Prothrombin Time Research Articles

"Amr Sign": A Case-Control Study Evaluating the Diagnostic Value of a New Clinical Sign in the Diagnosis of Acute Appendicitis.

Introduction Acute appendicitis, a prevalent cause of acute abdominal pain and a common indication for emergency surgery, presents a diagnostic challenge due to its diverse clinical presentation and variability in appendix location and symptoms. Traditional diagnostic approaches, including physical examination, clinical scoring systems, and imaging techniques, have limitations. This study introduces the "Amr sign," a new diagnostic indicator characterized by sudden reflex hyperextension of the neck upon palpation of the right iliac fossa, which is hypothesized to reflect local peritoneal irritation from an inflamed appendix. Methods We conducted a prospective observational study at Alwakra Hospital from November 2016 to January 2019 that included 195 patients aged 15 years and older with right iliac fossa pain and an Alvarado score of four or more. The "Amr sign" was evaluated alongside standard clinical examination and imaging results. Diagnostic accuracy was assessed via histopathological confirmation, which is the gold standard. Results The "Amr sign" had a sensitivity of 68.6% and a specificity of 67.3%. The positive predictive value (PPV) was 89%, whereas the negative predictive value (NPV) was 45%. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.679 for the "Amr sign" compared with 0.622 for the other imaging modalities, suggesting comparable diagnostic performance. The "Amr sign" demonstrated a higher likelihood ratio of a positive test (2.3) and a lower likelihood ratio of a negative test (0.46). Conclusion The "Amr sign" is a promising diagnostic tool for acute appendicitis, offering a simple, reliable, and quick test that can be performed by less experienced physicians. While its sensitivity and specificity are moderate, its high PPV suggests that it is particularly useful in confirming appendicitis. Further research and validation are needed to fully establish its role in clinical practice.

Causes, management, and prognosis of severe gastrointestinal bleedings in critically ill patients with pancreatic cancer: A retrospective multicenter study

BackgroundGastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients. AimsTo analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission. MethodsRetrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded. ResultsNinety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001). ConclusionIn pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.

Testing of battery separators: transducers and methods for air-coupled ultrasonic sensing.

Abstract Battery separator me3mbranes are thin polymeric microporous films placed between battery electrodes. They are a key component that strongly affects both battery performance and security and controlling its main properties is critical for the industry. In particular, the manufacturing process demands tests that allow checking both the mechanical integrity (porosity, thickness, pore size, etc.) of the materials and the consistency of these properties during the construction of the batteries. The use of an air-coupled ultrasonic system is proposed in this work. It is expected that this will make possible the non-destructive and quick testing of these materials, in order to evaluate thickness, stiffness, pore distribution and pore size of the separator. By means of three pairs of transducers, the modulus and phase of the transmission coefficient was measured from 0.35 to 1.4 MHz in different materials. The measurements show a clear modification of the film response produced by the presence of porosity. This suggests that the transmission of ultrasonic waves in battery separators using air-coupled ultrasound may have two contributions: one corresponds to the propagation though the solid part, the other corresponds to propagation in the pores. The former allows to determine properties like film thickness and elastic constants, while the latter allows to determine porosity and pore size and pore tortuosity. This work set the basis for the development of a quality test for the in-line inspection of these materials during their fabrication. The observed ultrasonic response in microporous separators suggest the possibility to use low frequency air-coupled transducers with limited sensitivity, where the use of MEM transducers at industrial scale can be advantageous.

Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review.

Hepatic compartment syndrome (HCS) is a rare but life-threatening entity that consists of a decreased portal flow due to intraparenchymal hypertension secondary to subcapsular liver hematoma. Lethal liver failure can be observed. We report three cases, and review the literature. A 54-year-old male was admitted for extensive hepatic subcapsular hematoma after blunt abdominal trauma. Initially, he underwent embolization of the hepatic artery's right branch, after which he presented clinical deterioration, major cytolysis (310 times the upper limit of normal [ULN]), and liver failure with a prothrombin time (PT) at 31.0%. A 56-year-old male underwent liver transplantation for acute alcoholic hepatitis. On postoperative day 2, he presented a hemorrhagic shock associated with deterioration of liver function (cytolysis 21 ULN, PT 39.0%) due to extensive hepatic subcapsular hematoma. A 59-year-old male presented a hepatic subcapsular hematoma five days after a cholecystectomy, revealed by abdominal pain with liver dysfunction (cytolysis 10 ULN, PT 63.0%). All patients ultimately underwent urgent surgery for liver capsule excision, hematoma evacuation, and liver packing, if needed. The international literature was screened for this entity. These three patients' outcomes were favorable, and all were alive at postoperative day 90. The literature review found 15 reported cases. HCS can occur after any direct or indirect liver trauma. Surgical decompression is the main treatment, and there is probably no place for arterial embolization, which may increase the risk of liver necrosis. A 13.3% mortality rate is reported. HCS is a rare complication of subcapsular liver hematoma that compresses the liver parenchyma, and leads to liver failure. Urgent surgical decompression is needed.

Application of a Novel UPLC-MS/MS Method for Analysis of Rivaroxaban Concentrations in Dried Blood Spot and Plasma Samples Collected from Patients with Venous Thrombosis.

Despite a higher safety profile compared to vitamin K antagonists, rivaroxaban therapy is still connected with multiple adverse effects, such as a high risk of bleeding. Thus, therapeutic drug monitoring (TDM) of rivaroxaban concentrations is suggested. An alternative to plasma samples can be dried blood spots (DBS), which minimize the cost of sample storage and transport. In this study, we developed a UPLC-MS/MS method for the analysis of rivaroxaban in DBS and plasma samples. Chromatographic separation was achieved on a Zorbax Eclipse Plus C18 column (2.1 × 100 mm; 3.5 µm, Agilent Technologies Inc., Santa Clara, CA, USA) with a mobile phase consisting of water and acetonitrile, both containing 0.1% formic acid. The analytes were detected using a positive ionization mode by multiple reaction monitoring. We validated the method according to ICH guidelines. The precision and accuracy were satisfactory. Extraction recovery was approximately 57% and 66% for DBS and plasma samples, respectively. A high correlation between rivaroxaban concentrations in plasma and DBS samples collected from patients was confirmed with Deming regression. The suitability of both sampling techniques for the rivaroxaban TDM was also verified by Bland-Altman plots based on DBS-predicted and observed plasma concentrations. In addition, we found a significant relationship between rivaroxaban concentrations and coagulation parameters, including prothrombin time (PT) and international normalized ratio (INR).

Serological Evaluation of the Anti-coagulant Activity of the Classical Siddha Medicine -‘Veera Mezhugu’ in Wistar Albino Rats

In setting the basis for the management of arterial thrombosis, cardiac ischemic changes followed by any severe coronary atherosclerotic changes or any venous thrombosis, there is a conventional use of Acute thrombolytic agents, Anticoagulants with antiplatelet medications in general. These symptoms complex are mentioned as Thamaraga vaayu or Ruththira vaayu or Maaradaippu(Acute coronary syndrome) and Uthirakattu(thromboembolism) in siddha literatures. Veera mezhugu is one of the Siddha formulations chosen from Anuboga vaithiya navaneetham part-4, which is indicated for Uthirakattu and Thamaragavaayu. The drug prepared as per the Siddha literature. The drug has undergone safety studies and the efficacy studies in Wistar albino rats where the serum of the different groups with different doses are compared with the placebo control to evaluate the anti-coagulant potential. Coagulation profile of the three parameters of Activated partial thromboplastin time(APTT), Prothrombin time(PT) and International normalized ratio(INR) are taken for evaluation and had significant difference between the groups[p&lt;0.05].Serological analysis of the Wistar rats shows significant anticoagulant activity in a dose dependent manner.

Optimizing Coagulation Profile E-Reporting: A Design Thinking Perspective on Healthcare and Technological Integration

The coagulation profile report is crucial for assessing blood clots and diagnosing various bleeding disorders. Key metrics in these reports include the international normalized ratio (INR), activated partial thromboplastin time (APTT), platelet count, and fibrinogen levels. Traditionally, these reports have been delivered through paper-based methods, which often face significant challenges such as human errors, delays in distribution, and limited accessibility. To address these issues, this preliminary investigation explores integrating technology into the reporting process for coagulation profiles. By leveraging a design-thinking approach, the study aims to understand the needs and preferences of stakeholders and users. This approach includes creating personas to represent different user types, mapping their experiences through empathy and journey maps, and generating and testing ideas through ideation and prototyping. The core objective of the study is to develop a mobile application that simplifies and enhances the reporting process of coagulation profiles. This application is designed to integrate seamlessly with Electronic Medical Record (EMR) systems, providing real-time notifications to healthcare providers when laboratory results are available. The proposed solution aims to improve the timeliness and accuracy of reporting, facilitating better patient care and more efficient workflows. The paper details the components of this solution, including the prototype design and the validation procedures used to ensure its effectiveness. The study seeks to revolutionize how coagulation profiles are documented and communicated in healthcare by adopting a digital reporting system.

Fibrin clot permeability (Ks) in patients on left ventricular assist device

Patients on left ventricular assist devices (LVAD) are prone to excessive hemostasis disturbances due to permanent contact of artificial pump surfaces with blood components. We aimed to investigate if fibrin clot permeability is altered in patients on long-term continuous-flow LVAD therapy and if the clot permeability is associated with clinical characteristics and adverse events. We investigated 85 end-stage heart failure patients (90.6% men, age 48.6–63.8 years) scheduled for continuous flow long-term LVAD support according to current clinical indications. The patients were assessed periodically: prior to LVAD implantation (T1), 3–6 months (T2) after LVAD implantation, 6–12 months after (T3) and then every 6 months. We tested the first three blood samples (T1-T3) and the last available blood sample (T4), but no longer than 5 years after LVAD implantation. We assessed hemostasis parameters (Activated Partial Thromboplastin Time (APTT) Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, d-dimer, Antithrombin, Thrombin Time, Factor VIII, and von Willebrand Factor, aspirin-induced platelet inhibition, adenosine-diphosphate test) changes during the study period. Fibrin Clot Permeability was evaluated using a pressure system and Permeability Coefficient (Ks) was calculated. We observed a decrease in fibrin clot permeability (Ks) between T1, T2, T3 and T4 time periods; P < 0.01 for each comparison. Fibrin clot permeability was negatively correlated with fibrinogen concentration: r = − 0.51, P < 0.001, factor VIII activity r = − 0.42, P < 0.001. There was no association of Ks with age, Left Ventricular Ejection Fraction (LVEF) and medications P > 0.001, however cumulative measurements in patients on aspirin showed shortening of Ks in this group P = 0.0123. Major adverse cardiac and cerebrovascular events (MACCE) occurred in 36.5% patients, bleeding events in 25.9%, Net Adverse Clinical Events (NACE) in 62.4%; 31.7% patients died, and 17.6% underwent transplantation. The transplantation was considered as the endpoint. Discrepancies in Ks were observed between patients with MACCE, bleeding, and NACE, and patients without adverse events. Ks showed a constant trend towards normalization (P < 0.01) only in patients without adverse events. Patients with advanced heart failure have disturbed clot structure. A trend towards normalization of the Ks values is associated with fewer thromboembolic and bleeding complications in this group of patients.

Quick or Owren prothrombin time methods: possibilities and limitations (literature review)

Quick or Owren prothrombin time methods: possibilities and limitations (literature review)

C-reactive protein, fibrinogen, prothrombin time and international normalized ratio levels as indicators of chronic inflammation in patients with metabolic syndrome

Aims: Although it has been stated in studies conducted in patients with metabolic syndrome (MetS) that elevated serum fibrinogen and C-Reactive Protein (CRP) may be due to chronic inflammation, sufficient studies have not been conducted on International normalized ratio (INR) and prothrombin time (PT). The aim of this study is to examine the fibrinogen, INR and PT levels of patients with MetS and to investigate the relationship between these parameters and MetS components. Methods: A total of 56 patients, 19 males and 37 females were included in our study who applied to the Internal Medicine outpatient clinic of Ondokuz Mayıs University Faculty of Medicine and met the MetS diagnostic criteria. The control group consists of a total of 64 people, 35 men and 29 women, who have at least one of the MetS criteria and do not have a chronic disease. Fasting blood glucose, total cholesterol (Total-C), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine, thyroid stimulating hormone (TSH), PT, INR and fibrinogen levels were examined from the available samples. Data were compared between healthy and patient groups. Results: As a result of our study, it was determined that the CRP level was significantly higher in the patient group (p&lt;0.01). The average fibrinogen level was calculated as 3.56 g/l in the patient group and 2.95 g/l in the control group, and a significant difference was detected when the two groups were compared (p&lt;0.001). The average PT value was 13.1 in the patient group and 12.04 in the control group and a significant difference was detected between both groups (p&lt;0.001). The average INR level was 1.14 in the patient group and 1.04 in the control group and a significant difference was detected between both groups (p&lt;0.001). Conclusion: MetS is associated with high CRP. In patients with MetS, PT, INR and fibrinogen levels are also high. In the follow-up and treatment of patients with MetS, the presence of chronic inflammation and factors affecting the coagulation system should be taken into consideration.

Coagulation aberrations in adult patients with acute leukemia: A single center experience

Background and objective: Acute leukemia (AL) patients are at high risk for bleeding and thrombotic events due to the disruption of the normal hemostatic system associated with this disease. As a result of the lack of data on coagulopathy in AL patients in our locality, we conducted this study to assess the hemostatic parameters in patients with newly diagnosed AL at the time of presentation. Methods: This prospective cross-sectional study included 59 patients with de novo AL, along with 35healthy control subjects. The study was conducted at Nanakali Hemato-Oncology Center between September 2021 and May 2022. Coagulation markers, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen levels (FBG), D-dimer (D-Di), antithrombin (AT), protein C (PC), and protein S (PS) were measured for each patient and control. Results: The median age of the patients was 41 years, with a male to female ratio of 1.1:1. Thirty-eight (64.4%) patients had acute myeloid leukemia (AML) and 21 (35.6%) patients had acute lymphoblastic leukemia (ALL). D-Dilevels were significantly raised in both AML and ALL compared to controls. PT was significantly higher, and PC and AT were significantly lower in AML compared to ALL or control groups. The Bleeding incidence in AML was significantly higher than in ALL (65.8% versus 23.8%). Thrombosis occurred in two (3.4%) patients. Conclusion: Coagulation abnormalities were common in AL. The hemostatic derangement and bleeding at the time of presentation were more pronounced in patients with AML than in ALL.

Analysis of early death in critically ill patients with acute promyelocytic leukaemia in the HICU

This study was conducted to identify the characteristics and risk factors for early death in critically ill acute promyelocytic leukaemia (APL) patients in the Hemato-oncology ICU (HICU). A total of 44 APL patients from 2017 to 2023 were included. The mortality among APL patients in the HICU was high (27/44, 61.36%). Compared with patients who survived, nonsurvivors had a longer prothrombin time (P = 0.002), lower fibrinogen (P = 0.022), higher white blood cell count (P = 0.004) and higher creatinine (P = 0.037) on hosipital admission. Severe bleeding was the most frequent complication (34 cases, 77.27%), which occurred either preinduction or on Day 5 (IQR 3–7.5 days) of induction. Cerebral bleeding associated with consciousness disturbance was the main reason for HICU admission (18 cases, 40.9%). The leading cause of death was fatal haemorrhage (18/34, 52.94%), which occurred either preinduction or on Day 4 (IQR 3–7 days) of induction. Another common cause of death was sepsis (8/18, 44.44%), which occurred on Day 12 (IQR 9.5–24.75 days) during induction. In conclusion, the main cause of death in APL patients treated in the HICU was primary being attributed to fatal bleeding, followed by sepsis.

Correlation between the prothrombin time values obtained by point-of care prothrombin time meter and clinical laboratory in paediatric intensive care unit of a developing country

Background: Monitoring of prothrombin time (PT) is essential for adequate management of children in pediatric intensive care unit (PICU) who require serial and repeated PT measurements. In contrast to laboratory testing, point-of-care (POC) PT meters have been configured especially for bedside that are cost effective with rapid turnaround time. Our study aimed to assess its feasibility for routine use in PICU by assessing the correlation between PT values obtained through the POC PT meter and those acquired from the laboratory. Methods: A total of 200 children of either gender aged between 1 month to 12 years, admitted to PICU of Indus hospital Karachi Pakistan from February to August 2023 were analysed in this cross-sectional study. Venous blood samples were collected in PT bottles and transported to the pathology department within a time frame of 20-30 minutes for analysis. Concurrently, a drop of blood was obtained via finger prick and promptly assessed using the POC device-Coaguchek INRange system, (Roche diagnostics Ltd, USA). Pearson’s correlation was applied. Results: 200 children (96 males, 104 females) having a mean age of 6.42±3.55 years. The mean PT values with POC meter and Laboratory were 2.588±1.299 and 2.574±1.304 respectively (p=0.100). Very strong correlation of PT between POC PT meter and laboratory evaluation was observed (r=0.996, p&lt;0.001). Conclusions: The strong correlation observed between POC PT meter and laboratory supports the use of these devices for timely coagulation monitoring, potentially improving patient outcomes in PICUs.

A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes.

Background Hypertensive complications during pregnancy play a significant role in the increased rates of maternal and perinatal morbidity and mortality on a global scale. Preeclampsia is characterized by elevated blood pressure levels and the presence of protein in the urine and is associated with diverse hematological alterations, particularly impacting the coagulation cascade. The primary objective of this research was to conduct a comparative analysis of the coagulation profiles and pregnancy outcomes in women with preeclampsia versus those with normal blood pressure during pregnancy. Methods This was a prospective case-control study with 74 participants across two groups, conducted from September 2022 to May 2024. The participants were enrolled and divided into two groups, with 37 in the clinically diagnosed preeclampsia group and 37 in the normotensive group. Coagulation parameters including platelet count, bleeding time, clotting time, international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen levels, alkaline phosphatase (ALP) levels, D-dimer levels, and fibrin degradation products (FDP) levels were assessed. Maternal and neonatal outcomes were also compared. In our study, we comprehensively examined both maternal and neonatal outcomes in preeclampsia and normotensive groups. Maternal complications analyzed included mode of delivery, incidence of eclampsia, placental abruption, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, postpartum hemorrhage (PPH), and peripartum cardiomyopathy (PPCM). For neonatal outcomes, we assessed birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, and the duration of neonatal intensive care unit (NICU) stays. Results The results showed that mean platelet count was significantly lower in the preeclampsia group (151,503 ± 59,875/µL) compared to the normotensive group (245,405 ± 69,021/µL) (p < 0.0001). Bleeding time, INR, APTT, and PT showed significant elevation in the preeclampsia group, indicating a slower coagulation process. Fibrinogen levels, ALP levels, and D-dimer levels were significantly higher in the preeclampsia group (p < 0.0001). The preeclampsia group had a higher rate of cesarean sections (65% vs. 24%) and lower neonatal birth weights (mean 2.3 kg vs. 2.5 kg). APGAR scores were comparable between groups, but a higher number of neonates went to the NICU in the preeclampsia group (64.9% vs. 10.8%). The preeclampsia group also showed higher rates of low birth weight (27%), intrauterine growth restriction (27%), respiratory distress syndrome (10.8%), and asphyxia (5.4%). Conclusion Preeclampsia is associated with significant hematological changes, particularly in coagulation parameters, and adverse fetomaternal outcomes. Early identification and monitoring of these changes are crucial for timely intervention and improving maternal and neonatal health outcomes.

Clinical characteristics and analysis of related factors associated with early death in newly diagnosed patients with acute promyelocytic leukemia

ObjectiveThe objective of this study was to investigate the clinical characteristics and analysis of related factors associated with early death in newly diagnosed patients with acute promyelocytic leukemia (APL).MethodsThis retrospective study included patients who visited our hospital between January 2010 and August 2022 and were diagnosed with APL for the first time. We analyzed their clinical and laboratory characteristics and analysis of related factors associated with early death.ResultsA total of 269 patients with a primary diagnosis of APL were collected. The male to female ratio was 6:5, and the median age was 42 years (range 7–80). Among patients with initial APL diagnosis, there were 34 early deaths, resulting in an early mortality rate of 13%. The median time from diagnosis to death was 8.5 days (range 3–24). Comparative analysis of the clinical characteristics between patients who died early and those who did not, using a logistic regression model, revealed that age, white blood cell count (WBC) at initial diagnosis, and prolongation time of prothrombin time (PT) were independent risk factors for early death in patients with primary APL (P < 0.05). Comparing the clinical characteristics during hospitalization between the early death group and the non-early death group, it was observed that the daily mean of WBC during hospitalization was significantly higher in patients who died early than in those who did not (P < 0.001). Conversely, the daily mean of platelet count (PLT) was significantly lower in patients who died early compared to those who did not (P < 0.001). Furthermore, statistically significant differences were found in the mean daily infusion of PLT (P < 0.05), fibrinogen (Fib) (P < 0.05), and fresh frozen plasma (FFP) (P < 0.05) during hospitalization between patients who died early and those who did not. Specifically, the mean daily infusion of PLT and FFP was significantly higher in the early-death group than in the non-early-death group. Cerebral hemorrhage was identified as the immediate cause of death in 25 out of the 34 early-death patients (74%). The remaining causes of death included infection in 5 cases (15%), all of which were severe pulmonary infections, including 2 cases of combined differentiation syndrome, and abandonment of treatment in 4 patients (11%) at initial diagnosis.ConclusionIn patients with primary APL, age, WBC at initial diagnosis, and PT prolongation time were identified as independent risk factors for early death (P < 0.05). Laboratory findings regarding WBC and PLT during hospitalization, as well as the infusion of PLT, Fib, and FFP during hospitalization, were also statistically significant. Cerebral hemorrhage was found to be the main cause of early death in patients with primary APL.

Evaluation of Von Willebrand Factor in Dogs with Parvoviral Enteritis

Canine parvoviral enteritis may lead to coagulopathy in various ways. In recent years, the importance of von Willebrand factor has become the focus of more attention in infectious diseases. The aim of this study was to determine the importance of von Willebrand factor level and coagulation parameters in dogs with parvoviral enteritis. The experimental group of this study consisted of 20 dogs with parvoviral enteritis of different breeds aged 2-6 months, and the control group consisted of 10 healthy dogs aged 2-6 months. Blood samples were taken from the dogs included in the experimental group at the 0th hour, 24th hour and before discharge, and only at the 0th hour from the healthy puppies in the control group The 0th and 24th hour von Willebrand factor values of the trial were significantly higher than the control group. The 0th hour Prothrombin Time of the trial was significantly prolonged compared to the control group. The 0th hour Activated Partial Thromboplastin Time value of the trial was significantly prolonged compared to the before-discharge and control group. The before-discharge fibrinogen level was determined to be significantly lower than at 0th and 24th hours of the trial. In conclusion, von Willebrand factor concentrations, which increase significantly in dogs with parvoviral enteritis compared to healty animals, can be evaluated as an acute phase protein. Prolongation of Prothrombin Time and Activated Partial Thromboplastin Time and no significant change in fibrinogen and D-dimer values demonstrated that dogs with parvoviral enteritis were in hypercoagulation state without dissemine intravascular coagulation.

Changes of coagulation function and platelet parameters in preeclampsia and their correlation with pregnancy outcomes.

Preeclampsia (PE) is a severe pregnancy complication characterized by significant alterations in coagulation function. This study aims to analyze the correlation between coagulation function, platelet parameters, and pregnancy outcomes in PE patients. Clinical data, along with blood and urine samples, were collected from 168 PE patients and 128 healthy pregnant women. General demographic and laboratory testing data were recorded, and maternal and fetal outcomes were followed up. Data were analyzed using Kaplan-Meier and logistic regression analyses. In mild PE patients, thrombin time (p=.000), platelet distribution width (PDW) (p=.000), and clot formation time (p=.000) were increased, while prothrombin time (p=.000) and fibrinogen (p=.045) were reduced. With increasing PE severity, prothrombin time (p=.000), platelet count (PLT) (p=.000), mean platelet volume (MPV) (p=.000), plateletcrit (p=.000), maximum amplitude (MA) (p=.000), and coagulation index (p=.001) decreased, whereas activated partial thromboplastin time (APTT) (p=.000), thrombin time (p=.002), D-dimer (p=.026), and PDW (p=.000) increased. Lower prothrombin time (p=.048), PLT (p=.004), and coagulation index (p=.026) or higher APTT (p=.032), thrombin time (p=.044), D-dimer (p=.023), and PDW (p=.016) were associated with a higher risk of poor pregnancy outcomes. Thrombin time was identified as an independent risk factor (p=.025, OR=2.918, 95% CI: 1.145-7.436), whereas gestational age was an independent protective factor (p=.000, OR=0.244, 95% CI: 0.151-0.395). This study demonstrates that specific coagulation and platelet parameters are significantly associated with PE severity and adverse pregnancy outcomes. These findings highlight the importance of monitoring coagulation function in PE patients to improve clinical management and outcomes.

Evaluation of Prothrombin and Activated Partial Thromboplastin Time in Patients with Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic disease accompanied by high blood glucose due to a defect in insulin secretion, insulin activity, or both. High blood glucose levels may lead to serious damage to some organs of the body, mainly blood vessels and nerves. Therefore, this study was conducted to evaluate prothrombin time (PT) and activated partial thromboplastin time (APTT) in diabetic patients. 100 venous blood samples were collected from diabetic patients attending the diabetes clinic in Sebha. Of them, 57 were males and 53 were females, and their ages ranged between 15-88 years. out of 100, 48 Were treated with insulin-regulating tablets and 52 Were treated with insulin injections. 34 blood samples were collected from healthy people (15 females and 19 males). They were used as a control group, aged between 14-55 years. 4 ml of venous blood was drawn, and 2 ml was placed in containers containing the anticoagulant sodium citrate to perform the PT and APTT. Place 2 ml of sample in tubes containing sodium fluoride anticoagulant to perform a fasting blood sugar (FBS). Place the tubes in a centrifuge at 3000 rpm to obtain plasma. The results showed the mean of PT in patients was (19.4 ± 3.6), the mean APTT was (35.9 ± 1.5) and the Mean FBS was (229.7 ± 80.39), whereas the mean PT, APTT, and FBS in control were (12.8 ± 1.6), (25.4 ± 2.1), and (91.9 ± 12.5) respectively. there was a significant increase of PT and APTT in patients compared to control (P&lt;0.05), PT and FBS were higher in patients who used insulin injection with significant differences(P&lt;0.05), while no significant differences were in APTT (P &gt; 0.05). The present study observed a statistically significant increase in PT and APTT among patients compared to controls, it would be helpful to incorporate coagulation screening as a routine investigation for the better management of diabetic patients.

FEATURES OF DRUG-DRUG INTERACTIONS BETWEEN RIVAROXABAN AND P-GLYCOPROTEIN INHIBITOR DEPENDING ON CYP3A4/A5 GENE POLYMORPHISM IN PATIENTS 80 YEARS AND OLDER WITH NONVALVULAR ATRIAL FIBRILLATION

Abstract Introduction. Increased risk of bleeding associated with rivaroxaban administration is associated with polymorphism of genes involved in its biotransformation, as well as with the use of drugs that inhibit common metabolic pathways. However, the data are contradictory. Objective of the work.To study the features of drug-drug interactions between rivaroxaban and a P-glycoprotein inhibitor (using verapamil as an example) depending on the polymorphism of the CYP3A4 (rs35599367)and CYP3A5 (rs776746)genes in patients aged 80 years and older with non-valvular atrial fibrillation. Material and methods. A total of 128 patients (median age 87.5 years [83-90 years], 75% women) were examined. All patients underwent genotyping for the studied polymorphisms, determination of the minimum steady-state concentration of rivaroxaban (Cmin,ss), standardization of the minimum steady-state concentration of rivaroxaban per daily dose (Cmin,ss /D), determination of prothrombin time (PT) in plasma, and analysis of medical records for the presence of clinically relevant non-major bleeding (CRNMB). Results.Co-administration of rivaroxaban with verapamil compared with patients receiving rivaroxaban without calcium channel blockers in CYP3A4gene CC carriers resulted in higher values of Cmin,ss(73.8 [49-113.5] vs 40.5 [25.6-73.3] ng/ml), Cmin,ss /D (2.5 [1.7-4.0] vs 4.7 [2.9-7.7] ng/ml/mg), PT (14.8 [13.3-17.3] vs 14.0 [12.6-14.5] sec) and CRNMB (10/30 (33.3%) vs 6/45 (13.3%) cases), (p0.05). In carriers of the GG gene, CYP3A5resulted in higher values of Cmin,ss (74.7 [50.6-108.8] vs 40.2 [25.7-72.3] ng/ml), Cmin,ss /D 4.6 [3.0-7.3] vs 2.5 [1.7-4.0] ng/ml/mg), PT (14.6 [12.8-15.2] vs 14.0 [12.6-14.5] sec) and CRNMB (10/27 (37%) vs 5/40 (12.5%) cases), (p0.05). And in GA+AA carriers of the CYP3A5gene, it resulted in higher values of Cmin,ss (88.1 [5.5-88.1] vs 52.8 [25.0-77.2] ng/ml), Cmin,ss /D 5.7 [0.4-5.7] vs 3.5 [1.7-5.2] ng/ml/mg), (p0.05). In CT carriers of the CYP3A4 gene, the combined use of rivaroxaban with verapamil was not observed in our sample. Conclusions:Carriers of the homozygous wild-type CYP3A4/A5 genotype showed high pharmacokinetic variability to verapamil (a strong P-glycoprotein inhibitor and a moderate CYP3A4 inhibitor).

Systematic review and meta-analysis of biomarkers predicting decompensation in patients with compensated cirrhosis

Background and aimsThe transition from compensated to decompensated cirrhosis is crucial, drastically reducing prognosis from a median survival of over 10 years to 2 years. There is currently an unmet...