) and therapeutic use group (group T).Immediately after induction of anesthesia (T1),at 30 min of anhepatic phase (T2),and at 30 min and 2 h of neohepatic phase (T3,4),central venous blood samples were collected to determine plasma fibrinogen concentration (Fib) and platelet count,and the arterial blood samples were obtained to detect thromboelastography (TEG) parameters.In group T,when lysis after 30 min＞7.5％ and Clot Index ≤ 1.0 according to the results of TEG,which indicating that primary hyperfibrinolysis occurred,tranexamic acid 15-20 mng/kg was injected intravenously.In group P,immediately after beginning of skin incision,immediately after occlusion of portal vein,and immediately after portal vein unclamping,tranexamic acid 1 g was injected intravenously,and a single injection of tranexamic acid 15-20 mg/kg was given when primary hyperfibrinolysis occurred.The intraoperative blood loss,fluid input and output and transfusion of blood components were recorded.The duration of stay in ICU,amount of abdominal drainage during stay in ICU,volume of blood transfused within 72 h after operation,and hepatic artery and portal vein thrombosis within 1 week after operation were recorded.Results Compared with group T,the intraoperative blood loss,volume of succinylated gelatin injection transfused,and requirement for platelet and cryoprecipitate were significantly reduced,Angle at T2 and lysis after 30 min at T2,3 and maximum amplitude at T3 were increased,and no significant change was found in the duration of stay in ICU,postoperative amount of abdominal drainage and volume of blood transfused in group P.No patients developed primary hyperfibrinolysis in group P.No hepatic artery and portal vein thrombosis was detected within 1 week after operation in the two groups.Conclusion Prophylactic use of tranexamic acid can effectively prevent hyperfibrinolysis and reduce intraoperative blood loss without increasing the risk of development of thrombosis,and it provides better blood-saving effect than therapeutic use guided by TEG in patients undergoing orthotopic liver transplantation.

Exames convencionais da coagulação como variáveis preditoras da indicação de transfusão de plasma fresco congelado durante o transplante de fígado

INTRODUÇÃO: sangramento por coagulopatia é problema comum durante o transplante hepático (TH). O uso adequado da monitorização da coagulação pode reduzir a transfusão de hemocomponentes, como o Plasma Fresco Congelado (PFC). Exames Convencionais da Coagulação (ECC), tais como Tempo de Protrombina (TP) e Tempo de Tromboplastina Parcial Ativada (TTPa), são os testes mais amplamente utilizados para monitorizar a coagulação durante o TH, mas algumas limitações têm sido apontadas acerca do seu uso em pacientes cirróticos. OBJETIVO: investigar o uso de ECC como variáveis preditoras da indicação de transfusão de PFC durante o TH em pacientes cirróticos. MÉTODO: analisou-se coorte histórica de 297 transplantes hepáticos com enxertos provenientes de doadores cadáveres. Foram incluídos receptores cirróticos de uma única instituição durante nove anos (2002-2010). A infusão profilática de ácido épsilon-aminocaproico (20 mg/kg/h) e outros pré-requisitos hemostáticos foram mantidos na cirurgia. O TP [expresso na forma de Percentual de Atividade da Protrombina (TP%) e de Relação Normalizada Internacional (INR)] e o TTPa foram medidos no pré-operatório e no fim de cada fase do TH. Os participantes só receberam transfusão de PFC quando se diagnosticou coagulopatia, independentemente dos resultados dos ECC. Os pacientes foram distribuídos em dois grupos, de acordo com a ocorrência de transfusão intraoperatória de PFC. Examinou-se o comportamento dos resultados dos ECC durante a cirurgia. Analisaram-se os fatores de risco para a transfusão de PFC por análises uni e multivariada. Os resultados pós-operatórios de ambos os grupos foram comparados. A acurácia dos ECC para predizer o uso de PFC em cada fase da cirurgia foi investigada por curvas ROC. Além disso, pontos de corte dos ECC não associados à coagulopatia foram calculados para cada fase da cirurgia...

BACKGROUND & AIMS: Bleeding due to coagulopathy is a common problem during liver transplantation (LT). Coagulation monitoring may reduce transfusion of blood components, including Fresh Frozen Plasma (FFP). Conventional coagulation assays (CCA), like Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT), are the most widely employed tests to monitor coagulation during LT, but some limitations have been assigned to their use in cirrhotic patients. This study investigated the predictive value of these blood coagulation tests in predicting FFP transfusions during LT in cirrhotic patients. METHODS: This historical cohort study analyzed 297 isolated, deceased donor LTs performed in cirrhotic patients from a single institution during a nine-year period (2002 - 2010). Prophylactic infusion of epsilon-aminocaproic acid [EACA] (20 mg/kg/h) and other hemostatic requirements were maintained intraoperatively. PT [expressed as Activity Percentage (PT%) and International normalized ratio (INR)] and aPTT [expressed in seconds] were measured preoperatively and by the end of each phase of LT. Hemostatic blood components were transfused only in case of coagulopathy. Patients were divided in two groups according to intraoperative FFP transfusion: FFP group and Non-FFP group. Behavior of CCA results during LT were examined in both groups. Univariate and multivariate analyses of risk factors associated with FFP transfusion were performed. Post-operative outcomes were compared between groups. Accuracy of CCA to predict FFP transfusions was investigated using receiver operating characteristic (ROC) curves. Also, alert values of CCA unassociated with coagulopathy in each phase of surgery were calculated...

Influence of Blood Lipids on Global Coagulation Test Results

BACKGROUND: High levels of blood lipids have been associated with high levels of coagulation factors. We investigated whether blood lipids influence the results of global coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin generation assay (TGA). METHODS: PT, aPTT, and TGA, along with procoagulant and anticoagulant factors, were measured in 488 normal individuals. Vitamin K status was assessed with prothrombin-induced by vitamin K absence-II (PIVKA-II). RESULTS: The procoagulant factors II, VII, IX, X, and XI and anticoagulant factors protein C and protein S showed significant correlations with triglyceride, and the procoagulant factors II, V, VII, IX, X, XI, and XII and anticoagulant factors antithrombin and protein C correlated with total cholesterol. There were no correlations of blood lipid levels with PIVKA-II levels. Subjects with high triglyceride levels (> or =200 mg/dL) showed shorter PT values than those with lower triglyceride levels. However, aPTT value was not changed in terms of blood lipid levels. In both 1 and 5 pM tissue factor-induced TGAs, subjects in the high-triglyceride or high-cholesterol groups (> or =240 mg/dL) had high levels of lag time, time-to-peak, and endogenous thrombin potential. Total cholesterol was a significant determinant of PT and TGA values. CONCLUSION: High blood lipids were related with increased coagulation activity in a normal population. Our findings are expected to help interpret the global coagulation test results in individuals with high lipid levels.