Partial Thromboplastin Time Research Articles

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.

This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS). Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment. A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference (P>0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group. Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.

A clot waveform analysis-based system for differential diagnosis of prolonged activated partial thromboplastin time in plasma samples.

Prolonged activated partial thromboplastin time (aPTT) in plasma samples requires quick and accurate differential diagnosis. We developed two methods using clot waveform analysis (CWA) for plasma samples with prolonged aPTT, particularly for factor (F)VIII deficiency. One method estimates FVIII activity (FVIII:C) using CWA without measuring FVIII:C by template matching. The other utilizes CWA in the mixing test to quickly differentiate FVIII deficiency (FD), FVIII inhibitor (Inh), and lupus anticoagulant (LA). To establish a more accurate system for differential diagnosis of aPTT prolongation, including FIX deficiency, by combining a CWA-based mixing test and template matching. Samples with FD (n = 96), LA (n = 19), and Inh (n = 28) were incubated with normal plasma. FD, LA, and Inh were differentiated using a mixing test, followed by CWA-based template matching. In the mixing test, sensitivity for FD, Inh, and LA was 100%, 93%, and 100%, and specificity was 96%, 100%, and 100%. Samples with FIX inhibitor (> 0.6 BU/mL) were differentiated as the inhibitor sample. In template matching, almost all severe hemophilia A and B were judged as the respective severe types. This novel CWA-based measurement system could aid in differential diagnosis of prolonged aPTT.

The impact of different treatments on thromboelastography and other conventional parameters in patients with colorectal cancer

ObjectiveTo comprehend the effects of diverse therapeutic interventions on thromboelastography (TEG) and conventional coagulation parameters among individuals diagnosed with colorectal cancer, this study aims to explore the clinical relevance of both thromboelastography and conventional coagulation metrics in evaluating coagulation function and predicting the incidence of thrombotic and hemorrhagic events in patients with colorectal cancer.MethodsA cohort of 122 patients with colorectal cancer retrospectively recruited and divided into 2 groups: those undergoing surgical intervention (operation group) and those not subjected to surgery (non-operation group). According to the different types of treatment they received, the operation group was divided into chemotherapy-only group and a group receiving a combination of targeted therapy and chemotherapy. Blood samples were collected on admission and subjected to coagulation parameter assessment, including conventional coagulation tests and thromboelastography (TEG) assessment. Receiver operating characteristic (ROC) analysis was performed to predict the occurrence of complications in patients with colorectal cancer.ResultsCompared with the operation group, the non-operation group showed significant reductions in reaction time(R-time) and kinetics time (K-time), and significant elevation in angle, maximum amplitude (MA), fibrinogen and platelets. Patients receiving targeted therapy and chemotherapy had lower angle and maximum amplitude and higher R-time and K-time, activated partial thromboplastin time and fibrinogen. The area under the curve for TEG in patients without treatment was 0.802. The area under the curve for TEG and conventional coagulation parameters were 0.654 and 0.660 respectively.ConclusionDiverse treatments distinctly impact on the coagulation indicators of individuals diagnosed with colorectal cancer. The coagulation parameters observed in patients prior to operation suggest a hypercoagulable state. Nevertheless, following postoperative chemotherapy and targeted therapy, this hypercoagulable state demonstrates a notable improvement, occasionally leading to a propensity for hypocoagulation. The findings of this investigation underscore the unique clinical importance of thromboelastography (TEG) alongside traditional coagulation parameters, demonstrating that these diagnostic tools possess complementary value and cannot be substituted interchangeably.

The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study

Aims and objectivesThis systematic review and meta-analysis study evaluated the association between mortality due to COVID-19 and coagulative factors.MethodsA systematic search was conducted on electronic databases including PubMed, Scopus, and the Web of Science from the beginning of the pandemic until October 2024 to identify relevant studies on COVID-19 patients and their laboratory findings related to coagulation markers and mortality outcome. Eligibility criteria were defined based on the PICO framework, and data extraction was performed by two authors independently using a standardized sheet. Statistical analysis was accomplished using the random effects model, and heterogeneity among studies was assessed using the I2 test. R and RStudio were used for statistical analysis and visualization.ResultsOur systematic literature search yielded 6969 studies, with 48 studies meeting the inclusion criteria for our meta-analysis. The mean platelet count was significantly lower in deceased COVID-19 patients compared to survivors (20.58), while activated partial thromboplastin time (aPTT) and fibrinogen levels did not show significant differences. The pooled mean difference of D-Dimer, International Normalized Ratio (INR), and prothrombin time (PT) were significantly lower in survived patients (-2.45, -0.10, and -0.84, respectively). These findings suggest that platelet count, D-Dimer, INR, and PT may serve as potential indicators of mortality in COVID-19 patients.ConclusionThe results of our systematic review and meta-analysis revealed a significant reduction in the pooled platelet count among deceased individuals when compared to survivors. However, no significant distinctions were observed in the pooled mean activated aPTT and fibrinogen levels between the deceased and survivor groups. On the other hand, there were noticeable variations in the pooled estimated mean of INR, PT, and D-Dimer levels, with significantly higher values in the deceased group compared to those who survived.

Ethylenediamine-modified alginate - A hemocompatible platform for polymer-drug conjugates

The study is dedicated to the synthesis, rheological properties, hemocompatibility, and further modification of water-soluble derivatives of sodium alginate containing fragments of ethylenediamine (Alg-EDA). Alg-EDA with an equal ratio of amide/amine groups and varying degrees of substitution were synthesized by the carbodiimide method. The influence of the molecular weight of Alg-EDA on the attachment of bioactive molecules such as hydroxybenzoic and ferulic acids was determined. Modification of alginate with ethylenediamine fragments leads to a reduction in dynamic viscosity and sensitivity to Ca2+ ions (internal gelation method). Alg-EDA derivatives, with differ in molecular weight and degree of substitution with phenolic acids, are characterized by high hemocompatibility (in vitro tests: erythrocyte hemolysis, blood recalcification time, activated partial thromboplastin time). Antioxidant properties of the synthesized alginate derivatives were characterized using models of varying complexity (including cellular models). It was found that Alg-EDA, at a concentration of 0.5 mg/mL, had a statistically significant membrane-protective activity under conditions of acute oxidative stress induced by both H2O2 and AAPH. Derivatives with lower molecular weight were more effective than high molecular weight ones. Modification of polysaccharides by the fragments of phenolic acids into the structure contributed to the enhancement of antioxidant properties. The hemocompatible macromolecular antioxidants synthesized in this study are promising for further in-depth investigation for the creation of biomedical materials.

Evaluation of the analytical performance of the Sysmex CS-2500 automated blood coagulation system

The aim of this study was to evaluate the analytical performance of the two new CS-2500 automated systems recently acquired by the laboratory. These are Sysmex automated systems that perform multiparametric haemostasis tests based on coagulometric, chromogenic and immunological principles with an optical detection system. The aim of this study was to evaluate their performance for prothrombin time (PT) and activated partial thromboplastin time (APTT) tests. Comparability results with the CS-2100 department's previous automated system showed high agreement between the systems, with high correlation coefficients (R ≥ 0.993). Intra-series and inter-series repeatability was less than 5%, demonstrating excellent measurement stability. The search for inter-sample contamination was negative. The automated systems showed excellent linearity over a wide range of values. All the results obtained during this evaluation point to very good analytical performance, making the CS-2500 suitable for medium- to high-activity haemostasis laboratories.

Analysis of Risk Factors and Establishment of a Risk Prediction Model for Severe Postpartum Haemorrhage.

Aims/Background Severe postpartum haemorrhage (PPH) is a dangerous condition, characterized by rapid progression and poor prognosis. It remains the leading preventable cause of maternal death worldwide. This study aimed to investigate the risk factors for severe PPH and establish a prediction model to identify severe PPH early, allowing for early intervention reduce maternal death. Methods Clinical data were collected from 784 patients diagnosed with PPH and delivered at the Second Affiliated Hospital of Anhui Medical University between December 2018 and December 2023. These cases were categorized into the training cohort. Severe PPH was diagnosed in 234 patients based on the criterion of the volume of vaginal bleeding volume exceeding 1000 mL within 24 hours after delivery; these patients were assigned to the experimental group. The remaining 550 patients with nonsevere PPH were assigned to the control group. Data from an additional 338 postpartum women from the same period were selected and classified into the validation cohort. Univariate and multivariate logistic regression analyses were performed to pinpoint the determinants associated with severe PPH. Additionally, these analyses were instrumental for developing and assessing a prediction model to forecast the risk of such complications. Results Most of the PPH cases in this study stemmed from uterine atony, the leading aetiology. The second most common factor was soft birth canal lacerations and haematoma formation, accounting for 7.26% of the subjects in experimental group and 6.55% of those in the control group. Uterine rupture, uterine inversion, and amniotic fluid embolism were exclusively observed in the experimental group. In the univariate analysis, notable disparities were identified across various parameters, including maternal age, gravidity, parity, abortion frequency, gestational week at delivery, prothrombin time (PT), activated partial thromboplastin time (APTT), in vitro fertilisation, foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy (p < 0.05). A multivariate logistic regression model revealed that a parity of two or more, two or more abortions, in vitro fertilisation, gestational weeks at delivery, foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy were independent predictors of severe PPH (p < 0.05). The predictive model demonstrated excellent calibration for the training and validation datasets, with the areas under the curve (AUC) for receiver operating characteristic (ROC) curves measuring 0.799 and 0.759, respectively. Clinical decision curve analysis (DCA) confirmed a significant threshold exceeding 0.9, signifying a substantial net benefit and model precision. Conclusion Parity ≥2 times, abortion ≥2 times, in vitro fertilisation, gestational week at delivery, abnormal foetal position, caesarean delivery, pregnancy with anaemia, and hypertensive disorders of pregnancy are independent risk factors for severe PPH. The predictive model established in this study accurately predicts the occurrence of severe PPH and has significant value for clinical application.

Exploring Disease Manifestations and Influencing Factors in Acute and Chronic Hepatitis B

Scope and Aims: The investigation of disease manifestations and influencing factors in both acute hepatitis B (AHB) and chronic hepatitis B (CHB) remains limited, with varying results. This study aimed to explore the factors influencing AHB and CHB and their disease manifestations within a Ghanaian population, with the goal of developing a control strategy. Methods: A retrospective study was conducted on 569 admitted hepatitis B cases. Demographic data and disease manifestations were compared between AHB and CHB patients. Logistic regression and correlation analyses were employed to identify the factors influencing the progression of the disease. Results: Significant differences were observed between AHB and CHB patients in terms of median age and hospitalization duration. Variations in age, gender, education level, and occupational distributions were statistically significant (P &lt; 0.05) between the two groups. Symptoms such as fever, nausea, polydipsia, palpitation, anicteric presentation, anorexia, and itching were less common in CHB patients (P &lt; 0.05), while abdominal pain, jaundice, and enlarged liver were more frequent (P &lt; 0.05). CHB patients exhibited significantly higher levels of aspartate aminotransferase, viral load, bilirubin, prothrombin time, partial thromboplastin time, HBeAg, albumin, abdominal ultrasound findings, and globin (P &lt; 0.05), while HBsAg and liver function test levels were significantly lower (P &lt; 0.05) in CHB patients compared to AHB patients. Logistic regression identified age, gender, occupation, education level, and hospitalization duration as significant influencing factors. Conclusion: Males and the adult population represented a higher proportion of CHB patients, with a significant association between CHB and elevated clinical and laboratory characteristics. Age, gender, occupation, education level, and hospitalization duration were established as key influencing factors in the progression of hepatitis B.

PERSISTENT COAGULATION ABNORMALITIES IN RECOVERED COVID-19 PATIENTS FOLLOWING VACCINATION: A RETROSPECTIVE ANALYSIS

This retrospective observational study assessed persistent coagulation abnormalities in individuals who recovered from COVID-19 and subsequently received two doses of COVID-19 vaccination. The study enrolled 250 individuals, aged 20–50 years, and evaluated four primary coagulation markers: prothrombin time, activated partial thromboplastin time, D-dimer, and fibrinogen. Blood samples were analyzed using the STA-R coagulation analyzer. Results indicated that 10% of participants exhibited elevated D-dimer levels, 34% had elevated prothrombin times, and 85% displayed prolonged activated partial thromboplastin times, while 7.2% showed increased fibrinogen levels. Statistical analysis revealed significant deviations in D-dimer, activated partial thromboplastin time, and fibrinogen from standard reference ranges. These abnormalities suggest a possible hypercoagulable state post-vaccination, potentially due to vaccine-induced mechanisms that activate coagulation pathways. Findings align with reports of vaccine-induced thrombotic complications, especially in adenovirus-vectored vaccines. This study underscores the importance of monitoring coagulation parameters in vaccinated individuals with prior COVID-19 infection to ensure vaccine safety and efficacy. Future studies should investigate the underlying mechanisms of these coagulation changes and their clinical implications.

Comparing the coagulation and platelet parameters of womenwith premature ovarian insufficiency with those of age-matched controls: A case-control study.

This study aimed to compare the coagulation and platelet parameters in women with spontaneous premature ovarian insufficiency (POI) with those in age-matched controls. This case-control study recruited 202 women with POI and 202 age-matched women with benign gynecological diseases as controls. Coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and thrombin time (TT), fibrinogen, and platelet parameters, including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW), were compared between women with POI and controls. Factors associated with coagulation and platelet parameters were also analyzed in women with POI. In women with POI, higher fibrinogen levels and PDW, lower PLT, MPV, and PCT levels, and shorter TT were observed (p < 0.001). Linear regression analysis further revealed that women with POI were more likely to exhibit increased serum fibrinogen levels (β = 0.465, 95% confidence interval [CI] 0.366-0.564) and PDW (β = 0.340, 95% CI 0.300-0.379), decreased TT (β = -1.101, 95% CI -1.233--0.969), PLT (β = -50.985, 95% CI -65.087--36.882), MPV (β = -1.498, 95% CI -1.875 to -1.120), PCT levels (β = -0.084, 95% CI -0.095--0.973). Additionally, follicle-stimulating hormone levels were positively associated with fibrinogen levels in women with POI. There were no statistically significant differences in PT, INR, and APTT between women with POI and controls. Women with POI exhibited decreased platelet numbers, abnormal platelet morphology, and elevated fibrinogen concentrations, potentially implicating POI's etiopathogenesis or contributing to an increased risk of cardiovascular disease in women with POI. No coagulation abnormalities were observed in women with POI.

Brief Report: Chronic murine schistosomiasis causes aberrant hemostasis

Schistosomiasis afflicts >250 million people worldwide, leading to an annual loss of >3 million disability adjusted life years. Schistosoma mansoni causes intestinal schistosomiasis with parasite eggs either transversing intestinal tissue or lodging within the liver and other organs, causing intestinal hemorrhage and liver pathology. Large (∼1cm) adult worms survive for years within blood vessels, but we lack a clear understanding of their impact on hemostasis. We used a chronic mouse model of schistosomiasis to determine the impact on platelet numbers, phenotype and function. Hemostatic function was assessed by platelet phenotyping (flow cytometry and proteomics), whole blood aggregometry and longitudinal coagulometry. Whilst platelets from schistosome-infected mice lack elevated surface P-selectin and activated αIIbβ3, unbiased proteomic analysis reveals infection-induced increases in MHC-I, IgM and IgG antibodies, and complement components. Whole blood from schistosome-infected mice spontaneously aggregates in the absence of exogenous agonists. Conversely, prothrombin and activated partial thromboplastin times are prolonged at the chronic stage of infection (10-12 weeks). In conclusion, our mouse model of S. mansoni infection shows wide-ranging changes in hemostatic function which may have clinically relevant implications for populations in endemic regions.

Detection of enoxaparin and argatroban by use of the novel viscoelastic coagulometer ClotPro

Owing to the simultaneous increase in the risk of thrombosis and bleeding in critically ill patients, point-of-care-available diagnostic tests to guide parenteral anticoagulation are warranted. We evaluated the detection of enoxaparin and argatroban, two commonly used parenteral anticoagulants, using the novel ClotPro viscoelastic coagulometer. For this experimental in vitro study at a tertiary care academic center, blood samples were drawn from twelve (six female, six male) healthy volunteers without intake of antithrombotic medication and no history of hemostatic disorders. Blood samples were spiked with enoxaparin (IU.ml− 1) and argatroban (µg.ml− 1) at increasing concentrations ranging from 0 to 1. The ClotPro Russell’s viper venom (RVV)-test and the ClotPro ecarin (ECA)-test clotting time were performed in parallel with conventional coagulation tests (anti-Xa activity, activated partial thromboplastin time, and diluted thrombin time). We observed a strong correlation between anti-Xa activity and the RVV-test clotting time (r = 0.88 (95% confidence interval (CI) 0.8–0.92; p < 0.001)). Although clotting time cutoff values of 71 and 145 s provided high sensitivity and specificity for detecting anti-Xa activity of ≤ 0.1 and ≥0.6 IU.ml− 1, we found a poor performance at both high and low concentrations. The ECA-test clotting time revealed a very strong correlation with activated partial thromboplastin time (r = 0.96 (95% CI 0.93–0.97; p < 0.001)) and diluted thrombin time (r = 0.97 (95% CI 0.96–0.98; p < 0.001)). The clotting time cutoff values of 86 and 298–431 s provided high sensitivity and specificity for detecting diluted thrombin time values ≤ 0.1 and 0.5-1 µg.ml− 1. Our results suggest that the RVV test is an unreliable method for monitoring enoxaparin treatment, whereas the ECA-test might be an accurate point-of-care alternative for detecting argatroban concentration with potential advantages over standard coagulation tests in terms of point-of-care applicability and turnaround time.

5. A SCOPING REVIEW: COMPARISON OF COAGULATION PARAMETERS RESULTS IN DECEASED AND RECOVERED COVID-19 PATIENTS

Objective: Compare coagulation markers between deceased and recovered COVID-19 patients. Methods: A search of PubMed was conducted to identify peer-reviewed articles published between January 1, 2022, and April 1, 2024. Articles were selected based on predefined inclusion and exclusion criteria. Data extraction focused on coagulation parameters, including platelet count, fibrinogen (Fib), D-Dimer, prothrombin time (PT), and activated partial thromboplastin time (APTT) across six selected studies involving a total of 7,052 patients. Results: The findings indicated that recovered patients had significantly higher platelet counts compared to deceased patients (p &lt; 0.05). D-Dimer and Fib levels were lower in recovered patients, while PT results were significantly prolonged in deceased individuals (p &lt; 0.05). APTT results showed variability, with some studies reporting higher levels in deceased patients, while others indicated longer APTT in recovered patients, remaining within normal ranges. Conclusion: Coagulation markers exhibit significant differences between deceased and recovered COVID-19 patients, suggesting their potential utility in predicting disease severity and guiding clinical management.

A nomogram for predicting early mortality in patients with traumatic brain injury requiring mechanical ventilation based on clinical laboratory data

We developed an intuitive and user-friendly nomogram based on clinical laboratory data for early outcome predictions for patients with traumatic brain injury requiring mechanical ventilation who were admitted to the intensive care unit for the first time. We included 625 patients from the Medical Information Mart for Intensive Care IV 2.2 database as the training cohort and 107 patients from the Affiliated Dongyang Hospital of Wenzhou Medical University as the external validation cohort. The least absolute shrinkage and selection operator regression analysis, combined with univariate and multivariate Cox regression analyses, was used to identify independent risk factors. Age, sex, partial pressure of carbon dioxide, white blood cell count, creatinine levels, prothrombin time, and partial thromboplastin time were included in the nomogram. The area under the receiver operating characteristic curve was 0.811 for the training cohort and 0.770 for the external validation cohort. The calibration curves, clinical decision curve analysis, and clinical impact curve demonstrated that the nomogram had a good goodness-of-fit and clinical utility. We developed a nomogram based on clinical laboratory data for predicting the early (14-day) mortality rate of patients with traumatic brain injury requiring mechanical ventilation, which may help assess patient risk and decision-making.

Troubleshooting heparin resistance.

The term heparin resistance is likely best defined as the failure of an appropriate dose of unfractionated heparin (UFH) to achieve a predetermined level of anticoagulation. Unfortunately, and despite many prior reports, there is no established consensus as to what either the appropriate dose or the predetermined level should be. Traditionally, assays used to monitor anticoagulation with UFH have been clot based, including the activated partial thromboplastin time, used for patients on the ward or intensive care unit, and the activated clotting time, used for patients undergoing vascular interventions and cardiopulmonary bypass. Unfortunately, these tests may be highly influenced by other factors occurring in many patients, especially those with inflammation or acute infection, as noted during the COVID-19 pandemic. Many hospitals have thus moved to anti-Xa testing for heparin monitoring. Another important factor in defining heparin resistance includes dosing, whether weight-based or total daily dosing is used, as initial reports of heparin resistance described daily doses independent of body weight. Multiple causes of apparent heparin resistance include hypercoagulability, antithrombin deficiency, andexanet alfa used for direct oral anticoagulant reversal, thrombocytosis, and antiphospholipid antibody syndromes. Treatment options for managing patients with heparin resistance include weight-based dosing and administration of additional UFH, antithrombin supplementation, or the use of an alternative anticoagulant such as the direct thrombin inhibitors bivalirudin or argatroban.

Hereditary combined deficiency of factors V and VIII: observations in the Russian population

Introduction. Combined deficiency of factors V and VIII is a rare hereditary bleeding disorder with a prevalence of 1:1,000,000 in the general population, but the disease is more common in regions where consanguineous marriages are acceptable. Data on this hereditary coagulopathy in the Russian Federation are limited.Aim: to analyze clinical and laboratory characteristics of the course of the disease in patients with hereditary combined deficiency of factors V and VIII in the Russian population.Materials and methods. The retrospective and prospective study involved 6 patients with hereditary combined deficiency of factors V and VIII in the Russian population.Results. The average age of patients was 50 years (32–72 years). The average age at the time of diagnosis was 40 years. Bleeding scores on the ISTH-BAT scale ranged from 17–29, with an average value of 23.5. The average value of activated partial thromboplastin time was 85 seconds, the prothrombin by Quick was 35 %, and the activity of FV and FVIII was 5.7 % and 9.0 %, respectively. The course of the disease was characterized more or less by cutaneous-mucous hemorrhagic syndrome, postoperative, obstetric-gynecological, and life-threatening bleeding.Conclusion. Clinical and laboratory characteristics of patients expand the understanding of hereditary combined deficiency of factors V and VIII and make it possible to accelerate diagnosis verification.

DOACs: role of anti-Xa and drug level monitoring.

Direct oral anticoagulants (DOACs) do not require routine monitoring of anticoagulant effect, but measuring DOAC activity may be desirable in specific circumstances to detect whether clinically significant DOAC levels are present (eg, prior to urgent surgery) or to assess whether drug levels are excessively high or excessively low in at-risk patients (eg, after malabsorptive gastrointestinal surgery). Routine coagulation tests, including the international normalized ratio (INR) or activated partial thromboplastin time (aPTT), cannot accurately quantify drug levels but may provide a qualitative assessment of DOAC activity when considering the estimated time to drug clearance based on timing of last drug ingestion and renal and hepatic function. Drug-specific chromogenic and clot-based assays can quantify drug levels but they are not universally available and do not have established therapeutic ranges. In this review, we discuss our approach to measuring DOAC drug levels, including patient selection, interpretation of coagulation testing, and how measurement may inform clinical decision-making in specific scenarios.

A ten-year experience with the diagnosis of von Willebrand disease in Mexico based on a cost-effective strategy

BackgroundVon Willebrand disease (VWD), is the most common inherited bleeding disorder worldwide, but its diagnosis is complicated, expensive, and poorly evaluated in several countries. ObjectiveTo report our long-term experience with the diagnosis of VWD based on a cost-effective strategy. MethodsWe studied 802 Mexican patients, men and women, children, and adults, with clinical suspicion of VWD. The following tests were performed: blood count, bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, VWF antigen, ristocetin cofactor activity, collagen binding assay, ristocetin-induced platelet aggregation, FVIII activity, and VWF multimers analysis. ResultsVWD was diagnosed in 639 patients; 582 had type 1 VWD (91.1%). Type 2 VWD was found in 52 patients (8.1%). Type 2A was present in 25 cases (48.1%), while types 2B and 2M accounted for 21 (40.4) and six (11.5%) cases, respectively. Type 3 VWD was present in five patients (0.8%). The mean age of patients with VWD was 25.3 years (range: 2–71) for males and 22.1 (range: 1–54) for females. The diagnosis was inconclusive in 40 cases (5.0%) and was discarded in 123 (15.3%). Blood group O was the most common among patients with VWD. ConclusionUsing a low-cost diagnostic strategy, we confirmed that VWD is as common in Mexico as in other countries. Review of the patient's history is mandatory when VWD is suspected, although laboratory confirmation may be difficult and expensive. The consequences of a lack of accurate and timely diagnosis affect the promptness and quality of treatment.

Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis

BackgroundHidden blood loss (HBL) is a notable complication in spinal endoscopic procedures. This study aims to compare tissue damage and hidden blood loss between two minimally invasive spinal techniques: unilateral biportal endoscopic lumbar discectomy (UBE) and percutaneous endoscopic interlaminar discectomy (PEID). Furthermore, the study examines the risk factors contributing to hidden blood loss in each procedure.Patients and methodsA single-center retrospective cohort study was conducted on 86 patients who underwent unilateral biportal endoscopic lumbar discectomy (UBE) and 73 patients who received percutaneous endoscopic interlaminar discectomy (PEID) between January 2021 and December 2023.Demographic data, blood loss parameters, and serum levels of creatine kinase (CK) and C-reactive protein (CRP) were recorded. Pearson or Spearman correlation analyses were conducted to evaluate associations between patient characteristics and HBL. Additionally, multiple linear regression analysis was used to identify independent risk factors for HBL.ResultsA total of 159 consecutive patients were included in this study, consisting of 83 females and 76 males. The average hidden blood loss (HBL) was 431.00 ± 160.52 ml in the UBE group and 328.40 ± 87.71 ml in the PEID group, showing a statistically significant difference (P < 0.05). Pearson or Spearman correlation analysis indicated that in the UBE group, HBL was associated with operation time, preoperative hematocrit (Hct), ASA classification, and paraspinal muscle thickness. In the PEID group, HBL was correlated with operation time, preoperative activated partial thromboplastin time (APTT), paraspinal muscle thickness, and the presence of diabetes (P < 0.05). Multiple linear regression analysis demonstrated a positive correlation between HBL and operation time in both groups (P < 0.05), identifying operation time as an independent risk factor for HBL. Furthermore, CRP and CK levels were generally lower in the PEID group compared to the UBE group, particularly on postoperative day 3 for CRP and postoperative day 1 for CK. Both total blood loss and hidden blood loss were significantly lower in the PEID group than in the UBE group.ConclusionCompared to UBE, PEID shows superior results regarding surgical trauma, total blood loss, hidden blood loss (HBL), and postoperative hematocrit (Hct) reduction. Consequently, PEID is recommended as the treatment of choice for younger patients or those with compromised baseline perioperative conditions.Additionally, Hidden blood loss remains a critical factor, and surgical duration presents a shared risk in both procedures.

Characteristics and outcome of patients requiring Decompressive Craniectomy for Traumatic Brain Injury: a retrospective analysis.

Brain swelling after Traumatic Brain Injury (TBI) can elevate intracranial pressure, necessitating Decompressive Craniectomy (DC) as the preferred surgical intervention. This study aimed to analyze a large institutional database to identify clinical characteristics of patients requiring primary DC and their outcomes. We reviewed TBI patients admitted to our center from 2015 to 2021, utilizing a prospectively maintained registry. Data collected included demographics, injury mechanisms, admission findings, neuroimaging results, DC necessity, procedures during hospitalization, and functional outcomes at discharge and six-month follow-up. A total of 4,011 patients were analyzed, with 506 undergoing primary DC. Factors such as International Normalized Ratio, activated Partial Thromboplastin Time, subdural hematoma, midline shift, epidural hematoma, intracerebral hemorrhage, and the presence of compressed or absent basal cisterns were independently linked to the need for DC. Additionally, the requirement for DC correlated with an increased likelihood of tracheostomy. For patients requiring DC, older age, lower hemoglobin levels, higher Rotterdam scores, and the presence of compressed or absent basal cisterns were associated with unfavorable outcomes in mild to moderate TBI cases. In severe TBI patients, lower Glasgow Coma Scale scores and fixed pupils were linked to poor outcomes. This study represents one of the most comprehensive analyses of primary DC requirements and outcomes, revealing that the need for DC is associated with worse outcomes in TBI patients and identifying several independent predictors of outcomes across varying severity levels.