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F Lehmann, J Rau, B Malcolm, M Sander, C von Heymann, T Moormann, T Geyer, F Balzer, K D Wernecke, L Kaufner
BACKGROUND: Adult cardiac surgery is often complicated by elevated blood losses that account for elevated transfusion requirements. Perioperative bleeding and transfusion of blood products are major risk factors for morbidity and mortality. Timely diagnostic and goal-directed therapies aim at the reduction of bleeding and need for allogeneic transfusions. METHODS: Single-centre, prospective, randomized trial assessing blood loss and transfusion requirements of 26 adult patients undergoing elective cardiac surgery at high risk for perioperative bleeding...
February 18, 2019: BMC Anesthesiology
Margaret R Passmore, Nchafatso G Obonyo, Liam Byrne, Ai-Ching Boon, Sara D Diab, Kimble R Dunster, Yoke L Fung, Michelle M Spanevello, Mohd H Fauzi, Sanne E Pedersen, Gabriela Simonova, Chris M Anstey, Kiran Shekar, John-Paul Tung, Kathryn Maitland, John F Fraser
INTRODUCTION: Fluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock. MATERIALS AND METHODS: Twenty-one adult female sheep were randomly divided into no endotoxemia (n = 5) or endotoxemia groups (n = 16) with an escalating dose of lipopolysaccharide (LPS) up to 4 μg/kg/h administered to achieve a mean arterial pressure below 60 mmHg...
February 12, 2019: Thrombosis Research
Ali Akbar Hajiagha Mohammadi, Mohammad Reza Azizi
BACKGROUND AND STUDY AIMS: Acute upper gastrointestinal bleeding is one of the main causes of hospitalisation. The purpose of this study was to determine the prognostic factors in non-variceal upper gastrointestinal bleeding. PATIENTS AND METHODS: Clinical outcomes, demographic and laboratory variables of the subjects were collected from the HIS software and national code with the SQL format from three hospitals in Qazvin. The data were linked to the database software designed by the author...
February 12, 2019: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
Gerhard Cvirn, James E Waha, Bianca Brix, Andreas Rössler, Andreas Jantscher, Axel Schlagenhauf, Martin Koestenberger, Willibald Wonisch, Thomas Wagner, Nandu Goswami
We investigated whether lower body negative pressure (LBNP) application leads to coagulation activation in whole blood (WB) samples in healthy men and women. Twenty-four women and twenty-one men, all healthy young participants, with no histories of thrombotic disorders and not on medications, were included. LBNP was commenced at -10 mmHg and increased by -10 mmHg every-five minutes until a maximum of -40 mmHg. Recovery up to 10 minutes was also monitored. Blood samples were collected at baseline, at end of LBNP, and end of recovery...
February 14, 2019: Journal of Applied Physiology
Marcel Tomaszewski, Marc Bienz, Omar Kherad, Sophie Restellini, Tania Laflèche, Alan Barkun, Margaret Warner, Talat Bessissow
INTRODUCTION: Haemophilia A and haemophilia B, von Willebrand disease (VWD), factor VII deficiency and factor XI deficiency are congenital bleeding disorders predisposing to bleeding during invasive procedures. The ageing population of people with congenital bleeding disorders will likely increasingly require gastrointestinal endoscopy. The bleeding risk postgastrointestinal endoscopy and optimal prophylactic treatment regimens are not well described. METHODS: We performed a retrospective chart review at the McGill University Health Centre...
February 12, 2019: Haemophilia: the Official Journal of the World Federation of Hemophilia
Kazuhiro Sugiyama, Hiroshi Fujita, Shigeko Nishimura
BACKGROUND: Hypofibrinogenaemia is a common complication of multiple trauma with severe traumatic brain injury (Abbreviated Injury Scale score of the head ≥4; body ≥3). In Japan, neither fibrinogen concentrate nor cryoprecipitate is permitted to treat acquired hypofibrinogenaemia with the purpose of rapidly restoring a haemostatic level of fibrinogen. The aim of this study was to investigate transfusion usage and mortality in patients with multiple trauma and severe traumatic brain injury who were given a cryoprecipitate prepared in-house, comparing those administered the product early or later...
January 22, 2019: Blood Transfusion, Trasfusione del Sangue
Ai Leen Ang, Wan Hui Wong, Jeslyn Tan, Heng Joo Ng, Chuen Wen Tan, Ponnudurai Kuperan, Sally Lam, Hwee Huang Tan, Sze Sze Chua
BACKGROUND/OBJECTIVES: We compared the ex vivo haemostatic capacity of RTFP24 with FFP upon thawing and >24 h post-thaw. We included thrombin generation (TG) as few studies had compared global haemostatic function, and most did not directly compare RTFP24 with FFP >24 h post-thaw. MATERIALS/METHODS: Twenty units each of RTFP24 and FFP were measured for coagulation factors and thrombin generation upon thawing (D0) and 4 days post-thaw (D4). Labile factors were also measured from D1 to D3...
February 7, 2019: Vox Sanguinis
Rebecca Kruse-Jarres, Johannes Oldenburg, Elena Santagostino, Midori Shima, Christine L Kempton, Craig M Kessler, Michaela Lehle, Sammy Chebon, Nives Selak Bienz, Elina Asikanius, Johnny Mahlangu
INTRODUCTION: Prospectively collected real-world data on bleeds, haemophilia treatment and safety in persons with haemophilia A (PwHA) without factor VIII (FVIII) inhibitors are limited. A global, non-interventional study (NIS; NCT02476942) prospectively collected real-world data in PwHA who were treated per local routine clinical practice. AIM: Assess annualized bleeding rate (ABR), haemophilia treatment practices and adverse events (AEs) in adult/adolescent PwHA without inhibitors...
February 6, 2019: Haemophilia: the Official Journal of the World Federation of Hemophilia
Magnus Strøh Schmidt, Louise Preisler, Rasmus Fabricius, Peter Svenningsen, Jens Hillingsø, Lars Bo Svendsen, Martin Sillesen
INTRODUCTION: Treatment-requiring acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common, potentially life-threatening emergency. This study investigated whether hospital admittance volume of patients with NVUGIB was associated with reduced mortality, reduced lasting failure of haemostatic procedures defined as rate of re-endoscopy with repeated haemostasis intervention (ReWHI), transfusion requirements and conversion to surgery. METHODS: Data on Danish nationwide admissions of patients with acute NVUGIB from 2011-2013 were analysed to estimate 30-day mortality, re-bleeding (ReWHI), transfusion rates and rates of conversion to surgery...
February 2019: Danish Medical Journal
Mirela Bojan
A primary goal of improving neonatal cardiopulmonary bypass has been making the circuit smaller and reduce the blood contacting surfaces. As bypass circuit size has decreased, bloodless surgery has become possible even in neonates. Since transfusion guidelines are difficult to construct based on existing literature, these technical advances should be taken advantage of in conjunction with an individualized transfusion scheme, based on monitoring of oxygen availability to the tissues. For the majority of neonatal heart operations, several centres have shifted towards normothermic bypass even for complex neonatal surgeries, in order to avoid the adverse effects of hypothermia...
February 3, 2019: Paediatric Anaesthesia
Matthew Welch, J Barratt, A Peters, C Wright
INTRODUCTION: Haemorrhage is one of the leading causes of battlefield and prehospital death. Haemostatic dressings are an effective method of limiting the extent of bleeding and are used by military forces extensively. A systematic review was conducted with the aim of collating the evidence on current haemostatic products and to assess whether one product was more effective than others. METHODS: A systematic search and assessment of the literature was conducted using 13 health research databases including MEDLINE and CINAHL, and a grey literature search...
February 2, 2019: Journal of the Royal Army Medical Corps
Sirak Petros
Trauma-induced coagulopathy (TIC) is a heterogeneous entity that contributes to a significant morbidity and mortality following trauma. The activated protein C system, endotheliopathy and platelet dysfunction have been implicated in the pathogenesis of TIC, although there are still controversies on the exact pathogenesis. TIC can be modified by hypoperfusion, acidosis, hypothermia, haemodilution, underlying disease conditions, pre-injury medications as well as genetic predispositions. Current definition of this syndrome is based on laboratory abnormalities that do not easily allow a distinction between adaptive and maladaptive changes of the haemostatic system...
January 31, 2019: Hämostaseologie
Pierre Chelle, Aurélie Montmartin, Pauline Damien, Michèle Piot, Michel Cournil, Anne Lienhart, Fabienne Genre-Volot, Hervé Chambost, Claire Morin, Brigitte Tardy-Poncet
The thrombin generation (TG) assay evaluates haemostatic balance, which is influenced by the levels of many coagulation factors and inhibitors. Our objective was to identify the determinant factors of TG in haemophilia A (HA) and haemophilia B (HB) patients and to compare them to those in healthy controls. Coagulation factor and inhibitor levels, and TG, were measured in platelet-poor plasma from 40 patients with HA, 32 patients with HB and 40 healthy subjects. Data were analysed using multiple regression models...
January 28, 2019: Haemophilia: the Official Journal of the World Federation of Hemophilia
Viola Denzinger, Kristina Busygina, Janina Jamasbi, Isabell Pekrul, Michael Spannagl, Christian Weber, Reinhard Lorenz, Wolfgang Siess
Ibrutinib and acalabrutinib are approved for B cell malignancies and novel Bruton's tyrosine kinase (Btk) inhibitors undergo clinical testing also in B cell-driven autoimmune disorders. Btk in platelets mediates platelet activation via glycoprotein (GP) VI, which is crucial for atherosclerotic plaque-induced platelet thrombus formation. This can be selectively inhibited by Btk inhibitors. Since patients on second-generation Btk inhibitors apparently show less bleeding than patients on ibrutinib, we compared the effects of ibrutinib and four novel irreversible Btk inhibitors on GPVI-dependent platelet aggregation in blood and in vitro bleeding time...
January 27, 2019: Thrombosis and Haemostasis
Dina Vara, Eugenia Cifuentes-Pagano, Patrick J Pagano, Giordano Pula
The regulation of platelets by oxidants is critical for vascular health and may explain thrombotic complications in diseases such as diabetes and dementia, but remains poorly understood. Here, we describe a novel technique combining electron paramagnetic resonance spectroscopy and turbidimetry, which has been utilised to monitor simultaneously platelet activation and oxygen radical generation. This technique has been used to investigate the redox-dependence of human and mouse platelets. Using selective peptide inhibitors of NOXs on human platelets and genetically modified mouse platelets (NOX1-/- or NOX2-/-), we discovered that:1) intracellular but not extracellular superoxide anion generated by NADPH oxidases (NOXs) is critical for platelet activation by collagen; 2) superoxide dismutation to hydrogen peroxide is required for thrombin-dependent activation; 3) NOX1 is the main source of oxygen radicals in response to collagen, while NOX2 is critical for activation by thrombin; 4) two platelet modulators, namely oxidised low density lipoproteins (oxLDL) and amyloid peptide β (Aβ), require activation of both NOX1 and NOX2 to pre-activate platelets...
January 24, 2019: Haematologica
A Poggetti, A Del Chiaro, M Nicastro, P Parchi, N Piolanti, M Scaglione
Hardware removal after surgical treatment fracture is one of the most common procedures in orthopaedic daily activity. A percentage from 14.5 to 21 of total removal involves the ankle joint. Trying to reduce the important socio-economic impact of this surgical procedure, we thought to perform it using the Wide Awake Local Anaesthesia Without Tourniquet (WALANT), a particular technique presented by D. Lalonde that associated a local anaesthetic drug with epinephrine in order to obtain an effective haemostatic effect despite the lack of a tourniquet...
November 2018: Journal of Biological Regulators and Homeostatic Agents
Juxian Tang, Yihui Lin, Huachao Mai, Yiping Luo, Renwei Huang, Qi Chen, Duan Xiao
Previously reported haemostatic reference intervals in normal pregnancy displayed considerable contradictions to establish convince gestational age-related haemostatic reference values. 30 clinical reports were recruited to collect and assemble existing clinical reports from the database D-dimer levels increased progressively with gestational ages and exceeded conventional value of 1 mg/L after 29-36 weeks, and reached a peak at 24 h postpartum with mean value of 6.44 mg/L [95% confidence interval (CI): 5...
January 2019: Taiwanese Journal of Obstetrics & Gynecology
Richard Crook, Kyrie Wheeler
Sickle cell anaemia results from homozygosity of an A-T point mutation leading to a substitution of glutamic acid for valine at point 6 of the β-globin gene. A person with sickle cell trait inherits one normal and one mutated allele. Patients with sickle cell anaemia, and to a lesser extent sickle cell trait, have a wide spectrum of haemostatic abnormalities. Here we describe the problems faced in obtaining an accurate activated clotting time measurement, in a patient with sickle cell trait, prior to commencement of cardiopulmonary bypass for decannulation of Berlin Heart...
January 10, 2019: Perfusion
Anne Godier, Dephine Garrigue, Dominique Lasne, Pierre Fontana, Fanny Bonhomme, Jean-Philippe Collet, Emmanuel de Maistre, Brigitte Ickx, Yves Gruel, Mikael Mazighi, Philippe Nguyen, André Vincentelli, Pierre Albaladejo, Thomas Lecompte
The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR), drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposals were discussed and validated by a vote; all proposals could be assigned with a high strength. Management of oral antiplatelet agents in emergency settings requires knowledge of their pharmacokinetic and pharmacodynamic parameters, evaluation of the degree of alteration of haemostatic competence and the associated bleeding risk...
January 5, 2019: Archives of Cardiovascular Diseases
Herbert Kaltner, Hans-Joachim Gabius
Although a plethora of players has already been revealed to be engaged in the haemostatic system, a fundamental consideration of the molecular nature of information coding can give further explorations of the mechanisms of blood clotting, platelet functionality and vascular trafficking direction. By any measures, looking at ranges of occurrence and of potential for structural versatility, at strategic positioning to influence protein and cell sociology as well as at dynamics of processing and restructuring for phenotypic variability, using sugars as an alphabet of life for generating the glycan part of glycoconjugates is a success story...
January 8, 2019: Thrombosis and Haemostasis
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