Résumé
Computer simulations can come in handy to train medical personnel with necessary skills to face the clinical scenarios involving various coagulopathies. Now a days, point of care (POC) devices such as thromboelastography, Sonoclot analyzer and newly approved rotational thromboelastometry (ROTEM) with faster results to assess coagulopathies are available on bedside of patients. ROTEM is emerging as a quick, portable, and well‑validated device to evaluate coagulopathy in critical care and perioperative setup. A novel platelet‑aggregometry integrated module enables simultaneous analysis of platelets as well as coagulation tests on the same screen. The entire gamut of POC signature curves obtained with different coagulation defects can be learned with graphical simulations. These simulations can be a valuable strategy to elucidate latent conditions, for which simulation interventions can then be designed to mimic different clinical scenarios.
Résumé
INTRODUCCIÓN: los fenómenos trombóticos son más frecuentes en las coronarias y, al parecer, los cambios que produce la enfermedad aterosclerótica en la reología y en la superficie endotelial son los responsables de este fenómeno. OBJETIVO: cuantificar la diferencia en la agregación plaquetaria de sangre venosa coronaria y sangre venosa periférica en pacientes con enfermedad coronaria severa. METODOLOGÍA: se seleccionaron pacientes mayores de treinta años, con enfermedad coronaria severa, de quienes se obtuvieron muestras de sangre periférica y del seno coronario, y se realizaron agregaciones plaquetarias por el método de absorbancia con ADP 10 mmol, ácido araquidónico (AA), epinefrina (Epi) 300 mmol y colágeno 10 mg/mL. RESULTADOS: se incluyeron en total 32 pacientes con edad promedio de 65 más o menos 10 años, 22 hombres, 10 (31 porciento) pacientes con enfermedad estable y 22 (69 porciento) con inestable. La agregación plaquetaria en sangre del seno coronario fue mayor con todos los agonistas usados, así: ADP 61,8 porciento vs. 53,4 porciento (p= 0,001), AA 15,1 porciento vs. 13,8 porciento (p= 0,48), colágeno 72,6 porciento vs. 69,2 porciento (p= 0,048) y Epi 58 porciento vs. 51,6 porciento (p= 0,01). Los pacientes con enfermedad inestable muestran una mayor agregación con ADP en el seno coronario: 58,5 porciento vs. 49,2 porciento (p= 0,001) y no hay diferencias en los inestables. La resistencia a la Aspirina fue similar (p= 1), sin embargo la resistencia al clopidogrel fue mayor en el seno coronario: 56 porciento vs. 48 porciento (p= 0,24).
INTRODUCTION: thrombotic events are more frequent in the coronary arteries and apparently the changes in rheology and endothelial surface produced by atheroesclerotic disease are responsible for this phenomenon. OBJETIVE: quantify the difference in platelet aggregation of coronary venous blood and peripheral venous blood in patients with severe coronary disease. METHODOLOGY: we selected patients older than 30 years with severe coronary disease and obtained samples of peripheral and coronary sinus blood. Platelet aggregation was realized by the absorbance method with ADP 10 mmol, arachidonic acid (AA), epinephrine (Epi) 300 mmol and collagen 10 ug/mL. RESULTS: we included a total of 32 patients with mean age 65 more or less 10 years. 22 were men; 10 patients (31 percentage) had stable disease and 22 (69 percentage) unstable disease. Platelet aggregation in coronary sinus blood was higher with all agonists used as follows: ADP 61.8 percentage vs. 53.4 percentage (p = 0.001), AA 15.1 percentage vs.13.8 percentage (p = 0.48), collagen 72.6 percentage vs. 69.2 percentage (p = 0.048) and Epi 58 precentage vs. 51.6 percentage (p = 0.01). Patients with unstable disease show increased aggregation with ADP in the coronary sinus 58.5 percentage vs. 49.2 percentage (p = 0.001) and there are no differences in the unstable. Aspirin resistance was similar (p = 1); however, clopidogrel resistance was higher in the coronary sinus 56 percentage vs. 48 percentage (p = 0.24). CONCLUSION: we describe the presence of higher platelet aggregation in the coronary sinus of patients with atheroesclerotic disease that is significant for ADP, collagen and epinephrine, and suggest the appearance of local factors associated with the coronary disease that increase platelet aggregation. Peripheral platelet aggregation doesn't reflect the local behavior in patients with coronary atheroesclerosis.