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OBJECTIVES@#The number of gestational women has been increased in recent years, resulting in more adverse pregnancy outcomes. It is crucial to assess the coagulation function of pregnant women and to intervene in a timely manner. This study aims to analyze the influencing factors on thrombelastography (TEG) and explore the evaluation of TEG for gestational women.@*METHODS@#A retrospective study was conducted on 449 pregnant women who were hospitalized in the obstetrics department in Xiangya Hospital of Central South University from 2018 to 2020. We compared the changes on the TEG parameters among normal pregnant women between different age groups, different ingravidation groups, and different stages of pregnancy groups. The influence on TEG of hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) as well as two diseases synchronization was explored.@*RESULTS@#Compared with the normal second trimester women, the R values and K values of TEG were increased, and α angle, CI values and LY30 values were decreased in third trimester women (all P<0.05). Compared with normal group, the R values and CI values of TEG of the HDP group have significant difference (both P<0.05). There were no significant difference of TEG between the GDM group, the HDP combined with GDM group and the normal group (all P>0.05). Multiple linear regression analysis showed that the influencing factors for R value in TEG were weeks of gestation (P<0.001) and mode of conception (P<0.05), for α angle was weeks of gestation (P<0.05), for MA value was mode of conception (P<0.05), and for CI value was weeks of gestation (P<0.05). The analysis of correlation between TEG with platelet (PLT) and coagulation routines represented that there was a correlation between TEG R values and activated partial thromboplastin time (APTT) (P<0.01), and negative correlation between TEG CI values and APTT (P<0.05). There was a negative correlation between TEG K values and FIB (P<0.05). The correlation of α angle (P<0.05), MA values (P<0.01) and CI values (P<0.05) with FIB were positive respectively.@*CONCLUSIONS@#The TEG parameters of 3 stages of pregnancy were different. The different ingravidation approach has effect on TEG. The TEG parameters were consistent with conventional coagulation indicators. The TEG can be used to screen the coagulation status of gestational women, recognize the abnormalities of coagulation and prevent the severe complication timely.
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Female , Humans , Pregnancy , Thrombelastography/methods , Blood Coagulation Tests/methods , Retrospective Studies , Blood Coagulation , Blood Platelets , Diabetes, Gestational/diagnosisABSTRACT
Objective:To investigate the correlation between triglyceride-glucose (TyG) index and high on-treatment platelet reactivity (HTPR) during clopidogrel treatment in patients with ischemic stroke.Methods:Patients with ischemic stroke who received maintenance dose of clopidogrel (75 mg/d) in the Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine from January 2017 to March 2021 were retrospectively included. The highest quartile (Q4) of the TyG index was defined as insulin resistance. Platelet reactivity was assessed by thromboelastogram and clopidogrel HTPR was defined as the clot strength induced by adenosine diphosphate (MA ADP) >47 mm. Multivariate regression model was used to analyze the independent correlation between TyG index and platelet reactivity. Results:A total of 83 patients were included. The TyG index showed a linear correlation with MA ADP. The patients were divided into 4 groups according to the quartile of TyG index. The incidence of clopidogrel HTPR increased significantly with the increase of the quartile of the TyG index ( Ptrend=0.017). Multivariate analysis showed that there was a significant independent correlation between insulin resistance and clopidogrel HTPR (odds ratio 4.597, 95% confidence interval 1.285-16.446; P=0.019). Conclusions:In patients with ischemic stroke treated with clopidogrel, the incidence of clopidogrel HTPR gradually increases with the increase of the quartile of the TyG index. The insulin resistance assessed by the TyG index is independently associated with clopidogrel HTPR.
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Introducción: actualmente, la indicación principal para la transfusión de FFP es corregir la deficiencia de los factores de coagulación en pacientes con hemorragia activa o sugestión de esta, sin embargo, la práctica clínica ha demostrado que un porcentaje grande de las transfusiones de FFP en neonatología no siguen las recomendaciones de las guías actuales y, en su mayoría, son innecesarias. Objetivo: ampliar el conocimiento que se tiene sobre la transfusión de FFP en neonatología y la implementación de la tromboelastografía para evitar realizar estas intervenciones. Metodología: se realizó una revisión de la literatura en la base de datos PubMed y Elsevier, usando palabras clave como tromboelastografía, transfusión de plasma en neonatos, hemostasia neonatal. Conclusión: se evidenció que los tiempos de coagulación de los neonatos y prematuros sanos son más prolongados en comparación a los adultos, por ello facilita su errada cuando se habla de transfusión de FFP, de ahí que la TEG sea una buena herramienta para evaluar el estado coagulante de los neonatos de manera integral, sin abrir paso a errores de interpretación y facilitando la decisión de tratamientos en los pacientes en UCIN, antes de requerir transfusiones de FFP.
Introduction: Currently the main indication for FFP transfusion is to correct coagulation factor deficiency in patients with active bleeding or its suggestion, however, clinical practice has shown that a large percentage of FFP transfusions in neonatology do not they follow current guideline recommendations and are mostly unnecessary. Objective: To expand the knowledge about these transfusions in neonatology and the implementation of thrombelastography to avoid performing these interventions. Methodology: A review of the literature was carried out in the PubMed and Elsevier databases, using keywords such as "thrombelastography", "plasma transfusion in neonates", "neonatal hemostasis". Conclusion: It was evidenced that the coagulation times of healthy neonates and premature infants are longer compared to adults, thus facilitating their misinterpretation and limiting their use when talking about FFP transfusion, therefore TEG is a good tool. to evaluate the coagulation interpretación y limita su utilización status of neonates in a comprehensive manner, without giving way to interpretation errors and facilitating treatment decisions in patients in the NICU before requiring FFP transfusions.
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Infant, Newborn , Plasma , Thrombelastography , Blood Transfusion , NeonatologyABSTRACT
Objective:To evaluate the prognostic value of thromboelastography maximum amplitude(MA)and arterial blood lactate levels for sepsis in elderly patients.Methods:A retrospective analysis was performed on clinical data of 63 sepsis patients(≥60 years old)admitted to the Intensive Care Unit(ICU)of Bethune Hospital of Shanxi Province from December 2018 to February 2020.MA values, white blood cell counts, lymphocyte counts, platelets, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores, sequential organ failure assessment(SOFA)scores, underlying diseases, body mass index, laboratory test results and other related treatments were analyzed.The subjects were divided into the survival group and the death group according to the 28-day survival outcome.Differences in MA, APACHE Ⅱ scores, SOFA scores and laboratory test results between the two groups were analyzed, and the correlations of MA with infection parameters and age were examined.Influencing factors of survival outcomes were analyzed using multivariate Logistic regression.The receiver operating characteristic curve(ROC)was used to calculate the prognostic value of MA and arterial lactate for sepsis in elderly patients.Results:The main sources of infections were pulmonary and abdominal(79.4%, 50/63)in 63 elderly patients with sepsis.The incidences of positive blood cultures and deaths were 15.9%(10/63)and 66.7%(42/63), respectively.There existed significant differences in lymphocyte counts, arterial lactate levels, MA and lengths of stay in the ICU between the survival group and the death group( t=3.847, 2.153, 2.745, -3.574, respectively, all P<0.05).MA was correlated with arterial lactate, SOFA score and survival outcome( r=-0.498, -0.506, and -0.358, respectively, all P<0.05).Multivariate Logistic regression analysis showed that MA and arterial lactate were independent factors for the survival outcome( OR=1.626, 0.766, all P<0.05).The area under the ROC curve(AUC, 95% CI)for the combination of MA and arterial lactate was larger than that of either MA or arterial lactate alone(0.89, range: 0.763-0.846; 0.58, range: 0.574-0.730; 0.77, range: 0.521-0.832; all P<0.05). Conclusions:The combination of thromboelastography maximum amplitude and lactate in arterial blood has important clinical value in assessing the prognosis of elderly patients with sepsis.
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Objective:To investigate the correlation between thromboelastography (TEG) and portal vein thrombosis in patients with cirrhotic esophagogastric varices.Methods:210 hospitalized patients with cirrhotic esophagogastric varices treated in Zhongshan Hospital Affiliated to Fudan University from December 2016 to December 2017 were retrospectively included. They were divided into portal vein thrombosis group (PVT group) and non portal vein thrombosis group (NPVT group) according to whether they were complicated with portal vein thrombosis. The correlation between the results of TEG coagulation reaction time (R value), coagulation time (K value), αAngle, maximum amplitude (MA) and coagulation composite index (CI) and portal vein thrombosis was analyzed. The characteristics of coagulation status in patients with portal vein thrombosis in cirrhosis were compared.Results:A total of 91 patients (43.3%) were complicated with portal vein thrombosis. The R value in the PVT group was significantly lower than that of NPVT group [5.49(5.22-5.77) vs 5.98(5.76-6.20), P=0.006]. Logistic regression analysis showed that Child Pugh grade ( OR=2.883, 95% CI: 1.630-5.098, P<0.001) and R value ( OR=0.739, 95% CI: 0.575-0.950, P=0.018) were independently associated risk factors of PVT. The R value of patients was significantly correlated with Child Pugh grade ( r=0.147, P=0.034), platelet ( r=-0.358, P<0.001), prothrombin time (PT) ( r=0.334, P<0.001) and international standardized ratio (INR) ( r=0.328, P<0.001). Conclusions:The decrease of TEG-R value is closely related to PVT in liver cirrhosis.
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Objective:To compare the effects of dexmedetomidine combined with propofol on anesthesia and thromboelastography in patients undergoing radical gastrectomy.Methods:From September 2017 to December 2019, 120 patients undergoing radical gastrectomy in Chaoyang Central Hospital were prospectively selected and divided into control group and observation group according to random number table method, with 60 cases in each group.The two groups used the same drugs before induction and the same way of anesthesia induction. During the maintenance of anesthesia, remifentanil and propofol were injected intravenously in the control group, and dexmedetomidine was injected in the observation group on the basis of the control group. The indexes of thromboelastography, preoperative and postoperative cellular immune function, postoperative analgesic effect [Visual Analogue Scale (VAS)], Ramsay sedation score, and postoperative adverse reactions were compared between the two groups at different times.Results:The reaction time of coagulation factor (R) and fibrinogen (K) in the two groups decreased 3 hours after operation, and those in the observation group were lower than those in the control group (all P<0.05); The maximum thrombus amplitude (MA) of the two groups increased 3 hours after operation, and MA in the observation group was higher than that in the control group (all P<0.05). Compared with that before operation, the VAS scores and Ramsay sedation scores in the control group and the observation group at 24 h and 48 h after operation were significantly lower (all P<0.05), and the VAS scores and Ramsay sedation scores in the observation group at 24 h and 48 h after operation were significantly lower than those in the control group (all P<0.05). Compared with that before operation, the CD4 +, CD8 +, CD4 + /CD8 + in the control group and the observation group were improved at 6 h and 48 h after operation (all P<0.05), and the improvement in the observation group was significantly better than that in the control group at 6 h and 48 h after operation (all P<0.05). The incidence of adverse reactions in the control group was 6.67%(4/60), which was slightly higher than that in the observation group of 5.00%(3/60), but the difference was not statistically significant ( P>0.05). Conclusions:Compared with propofol and remifentanil alone, combined application of dexmedetomidine can help patients undergoing radical gastrectomy for gastric cancer to achieve better analgesic effect, improve the blood coagulation state of patients, and play a better regulatory role on cellular immune function, which is worthy of further promotion in clinic.
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Objective:To investigate the correlation and predictive value of thromboelastography (TEG) in the severity and prognosis of patients with sepsis.Methods:Clinical data of 147 patients with sepsis admitted to Intensive Care Unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019 were retrospectively analyzed. Inflammation indicators and TEGt were performed within 24 h after admission, and APACHE Ⅱ score was evaluated. According to APACHE Ⅱ score, the patients were divided into the mild group and severe group. TEG indicators were compared between the two groups. Patients with sepsis were divided into the death group and survival group to assess the value of TEG for prognosis of patients with sepsis.Results:Compared with patients with mild sepsis, patients with severe sepsis had lower α angle ( P=0.015), longer K time ( P=0.015), and higher maximum amplitude ( P=0.045). The K time of the death group was significantly longer than that of the survival group. When K time ≥2.2 min (sensitivity 77.27% and specificity 95.2%), the risk of sepsis death was the highest ( P<0.001). Conclusions:Patients with severe sepsis show marked hypocoagulability, and K time has predictive value for the prognosis of patients with sepsis.
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Resumen Antecedentes: la enfermedad renal cursa con alteraciones de la hemostasia, lo que aumenta el riesgo de eventos trombóticos y hemorrágicos. Objetivo: describir las anormalidades de la coagulación en pacientes con urgencia dialítica según tromboelastografía y pruebas convencionales. Materiales y métodos: serie de casos de 60 pacientes adultos con urgencia dialítica. Se tomaron muestras de sangre previas al implante de catéter de hemodiálisis o de diálisis peritoneal y se procesaron para tromboelastografía y pruebas convencionales. Resultados: en la interpretación global del tromboelastograma se identificó estado hipercoagulable en 60 % de los pacientes. En el análisis individual de parámetros del trazado se demostraron alteraciones en la fase enzimática con ángulo-α, aumentado en el 61,7 % y tiempo R acortado en el 58,3 % de los casos, alteraciones en la fase celular con MA y G aumentados en cerca del 45 % y alteraciones en la estabilidad con hiperfibrinolisis en el 18 %. El aPTT estaba prolongado en 23,7 %. Conclusiones: en la interpretación global de la tromboelastografía de pacientes con urgencia dialítica, el hallazgo más frecuente es el estado hipercoagulable. En el análisis individual se encontraron alteraciones en todas las fases de la coagulación, siendo la más frecuente la formación acelerada del coágulo, seguida por aumento de la fuerza de este. La tromboelastografía debería ser considerada como una prueba enfocada en la cabecera del paciente para la valoración de la hemostasia en estos pacientes.
Abstract Background: Kidney disease causes alterations of hemostasis increasing the risk of thrombotic and hemorrhagic events. Objective: Describe coagulation abnormalities in patients with kidney disease and dialytic urgency according to thrombelastography and conventional tests. Materials and methods: Case series of 60 patients hospitalized due to dialytic urgency. Blood samples were taken prior to implantation hemodialysis catheter or peritoneal catheter, processed for thrombelastography and conventional tests. Results: In the global interpretation of the thrombelastography hypercoagulable state was identified in 60% of the patients. In the individual analysis of the parameters of the plot, alterations in the enzymatic phase were demonstrated with an increased angle-α in 61.7% and shortened R time in 58.3% of the cases, alterations in the cellular phase with increased MA and G by about 45% and hyperfibrinolysis in 18%. The aPTT was prolonged by 23.7% of cases. Conclusions: In the overall interpretation of the thrombelastography of patients with dialytic urgency, the most frequent disorder was the hypercoagulable state. In the individual analysis, alterations were found in all the phases of coagulation, the most frequent being the accelerated formation of the clot, followed by an increase in strength. Thrombelastography should be considered as point-of-care test for the assessment of hemostasis in these patients.
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Abstract Introduction Glanzmann thromboasthenia is a rare congenital bleeding disorder caused by a mutation in platelet glycoprotein α-IIb and β3 encoding genes (ITGA2B; 607759 and ITGB3; 173470) in chromosomes I7q21.31 and 17q21.32, respectively, which results in a qualitative or quantitative alteration of the platelet integrin αIIbβ3 (glycoprotein IIb/IIIa) receptor. Glanzmann thromboasthenia is classified as type I when less than 5% of glycoprotein αIIbβ3 is expressed, and as type II when more than 5% is expressed. Case presentation Description of the perioperative management of a 13-year-old female patient with Glanzmann thromboasthenia who underwent endoscopic anterior bilateral ethmoidectomy. Management was centered on prophylactic platelet transfusion plus the use of tranexamic acid, as well as thromboelastographic determination of hemostasis. There were no bleeding complications during or after the procedure. Conclusiones Pediatric patients with Glanzmann thromboasthenia are at a high risk of perioperastive bleeding. Platelet transfusion is the best prophylactic and therapeutic alternative; however, even in the absence of anti-platelet antibodies, it may not be effective, and viscoelastic testing must be used for assessment during the surgical procedure in order to improve patient safety.
Resumen Introducción La trombastenia de Glanzmann es un trastorno hemorrágico congénito infrecuente, causado por mutación en los genes que codifican las glucoproteínas plaquetarias α-IIb (ITGA2B; 607759) y β3 (ITGB3; 173470) en los cromosomas I7q2i.3i y I7q2i.32, respectivamente, alterando cualitativa o cuantitativamente al receptor plaquetario de integrina αIIbβ3 (glucoproteína IIb/IIIa). La trombastenia de Glanzmann se clasifica como tipo I cuando se expresa menos del 5 % de la glucoproteína αIIbβ3 y como tipo II, cuando es mayor al 5 %. Presentación del caso Se describe el manejo perioperatorio de una paciente de 13 años de edad con trombastenia de Glanzmann, sometida a etmoidectomía anterior bilateral endoscópica. El manejo se centró en la transfusión profiláctica de plaquetas y ácido tranexámico, así como en la evaluación de la hemostasia con tromboelastografía. No hubo complicaciones hemorrágicas durante y después del procedimiento. Conclusiones Los pacientes pediátricos con trombastenia de Glanzmann tienen alto riesgo de hemorragia perioperatoria. La transfusión de plaquetas es la mejor alternativa profiláctica y terapéutica; sin embargo, incluso en ausencia de anticuerpos antiplaquetarios, puede no ser efectiva y debe evaluarse mediante pruebas viscoelásticas durante los procedimientos quirúrgicos para mejorar la seguridad del paciente.
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Humans , Female , Adolescent , Thrombasthenia , Factor VIIa , Thrombelastography , Platelet Transfusion , Factor VII Deficiency , Genetic Diseases, InbornABSTRACT
【Objective】 To explore the effects of intraoperative autologous blood(ABT) transfusion on thrombelastography(TEG) in patients underwent neurosurgical procedures. 【Methods】 96 patients (49 males and 47 females) aged 15~79 years who received neurosurgical procedures in our hospital from November 2018 to November 2020 were retrospectively analyzed and divided into autologous blood transfusion group(Group A, n=52)and allogeneic blood transfusion group(Group B, n=44)according to different blood transfusion strategy in operation. The red blood transfusion status, hemoglobin (Hb), hematocrit (Hct), platelet (Plt), fibrinogen(Fib), prothrombin time (PT), activated partial thromboplastin time(APTT), and TEG parameters [activated clotting time(ACT), coagulation time (K), angle rate of clot formation(Angle), maximum amplitude(MA)] before and 1 day after surgery were compared between the two groups. 【Results】 The amount of average blood transfusion didn′t differ significantly by groups (P>0.05). The incidence of extra allogeneic blood transfusion was 17.3%(9/52) in group A, and the amount of average allogeneic blood transfusion in group A was significantly lower than that in group B(333.3±81.7 vs 639.8±258.2, P<0.05). Before operation, the differences in Hb, Hct, Plt, Fib, PT, APTT, ACT, K, MA and Angle levels between the 2 groups were not statistically significant (P>0.05). One day after operation, the Hb(g/L) (109.4±15.8 vs 97.0±15.1), Hct (%) (32.0±4.3 vs 28.3±6.1), Plt(×109/L)(154.2±54.2 vs 120.7±41.6), Fib(g/L)(2.2±0.5 vs 1.6±0.6), MA(mm)(65.0±7.2 vs 60.7±8.7) and Angle levels(deg)(69.1±5.2 vs 62.6±9.8) in group A were significantly higher than those in group B(P<0.05), and the PT(s)(11.9±1.5 vs 12.8±0.9), APTT(s)(27.4±3.3 vs 30.4±5.4), ACT(s)(111.0±14.9 vs 119.1±12.3) and K levels(min)(87.2±25.7 vs 106.4±28.0) in group A were significantly lower than those in group B (P<0.05). 【Conclusion】 Intraoperative ABT in patients underwent neurosurgical procedures can reduce allogeneic blood transfusion, has less effect on coagulation function and TEG, and is safe and effective.
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Objective: The transfusion of blood components and blood products in cardiac surgery patients can be guided by protocols based on standard laboratory tests and/or clinical decisions (Standardof-Care, SOC) or viscoelastic haemostatic assays (VHA). The aim of this study is to evaluate the cost-effectiveness and budget impact of VHAs compared to SOC. Methods: A decision tree model was built in TreeAge Pro® 2009. Costs and benefits were taken from the medical literature. The costeffectiveness was evaluated in a base-case scenario and a worst-case scenario, considering low costs of adverse events. The budget impact was evaluated from data taken from Datasus. Cost data were measured in 2019 USD and outcomes were measured in QALYs. Results: VHAs were considered dominant in the base-case scenario and very cost-effective in the worst-case scenario (ICER = $ 1,083.21 USD/QALY). The budget impact analysis varied from a cost-saving result in the base-case scenario to a reasonable increase in cost in the worst-case scenario. Since the total market share of the technology is unlikely, a reasonable estimative for the base-case scenario and the worst-case scenario are about -$275 million USD and $132 million USD, respectively. Conclusion: We conclude that the VHAs are cost-effective and should be recommended for the use in the perioperative period of cardiac surgeries, especially for patients with a high risk of hemorrhage or coagulation problems.
Objetivo: A transfusão de sangue, hemocomponentes e produtos sanguíneos em pacientes submetidos a cirurgia cardíaca pode ser guiada por protocolos baseados em testes laboratoriais padrão e/ou decisão clínica (Standard-of-Care, SOC) ou testes viscoelásticos (TVEs). O objetivo deste estudo é avaliar o custo-efetividade e o impacto orçamentário dos TVEs em comparação com o SOC. Métodos: Um modelo de árvore de decisão foi construído em TreeAge Pro® 2009. Os parâmetros de custos e benefícios foram obtidos da literatura médica. A relação custo-efetividade foi avaliada em um cenário-base e no pior cenário, considerando baixos custos de eventos adversos. O impacto orçamentário foi avaliado a partir de dados extraídos do Datasus. Os custos foram avaliados em USD 2019 e os desfechos em AVAQs. Resultados: Os TVEs foram considerados dominantes no cenário-base e muito custo-efetivos no pior cenário avaliado (RCEI = 1.083,21 USD/QALY). A análise de impacto orçamentário variou de um resultado de economia de custos no cenário-base a um aumento razoável no custo no pior cenário. Como a hipótese de que a tecnologia será adotada para toda a demanda do mercado é improvável, estimativas razoáveis para o cenário-base e o pior cenário são de aproximadamente -275 milhões de USD e 132 milhões de USD, respectivamente. Conclusão: Concluímos que os VHAs são econômicos e devem ser recomendados para uso no período perioperatório de cirurgias cardíacas, principalmente para pacientes com alto risco de problemas de hemorragia ou coagulação.
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Technology Assessment, Biomedical , Thoracic Surgery , Thrombelastography , Blood Coagulation , Cost-Effectiveness AnalysisABSTRACT
OBJECTIVES@#To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT.@*METHODS@#A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. -test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, -dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients.@*RESULTS@#There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all <0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy.@*CONCLUSIONS@#Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.
Subject(s)
Humans , Craniotomy , Postoperative Complications , Epidemiology , Postoperative Period , Risk Factors , Thrombophilia , Venous Thrombosis , EpidemiologyABSTRACT
Objective@#To explore the characteristics of thrombelastogaphy (TEG) in term neonates, and to evaluate their correlation with traditional coagulation tests.@*Methods@#A total of 52 term neonates were enrolled as neonatal group and 34 adults undergoing elective surgery as adult control group in Jiangmen Central Hospital from January to December 2017.TEG, plasma coagulation test and platelet counts (PLT) were performed and the corresponding ana-lysis was conducted.@*Results@#TEG parameters in term neonates: response time(R)(4.18±1.08)min, clot kinetics(K)(1.21±0.45) min, α angle (Angle)(73.08±5.74)°, maximum amplitude(MA)(65.68±7.13)mm.Compared with adult control group, neonatal group exhibited shorter R and K(t=3.764, P<0.001; t=4.888, P<0.001), higher Angle, MA(t=5.539, P<0.001; t=2.873, P=0.001). In traditional coagulation, compared with adult control group, neonatal group showed longer prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT) (t=5.449, P<0.001; t=13.134, P<0.001; t=3.575, P=0.001), lower fibrinogen(Fib) (t=4.164, P<0.001), and higher PLT (t=4.230, P<0.001). In addition, K was negatively correlated with Fib(r=-0.374, P=0.004), while Angle and MA were positively correlated with Fib(r=0.354, P=0.007; r=0.630, P<0.001); K was negatively correlated with PLT(r=-0.430, P=0.001), but Angle and MA were positively correlated with PLT (r=0.427, P=0.001; r=0.586, P<0.001); K was positively correlated with APTT(r=0.285, P=0.035), and MA was negatively correlated with APTT(r=-0.324, P=0.017). There was no significant correlation between R and traditional coagulation test.K, MA and Angle were not significantly correlated with PT (all P>0.05), and Angle and APTT were not significantly correlated (all P>0.05).@*Conclusions@#The reference interval of TEG in term neonates is different from adults.And the parameters of TEG in term neonates are partly related to the traditional coagulation tests.
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Objective:To explore the value of thrombelastography in long-term prognosis for patients with cerebral infarction. Methods:From January, 2015 to July, 2017, 255 patients with cerebral infarction hospitalized were selected. Thrombelastography and routine coagulation test (four coagulation and platelets) were tested after patients' admission. And thrombelastographic test was performed again 3 months after discharge. The patients were followed up for a year by outpatient visits or telephone contact. According to whether cerebral infarction recurred, they were divided into unfavorable prognosis group (n = 51) and favorable prognosis group (n = 204), and the difference of thrombelastography and routine coagulation test were compared between the two groups. Results:There was no statistically significant difference in total cholesterol, triglyceride, low density lipoprotein cholesterol, diabetes, hypertension, smoking, scores of National Institutes of Health Stroke Scale, and administration of antiplatelet drugs between the two groups (P > 0.05); There was no statistically significant difference in thrombin time, prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet in routine coagulation test between the two groups (P > 0.05). Compared to the favorable prognosis group at admission, reaction time and kinetics time of thrombelastographic test shortened significantly, while rate of clot strengthening and maximum amplitude increased significantly in the unfavorable prognosis group (P < 0.05); three months after discharge, only maximum amplitude increased significantly (P < 0.05) while there was no significant difference in reaction time, kinetics time and rate of clot strengthening in the unfavorable prognosis group (P > 0.05). Conclusion:Abnormal parameters of thrombelastographic test may indicate hypercoagulability in blood in the patients with cerebral infarction which predicts unfavorablein long-term outcome.
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Objective@#To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.@*Methods@#We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018. The definition of TIC is prothrombin time (PT) 18 s, international normalized ratio (INR) 1.5, activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100×109/L. The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.@*Results@#A total of 242 patients were included, including 62 patients in the TIC group and 180 patients in the non-TIC group. The differences in TEG between the two groups were statistically significant. The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest, 0.779 and 0.786 respectively, and the sensitivity were greater than 80% and NPV were greater than 90%. The sensitivity, PPV and NPV of reaction time (R) were minimal. After confounders were controlled, all TEG values were correlated with blood volumes within the first 24 h and massive transfusion, of which R had the highest odds ratio and regression coefficient.@*Conclusions@#MA and CI have the highest diagnostic value, while R has little diagnostic value but a relatively large blood therapeutic significance of TIC. MA < 52.9 mm or CI < -1.0 can be used as a threshold for identifying TIC. The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.
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Objective@#To investigate the predictive value of thromboelastography (TEG) for early neurological deterioration (END) in patients with acute ischemic stroke.@*Methods@#Patients with acute ischemic stroke admitted to the Department of Neurology, Jiujiang Hospital Affiliated to Nanchang University from January 2018 to May 2019 were included as case group, and the healthy physical examinees in the same period were selected as control group. END was defined as an increase of ≥2 of the National Institutes of Health Stroke Scale score from baseline within 7 d after the onset of acute ischemic stroke. All subjects were routinely tested for traditional coagulation function, including prothrombin time, activated partial thromboplastin time, thrombin time, and plasma fibrinogen level. The reaction time (R value), coagulation time (K value), coagulation angle (α) and maximum amplitude (MA value) were monitored by TEG. Univariate analysis was used to compare the differences in clinical and laboratory results between the END group and the non-END group, and then multivariate logistic regression analysis was used to determine the independent risk factors for END.@*Results@#A total of 96 patients with acute ischemic stroke and 20 controls were included. Compared with the control group, the traditional coagulation parameters of the case group were not significantly different. For the TEG parameter, compared with the control group, the R value and K value of the case group were significantly shortened, and the α angle and MA value were significantly increased (all P<0.05). A total of 31 patients (32.3%) developed END, and the R and K values in the END group were significantly shorter than those in the non-END group (all P<0.05). Multivariate logistic regression analysis showed that R value (odds ratio 1.192, 95% confidence interval 1.006-1.410; P=0.001) and K value (odds ratio 1.054, 95% confidence interval 1.012-1.150; P=0.001) shortening were the independent predictors of END.@*Conclusion@#The sensitivity of TEG in the monitoring of coagulation function in patients with acute ischemic stroke is higher than that of traditional coagulation indicators. The shortenings of R and K values are independent predictor of END in patients with acute ischemic stroke.
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Objective To explore the characteristics of thrombelastogaphy( TEG)in term neonates,and to evaluate their correlation with traditional coagulation tests. Methods A total of 52 term neonates were enrolled as neo-natal group and 34 adults undergoing elective surgery as adult control group in Jiangmen Central Hospital from January to December 2017. TEG,plasma coagulation test and platelet counts(PLT)were performed and the corresponding ana-lysis was conducted. Results TEG parameters in term neonates:response time(R)(4. 18 ± 1. 08)min,clot kinetics (K)(1. 21 ± 0. 45)min,α angle( Angle)(73. 08 ± 5. 74)°,maximum amplitude( MA)(65. 68 ± 7. 13)mm. Com-pared with adult control group,neonatal group exhibited shorter R and K(t=3. 764,P<0. 001;t=4. 888,P<0. 001), higher Angle,MA(t=5. 539,P<0. 001;t=2. 873,P=0. 001). In traditional coagulation,compared with adult control group,neonatal group showed longer prothrombin time( PT),activated partial thromboplastin time( APTT),thrombin time(TT)(t=5. 449,P<0. 001;t=13. 134,P<0. 001;t=3. 575,P=0. 001),lower fibrinogen( Fib)(t=4. 164, P<0. 001),and higher PLT(t=4. 230,P<0. 001). In addition,K was negatively correlated with Fib(r= -0. 374, P=0. 004),while Angle and MA were positively correlated with Fib(r=0. 354,P=0. 007;r=0. 630,P<0. 001);K was negatively correlated with PLT(r= -0. 430,P=0. 001),but Angle and MA were positively correlated with PLT (r=0. 427,P=0. 001;r=0. 586,P<0. 001);K was positively correlated with APTT(r=0. 285,P=0. 035),and MA was negatively correlated with APTT(r= -0. 324,P=0. 017). There was no significant correlation between R and tra-ditional coagulation test. K,MA and Angle were not significantly correlated with PT(all P >0. 05),and Angle and APTT were not significantly correlated(all P>0. 05). Conclusions The reference interval of TEG in term neonates is different from adults. And the parameters of TEG in term neonates are partly related to the traditional coagulation tests.
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Objective To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.Methods We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018.The definition of TIC is prothrombin time (PT) 18 s,international normalized ratio (INR) 1.5,activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100 x 109/L.The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve,area under the curve (AUC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV),and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.Results A total of 242 patients were included,including 62 patients in the TIC group and 180 patients in the non-TIC group.The differences in TEG between the two groups were statistically significant.The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest,0.779 and 0.786 respectively,and the sensitivity were greater than 80％ and NPV were greater than 90％.The sensitivity,PPV and NPV of reaction time (R) were minimal.After confounders were controlled,all TEG values were correlated with blood volumes within the first 24 h and massive transfusion,of which R had the highest odds ratio and regression coefficient.Conclusions MA and CI have the highest diagnostic value,while R has little diagnostic value but a relatively large blood therapeutic significance of TIC.MA ＜ 52.9 mm or CI ＜-1.0 can be used as a threshold for identifying TIC.The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.
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Objective To analyze the correlation between thrombelastography (TEG) and conventional coagulation indexes in breast cancer patients, and to compare the differences between the two methods in the detection of coagulation function in breast cancer patients.Methods Retrospectively analyzed the clinical data of180patients with breast cancer who were performed TEG, coagulation and blood test in the same day in our hospital from November 2016to May 2017.Linear correlation and regression analysis were performed among the parameters.The differences of positive rates of TEG parameters and conventional coagulation indexes were compared.Results The R value of TEG parameters of breast cancer patients was positively correlated with K and APTT, and negatively correlated withα-Angle, MA, CI, DD, FDPs.K was positively correlated with APTT and TT, and negatively correlated withα-Angle, MA, FIB, DD, FDPs and PLT.α-Angle was positively correlated with MA, CI, FIB, DD, FDPs and PLT.MA was positively correlated with CI, FIB, DD, FDPs and PLT.CI was positively correlated with FIB, DD, FDPs and PLT.α-Angle, MA and CI were all negatively correlated with APTT and TT, the difference were statistically significant (P＜0.05).A linear regression equation of TEG parameters and coagulation indexes was obtained.There was no significant difference between TEG detection positive rate and conventional coagulation test (P＞0.05).Conclusion There are significant correlation between the TEG parameters and routine coagulation or platelet, and the results are consistent.
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Objective To discuss the diagnosis effect and clinical significance of thrombelastography in chronic kidney disease. Methods From June 2016 to February 2017, two hundred and seventy non-dialysis patients with chronic kidney disease ( CKD) treated in the Fourth Hospital of Hebei Medical University were divided into non-hypercoagulable group and hypercoagulable group according to TEG comprehensive coagulation index. The changes of related clinical indexes between the two groups were analyzed and the related factors affecting the differences between the two groups were studied. Results The correlation between the two groups showed that the coagulation reaction time ( R ) , coagulation formation time ( K ) and albumin in the hypercoagulable group were significantly lower than those in the non-hypercoagulable group ((4. 69±0. 94) min vs. (6. 29±1. 63) min,(0. 93±0. 13) min vs. (1. 51±0. 58) min,(27. 54±7. 81) g/L vs. (34. 26±8. 39) g/L, P= 0. 000 ) Angle angle, maximum thrombus strength ( MA ) , fibrinogen, D-dimer, platelet count, protein/creatinine and protein content in hypercoagulable group were significantly higher than those in non-hypercoagulable group((76. 76±2. 23)°vs. (68. 19±7. 65)°;(75. 13±3. 81)mm vs. (66. 35±7. 81)mm;(4. 28 ±0. 93) g/L vs. (3. 56±1. 10) g/L ;0. 4(0. 15,0. 91) mg/L vs. 0. 22(0. 12,0. 52) mg/L;(276. 03±127. 15) ×109/L vs. (198. 18±78. 46)×109/L;5430(2579,9634) mg vs. 2620(692,5286) mg;4864(2341,7712) mg/g vs. 2557(840,5805) mg/g,P<0. 05). The differences were statistically significant. There was no significant difference in prothrombin, thromboplastin time, thrombin time, total cholesterol, triglyceride, low density lipoprotein,high density lipoprotein,creatinine between the two groups ( P>0. 05) . Correlation analysis of common clinical indicators showed that the comprehensive coagulation index ( CI) was positively correlated with Angle angle,maximum thrombus strength,fibrinogen,platelet count,protein/creatinine and protein quantification (r=0. 532,0. 522,0. 307,0. 354,0. 293,0. 216,P<0. 05),was negatively correlated with coagulation reaction time,coagulation formation time and albumin (r=- 0. 462,- 0. 496,- 0. 360,P<0. 05). Logistic regression analysis showed that platelet count, albumin and fibrinogen were the influencing factors for the grouping of comprehensive coagulation index ( OR ( 95％CI ) :1. 007 ( 1. 002-1. 013 ) , 0. 868 ( 0. 827-0. 912 ) , 1. 510 (1. 042-2. 187),P<0. 05). Conclusion TEG is a more sensitive indicator to reflect the coagulation status of patients with CKD, and has a certain guiding significance for anticoagulation treatment of patients with CKD;platelet count,albumin,fibrinogen are the factors affecting coagulation function of patients.