Activation of coagulation in chronic urticaria in relation to disease severity and activity

BACKGROUND: The pathogenesis of chronic urticaria is incompletely understood. There is growing interest in the role of the coagulation cascade in chronic urticaria. We aimed to assess the possible activation of the coagulation cascade in chronic spontaneous urticaria (CSU) in relation to disease severity and activity. METHODS: This study was conducted on 30 patients with active CSU and 30 apparently healthy individuals as controls. Patients with acute urticaria, physical urticaria, or any form of urticaria other than spontaneous urticaria were excluded. Plasma levels of D-dimer and activated factor VII (FVIIa) were measured by ELISA at baseline for all recruited patients and controls. In addition, they were measured for CSU patients after complete disease remission. RESULTS: Plasma levels of D-dimer and FVIIa were significantly higher among patients with active CSU than among healthy controls. D-dimer levels were lowest among patients with grade 1 severity and highest among those with grade 4 severity. Factor VIIa levels did not differ significantly according to disease severity grades. After complete disease remission, there was a significant dramatic drop in levels of D-dimer and FVIIa among patients. CONCLUSION: We conclude that activation of the coagulation cascade occurs in CSU, and we demonstrate the novel finding that activated factor VII levels are significantly reduced after medical therapy, confirming the implication of the extrinsic pathway activation in CSU. Future controlled studies may investigate the role of anticoagulant therapy in refractory chronic urticaria

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A comparison of coagulation study results between heparinized peripherally inserted central catheters and venipunctures.

PURPOSE/OBJECTIVE: The purpose of this study was to test an evidence-based procedure of drawing blood samples for coagulation testing from heparinized peripherally inserted central catheter (PICC) by comparing results with blood drawn from venipuncture (VP). DESIGN: A prospective, quasi-experimental design using purposive sampling was used. SETTING: The setting was a 230-bed community hospital located in the Southwest. The hospital is part of a 15-hospital system. SAMPLE: : The sample was composed of 30 hospitalized patients with heparinized PICCs. METHODS: Informed consent was obtained. Using aseptic technique, samples of blood were drawn via VP and from the PICC using the evidence-based procedure. Data were analyzed using Pearson product moment correlations and Bland-Altman analysis. FINDINGS: For 5 coagulation tests studied, correlations between PICC values and VP values ranged from 0.990 to 0.998, indicating almost perfect correlations. In Bland-Altman analyses, mean biases and SDs were small to moderate for prothrombin time, 0.13 seconds (-0.55 to 0.81 seconds) (P = 0.0484); international normalized ratio, 0.010 (-0.050 to 0.070) (P = 0.085); partial thromboplastin time, 2.16 seconds (-5.10 to 9.43 seconds) (P = 0.0033); and fibrinogen, -18.2 mg (-70.4 to 34.1 mg) (P = 0.0033) and 0.52 (-0.73 to 1.77) seconds (P = 0.0003). Correlations of absolute difference versus average ranged from 0.18 to 0.49. Only the paired international normalized ratio samples had P values suggesting nonagreement. CONCLUSIONS: Drawing blood samples from heparinized PICCs for coagulation tests using the evidence-based procedure developed for this study resulted in accurate coagulation test results in 4 of the 5 tests: prothrombin time, partial thromboplastin time, and fibrinogen in seconds and in milligrams.

Anticoagulant monitoring in ventricular assist device patients: a feasibility study.

We conducted a feasibility study to monitor coagulation using a point-of-care device (proTime micro coagulation system) in ventricular assist device (VAD) patients. The aim of the study was to compare International Normalized Ratio (INR) readings using a standard laboratory method and proTime micro coagulation device in order to confirm a correlation between these two methods. The nurse's feedback about anticoagulation monitoring using portable anticoagulant monitoring devices in the hospital was also assessed. Four patients admitted in the cardiac surgery unit at University of Maryland, Baltimore were enrolled between 25 November 2006 and 20 December [corrected] 2006. These patients had given consent to undergo both venous and finger-stick blood samplings to monitor their anticoagulant levels. Six hospital nurses participated in the study. Forty-one INR readings were compared using both methods. Correlation coefficients determined association between INR readings using two methods. All the patients were males and were hypertensive. Significant positive association was seen in the INR readings using two methods (r=0.96; P<0.0001). Four of the six nurses believed patients would be significantly safer if INR is monitored by VAD patients in their homes. Further research needs to be done to determine the impact of home INR monitoring and long-term health in these patients.

Assessing the bleeding patient: factors affecting hemostasis and common coagulation studies.

This column discusses the factors affecting hemostasis and the common coagulation studies used to assess patients with bleeding disorders.

Assessment of red blood cell and coagulation laboratory data.

Critically ill patients present with a myriad of hematologic problems of various etiologies. The astute advanced practice nurse carefully reviews laboratory data incorporating principles of diagnostic reasoning and critical thinking while developing the plan of care. An in-depth understanding of hematology including red blood cells, red blood cell indices, and coagulation laboratory data is essential in the quest to understand the patient's pathophysiology. With every decade, nurses and physicians learn more about diseases that have plagued mankind for centuries--learning in greater detail about the deleterious effects and subsequent outcomes that often begin as subtle changes in traditional laboratory data. Greater focus on interpreting hematologic data and seeking support for diagnoses in clinical correlates will serve nurses well. This article intends to move advanced practice nurses beyond their current understanding of hematologic values--enabling them to understand that how and why we measure is as important as what we measure. No longer is it enough to simply measure physiologic data to develop a care plan driven by the patient's diagnoses. The contemporary nurse understands the importance of assigning meaning to data. Meaningful data are manageable data.