Changes In Coagulation Parameters Research Articles

Do interleukin-17 and interleukin-23 inhibitors alter the coagulation parameters in psoriasis patients?: A retrospective study.

Psoriasis is a chronic inflammatory skin condition associated with systemic inflammation and a higher risk of cardiovascular comorbidities. This study retrospectively evaluates coagulation parameters in psoriasis vulgaris patients treated with IL-17 inhibitors (secukinumab, ixekizumab) and IL-23 inhibitors (risankizumab, guselkumab), compared to those untreated systemically. The study reviewed records from 177 patients treated between January 2019 and March 2023. Patients were grouped into control (n = 77), secukinumab (n = 36), ixekizumab (n = 19), guselkumab (n = 24), and risankizumab (n = 21). Coagulation parameters, including PT, aPTT, PLT, MPV, INR, fibrinogen, D-dimer, and B12 levels, were analyzed. The primary endpoint was the comparison of coagulation parameters between groups. Significant differences were found in PT, with secukinumab-treated patients showing a significantly shorter PT compared to controls (p = 0.002). No significant differences were observed in other coagulation parameters across the groups. The study highlights a potential effect of secukinumab on coagulation pathways, possibly related to IL-17's role in inflammation and endothelial function. Despite current literature suggest a risk of cerebrovascular events with risankizumab, this study did not show any significant changes in coagulation parameters with risankizumab, indicating no hypercoagulability risk associated with this IL-23 inhibitor. Our findings suggest IL-17 and IL-23 inhibitors are generally safe concerning coagulation parameters, but regular monitoring may be warranted for patients on secukinumab due to its effect on PT. Further long-term studies are needed to fully understand the cardiovascular risks associated with these therapies.

Clinical value of coagulation parameters in predicting the severity of severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus infection with a high lethality rate. The purpose of this study was to investigate the changes in coagulation parameters in patients with SFTS, aiming to provide clinical evidence for early diagnosis, treatment, and disease analysis. A total of 40 patients with SFTS attended from April 1, 2020 to May 21, 2022 in Nanjing Drum Tower Hospital were selected and grouped according to the duration of the disease, mild and severe disease, cure and death, with 50 healthy physical examiners as controls, and the risk of severe and death disease was predicted using ROC curves. Comparison between the healthy, mild and severe groups revealed that PT, INR, APTT, TT, D-D and vWF levels were higher than those in the healthy control group, and FII, FIX, FX, FXI, FXII, PC and PS levels were lower than those in the healthy control group, the differences were statistically significant (p < 0.05). Comparing the results of SFTS patients with different course times, the results of Fib, FV, FVII, FVIII, FIX, FX, FXI were statistically significant (p < 0.05). Among the survived and deceased patients, the PT, INR, DD and PS results of the deceased patients were higher than those of the survived patients, and the FVIII, FIX, FXI, FXII and PC were lower than those of the survived patients. The area under the ROC curve showed that D-D had higher predictive ability for the risk of severe disease (AUROC 0.93, sensitivity and specificity at a Cut-off value of 1.50 mg/L were 90.0 and 86.5%, respectively) and the risk of death occurring (AUROC 0.84, sensitivity and specificity at a Cut-off value of 3.39 mg/L were 87.5 and 80.0%, respectively). The monitoring of the coagulation parameters in patients with SFTS is great significance for identifying the severity and death of the patient's condition, and it is of great clinical value to provide early attention, timely intervention and maximum reduction of the mortality rate for patients at risk of severe disease.

Coagulation and inflammatory response after intramuscular or intradermal mRNA-1273 SARS-CoV-2 vaccine: secondary analysis of a randomized trial

BackgroundFractional-dosed intradermal (i.d.) vaccination produces antibody concentrations above the proposed proxy for protection against severe disease as compared with intramuscular (i.m.) vaccination and may be associated with a decreased prothrombotic effect. ObjectivesTo assess changes in coagulation following standard dosed i.m. or fractional-dosed i.d. (one-fifth of i.m.) mRNA-1273 SARS-CoV-2 vaccine and to determine the association between the inflammatory response and coagulation. MethodsThis study was embedded in a randomized controlled trial assessing the immunogenicity of an i.d. fractional-dosed mRNA-1273 vaccine. Healthy participants, aged 18 to 30 years, were randomized (2:1) to receive either 2 doses of i.d. or i.m. vaccine. Blood was drawn prior to first and second vaccination doses and 1 and 2 weeks after the second dose. The outcomes were changes in coagulation parameters (primary endpoint peak height of the thrombin generation curve) and inflammation (high-sensitivity C-reactive protein [hs-CRP]). ResultsOne hundred twenty-three participants were included (81 i.d.; 42 i.m.). Peak height increased after vaccination (i.m., 28.8 nmol; 95% CI, 6.3-63.8; i.d., 17.3 nmol; 95% CI, 12.5-47.2) and recovered back to baseline within 2 weeks. I.m. vaccination showed a higher inflammatory response compared with i.d. vaccination (extra increase hs-CRP, 0.92 mg/L; 95% CI, 0.2-1.7). Change in endogenous thrombin potential was associated with change in hs-CRP (beta, 28.0; 95% CI, 7.6-48.3). ConclusionA transient increase in coagulability after mRNA-1273 SARS-CoV-2 vaccination occurred, which was associated with the inflammatory response. While i.d. administration showed antibody concentrations above the proposed proxy for protection against severe disease, it was associated with less systemic inflammation. Hence, i.d. vaccination may be safer.

Examining the Changes in Coagulation Parameters in Patients Infected with SARS-CoV-2 Variants (Alpha, Beta, Delta, and Omicron)

Background: It is known that the change in coagulation parameters has an effect on mortality and prognosis in COVID-19 patients. The SARS-CoV-2 virus has changed with mutations in the genome of the virus since the beginning of the pandemic, and the resulting variants have been recorded by the World Health Organization. With these variations, the clinical severity of the disease and laboratory parameters have also changed. Objectives: In this study, we examined the changes in D-dimer levels, fibrinogen levels, platelet count (PLT), and mean platelet volume (MPV) between SARS-CoV-2 Alpha (B.1.1.7), Beta (B.1.351) Delta (B.1.617.2), and Omicron (B.1.1.529) variants. Methods: The study was conducted retrospectively on 28 195 adult patients with SARS-CoV-2 infection. At the time of application, data on age, gender, SARS-CoV-2 variant status, D-dimer levels (n = 7090), fibrinogen (n = 5709), PLT (n = 7066), and MPV (n = 8330) were collected. Patients were divided according to alpha, beta, delta, and omicron variants. The changes in variants were examined statistically. Results: The incidence of the delta variant in women was higher than the other variants, followed by alpha and omicron (P = 0.001). The Beta variant was detected at a higher rate in males. The ages of the cases with the Omicron variant were higher than the cases with Alpha, Beta, and Delta variants (P = 0.001, P = 0.001, P = 0.001, and P &lt; 0.01, respectively). In laboratory parameters, D-dimer and fibrinogen levels were detected to be significantly higher in Delta and Omicron variants. PLT and MPV were determined to be lower in delta and omicron than in alpha and beta variants. Conclusions: Examination of the changes in laboratory coagulation parameters according to variants shows that the tendency to clot increases from alpha to omicron.

Changes in coagulation indices and D-dimer levels in hypertriglyceridemic acute pancreatitis and their value in predicting disease severity.

Hypertriglyceridemic acute pancreatitis (HTG-AP) is one of the common acute and severe cases of digestive system. Incidence of HTG-AP is increasing year by year, and there is a trend of younger and severe cases. Early identification of severe patients and timely intervention are conducive to improve the prognosis. Dysfunction of coagulation and fibrinolysis systems plays an important role in the development of HTG-AP. Prothrombin time (PT) and activated partial thromboplastin time (APTT) are sensitive indicators of exogenous and endogenous coagulation system, respectively. Fibrinogen (FIB) is an acute reactive protein with coagulation function. D-dimer is a sensitive index to judge the abnormality of coagulation and fibrinolysis system. This study aims to investigate the changes of coagulation parameters and D-dimer level in patients with HTG-AP and their value in predicting the severity of the disease. The clinical data of 189 HTG-AP patients admitted to Jiangjin Hospital Affiliated to Chongqing University (Jiangjin District Central Hospital of Chongqing) from January 2019 to December 2020 were collected, including gender, age, medical history, complications, causes, and acute physiology and chronic health evaluation II (APACHE II) scores. According to the severity of the disease, the patients were divided into a mild HTG-AP group and a severe HTG-AP group. The changes of coagulation indexes (PT, APTT and FIB), D-dimer and C-reactive protein (CRP) levels were detected. Coagulation indexes, D-dimer level and disease severity (CRP level, APACHE II scores) were compared between the 2 groups. Spearman correlation analysis was used to analyze the correlation between the above indexes. Univariate and multivariate binary logistic regression analysis were used to identify the independent risk factors for severe HTG-AP. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of PT, FIB, and D-dimer for the severity of HTG-AP. There were significant differences in gender between the mild HTG-AP group and the severe HTG-AP group (P<0.05). There was no significant difference in age, recurrence rate and incidence of complications between the 2 groups (all P>0.05). The basic conditions of the 2 groups were similar and comparable. PT, FIB and D-dimer levels in the severe HTG-AP group were significantly higher than those in the mild HTG-AP group (all P<0.001). There was no significant difference in APTT between the 2 groups (P>0.05). The CRP level and APACHE II scores in the severe HTG-AP group were significantly higher than those in the mild HTG-AP group (all P<0.05). Spearman correlation analysis showed that PT, FIB and D-dimer were positively correlated with CRP and APACHE II scores (all P<0.05), while APTT was not correlated with CRP and APACHE II scores (all P>0.05). Logistic regression analysis showed that prolonged PT and elevated D-dimer level were independent risk factors for severe HTG-AP (both P<0.05). ROC curve analysis showed that the AUC of PT for predicting severe HTG-AP was 0.764 (95% CI 0.690 to 0.837, P<0.001), when PT>14.40 s, the sensitivity, specificity, positive predictive value, and negative predictive value were 63.07%, 79.03%, 59.42%, and 80.00%, respectively. TheAUC of FIB for predicting severe HTG-AP was 0.669 (95% CI 0.588 to 0.751, P<0.001), when FIB>4.18 g/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 61.53%, 70.17%, 49.38%, and 76.85%, respectively. The AUC of D-dimer for predicting severe HTG-AP was 0.753 (95% CI 0.680 to 0.826, P<0.001), when D-dimer>1.28 μg/mL, the sensitivity, specificity, positive predictive value, and negative predictive value were 73.84%, 66.12%, 53.33%, and 82.82%, respectively. The AUC of PT combined with D-dimer for predicting severe HTG-AP was 0.797. There are abnormalities in coagulation and fibrinolytic system in patients with HTG-AP in the early stage. PT, FIB and D-dimer levels are increased with the aggravation of the AP, and have a positively correlation with it. Elevated PT and D-dimer level are independent risk factors for severe HTG-AP. PT combined with D-dimer may be a sensitive indicator for prediction of the severity of HTG-AP in early phase.

Effects of frozen storage conditions and freezing rate on the stability of coagulation proteins in human plasma.

Degradation of coagulation proteins in frozen plasma may influence assay results. The aims of this study were to explore the changes in coagulation parameters in patient plasma and internal quality control (IQC) after different freezing and storage conditions during the short-term and long-term periods. Platelet poor plasma was prepared from citrated peripheral blood collected from a group of healthy donors. The plasma was pooled, frozen and stored in a variety of freezing and storage conditions. The changes were monitored using routine coagulation assays, as well as factor VIII (FVIII) and protein S (PS) assays. Plasma stored in liquid nitrogen (LN2) or in -80°C showed long-term stable values for routine tests for a period of over 12 months, and 6 months for FVIII. Interestingly, the activated partial thromboplastin time (aPTT) showed a temporary significant prolongation over the first two weeks. Plasma frozen and stored in -40°C is not viable for aPTT and FVIII testing, otherwise it can be used for other parameters for up to 4 months. PS showed a significant increase in all frozen samples. Freezing rate has a significant impact on plasma quality and the final storage temperature influences the long-term stability. The optimal storage conditions are ultra-low temperatures (LN2 or -80°C) and the highest freezing rate possible. However, frozen plasma is not viable for IQC of aPTT during a period of two weeks after freezing. This study is unique in its conception as a practical guide for the handling of frozen plasma samples in modern laboratory settings.

Coagulation Parameters Among Sudanese Individuals Vaccinated with Johnson and Johnson Vaccine at Khartoum State, 2022

<i>Background: </i>A COVID 19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome corona virus 2. Ad26.COV2.S (Johnson & Johnson) vaccine is adenovirus vector-based vaccine that targets the spike protein of the SARS-CoV-2 virus, when it enters the body it stimulates the immune response. <i>Materials and methods: </i>This was a cross sectional study, health facility base, Conducted in Vaccine centre at Omer ben Alkhatab, Khartoum, Sudan during the period July to August, 2022 to estimate changes of coagulation parameters among Sudanese vaccinated with Johnson & Johnson vaccine. Sixty samples were collected from the Participants that took the first dose of Johnson & Johnson vaccine; thirty samples before the vaccination, and thirty after vaccination. The coagulation parameters were performing by different methods. <i>Results:</i> The means of parameters before the vaccination were; APTT was (36.2 ±3), PT was (15.8±2.4), INR (1.2 ±0.2), platelets (285.9 ±7.2), fibrinogen (243.4 ±4.6) and D-dimer (0.17±0.03). The means of parameters after the vaccination for the APTT, PT, INR, platelets count, fibrinogen and the D-dimer were; (35.2 ±2.9), (13.9±2.1), (1.21±0.3), (272.8±57.9), (284.2 ±53.3) and (0.37±0.8) respectively. When compared between the results of parameters per and post vaccination the results revealed that; there was significant decrease in the time for the APTT and PTT (p value ≤0.05), in significant differences with the INR and platelets count (p value ≥0.05), significant increase for the fibrinogen and D- dimer level (p value ≤0.05). While when compared the mean of the parameters with the age, genders, and symptoms there was insignificant differences (p value ≥0.05), except the D – dimer had a significant differences with the age and symptoms (p value ≤0.05).<i> Conclusion:</i> In the conclusion of this study there was significant decrease of the activated partial thromboplastin time (APTT), Prothrombin time (PT), and significant increase in fibrinogen and D-dimer level in the Sudanese individuals after the first dose of Johnson and Johnson Vaccine.

Heparin therapy in COVID-19: Call for randomized controlled trials (RCTs).

Coronavirus disease 2019 (COVID-19) is associated with increases in abnormal coagulation, and particularly D-dimer (D-D) levels. Heparin therapy has been recommended as pharmacologic thromboprophylaxis in patients hospitalized with COVID-19; however, data on its efficacy are lacking. The current study retrospectively analyzed changes in blood coagulation and the impact of heparin therapy. Medical records of 593 patients with confirmed COVID-19 were collected. On admission, elevated fibrinogen (Fg) levels were noted in with 42.2% (250/593) of patients, followed by increases in D-D (28.5%) and a prolonged prothrombin time (PT) (23.9%). Patients with severe/critical COVID-19 had a higher proportion of abnormal coagulation parameters than patients with mild/ordinary COVID-19. Dynamic changes in coagulation parameters were plotted on timeline charts for 97 patients with COVID-19 after heparin treatment. These changes, when combined with Fg, PT, D-D, and other indicators, may provide a relatively comprehensive description of coagulation abnormalities. Heparin seems to be important in the treatment of patients with COVID-19 based on the current findings. The efficacy of heparin in the treatment of COVID-19 should be confirmed by randomized controlled trials (RCTs) as soon as possible.

Phenotype-oriented anticoagulant therapy for sepsis: still a work in progress.

Coagulation disorders ranging from subtle changes in coagulation parameters to fatal disseminated intravascular coagulation (DIC) are common in septic patients. Coagulation activation is considered to be one of the most important factors contributing to multiple organ dysfunction syndrome (MODS) in sepsis. Anticoagulant therapy is, therefore, necessary to prevent MODS, but eligibility criteria remain controversial. Sepsis is a highly heterogeneous syndrome, which could explain the negative results of clinical studies on the treatment of sepsis. Recently, sepsis has been subdivided into several phenotypes with different therapeutic outcomes. At present, septic patients with dysfunctional coagulation expressed as increased D-dimer and fibrin/fibrinogen degradation products (FDPs) are considered to be candidates for anticoagulant therapy. In this review, we aimed to describe the features of different septic phenotypes. We also discuss factors that contribute to controversies in this area, and challenges in defining which septic phenotypes are good candidates for anticoagulant therapy.

The Non-Activated Thromboelastometry (NATEM) Assay's Application among Adults and Neonatal/Pediatric Population: A Systematic Review.

The non-activated thromboelastometry (NATEM) assay is a point-of-care assay that can provide a comprehensive insight into the actual hemostatic mechanism. However, there are very limited data about its use in clinical practice. The aim of this study was to systematically review the literature for any data regarding the use of NATEM in several clinical settings. A systematic review of PubMed and Scopus databases was conducted through 20 January 2022 for studies evaluating the use of the NATEM assay in different clinical settings. The literature search yielded a total of 47 publications, 30 of which met the eligibility criteria for this review. Evaluation of NATEM’s detecting ability for hemostasis disorders is limited in the literature. The results of the included studies indicate that NATEM seems to be a sensitive method for the detection of hyperfibrinolysis and may have an advantage in the diagnosis of hemostatic disorders. It could be more informative than the other ROTEM assays for detecting changes in coagulation parameters in patients who receive anticoagulants. However, the reported outcomes are highly varying among the included studies. NATEM has a high sensitivity to detect hypo- or hypercoagulability and provides a detailed insight into the whole hemostatic process from clot formation to clot breakdown. It could be a useful technique in variable fields of medicine, not only in adults, but also in pediatric and neonatal populations, to guide different hemostatic treatments and predict coagulation disorders or mortality/morbidity; this issue remains to be further investigated.

Inflammatory bowel disease and thromboembolic events: a c'lot to learn.

Background:Inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations including arterial and venous thromboembolism. Research evidences that IBD patients have about a 2- to 3-fold increase in the risk of venous thromboembolism when compared with the general population.Objectives:We intended to evaluate the coagulation parameters and the prevalence of thromboembolic events (TE) in IBD patients. It was also our aim to investigate the correlation between coagulation parameters and disease phenotype and activity in this population.Methods:This single center prospective observational study was performed between November 2016 and April 2020. The cohort included patients with 18 years of age or older, diagnosed with IBD and followed at a gastroenterology consultation, during a follow-up period of 36 months. Patients were evaluated in terms of IBD type, extent and disease behavior, clinical scores of IBD activity, medication, smoking history, family and personal history of TE, coagulation parameters, fecal calprotectin levels, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hospitalization due to TE, IBD-related hospitalization or surgery, pregnancy, or diagnosis of malignancy.Results:The study included 149 IBD patients (67 males and 82 females). Coagulation parameters were similar in CD and UC patients and only plasminogen was increased in CD patients [97.4 (17.0) versus 91.6 (13.3), p = 0.035], when comparing with UC patients. The determined values were in the range of the reference values described in literature for the standard population. During the follow-up period, none of the patients experienced a TE that demanded hospitalization.Conclusion:In our study, acquired and inherited risk factors for TE and changes in coagulation parameters did not show to influence prothrombotic predisposition in IBD patients. As such, the clinical relevance of measuring coagulation parameters in this population is questionable.Trial Registry:NCT05162339 (ClinicalTrials.gov ID).

Meglumine Sodium Succinate to Correct COVID-19-Associated Coagulopathy: the Feasibility Study

Aim of the study: to evaluate the effect of meglumine sodium succinate (MSS) on the efficacy of anticoagulant therapy in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia.Materials and methods. Overall efficacy of treatment was analyzed in 12 patients hospitalized to ICU with the diagnosis of severe confirmed COVID-19 coronavirus infection (U07.1) complicated by bilateral multisegmental pneumonia. All patients received prophylactic anticoagulation with unfractionated heparin. The patients were divided into two groups: 7 of them received a multi-electrolyte solution containing MSS 5 ml/kg daily for the entire ICU stay (3-10 days) as a part of therapy; 5 patients received a similar volume of a conventional multi-electrolyte solution containing no metabolically active substrates and comprised a control group. Coagulation parameters were measured in arterial and venous blood of all patients at the following stages: 1) upon admission to the ICU; 2) 2-4 hours after the first dose of heparin; 3) 8-12 hours after the second dose of heparin; 4) 24 hours after the beginning of intensive therapy. On the 28th day of follow-up, mortality, duration of ICU stay, and incidence of thrombotic complications in the groups were evaluated. Nonparametric methods of statistical analysis were used to assess intragroup changes and intergroup differences.Results. The group of patients administered with MSS had significantly fewer thromboembolic events during 28 days of treatment and shorter ICU stay. These patients responded faster to anticoagulant therapy, which was suggested by more distinct changes in coagulation parameters, i.e. increased APTT, persisting viable thrombocyte population, reduced D-dimer and fibrinogen levels.Conclusion. The metabolic action of succinate possibly increases endothelial resistance to damaging factors and reduces its procoagulant activity. The hypothesis requires testing in a larger clinical study with a design including laboratory evaluation of the efficacy of varying doses of the studied drug as well as aiming at elucidation of the mechanisms of its effect on specific pro- and anticoagulation system components.

Efficacy evaluation and mechanical study of short- and long-term antithrombotic therapy for Kawasaki disease.

BackgroundAntithrombotic therapy was commonly applied in treating Kawasaki disease (KD) children; however, the effects and mechanisms of different plans were not fully elucidated. In this study, we aimed to evaluate different antithrombotic drugs.MethodsEighty-two children diagnosed with KD in Hebei Children’s Hospital from January 2017 to January 2020 were recruited. For cohort study, KD children were divided into a series of groups according to whether they were complicated with coronary artery lesions (CAL), drug therapy plan, and the presence of liver damage. The thromboelastogram (TEG) indexes [clotting time (R), clot formation time (K), clot formation angle (α), maximum amplitude of the clot (MA), arachidonic acid (AA), and adenosine diphosphate (ADP)] were employed to evaluate the relationship between disease state and drug treatment efficacy. Meanwhile, children were divided into different therapy groups according to their degree of CAL, the treatment efficiency was evaluated by TEG indexes, and the bleeding ratio was recorded. In addition, the warfarin metabolic gene was detected to explain the changes of coagulation parameters in children treated with warfarin.ResultsThe R value and coagulation index (CoI) were significantly lower (P<0.05) and MA value was significantly higher (P<0.05) in CAL group than those in non-coronary artery lesion (NCAL) group. There were significant individual differences in platelet inhibition between aspirin and dipyridamole groups. The AA% in aspirin group was 64% [95% confidence interval (CI): 49% to 74.3%] and the ADP% was 28.5% (95% CI: 26.2% to 37.2%) in dipyridamole group, and were significantly between groups. Warfarin and aspirin had a synergistic effect in anticoagulation. Warfarin metabolic gene detection was shown to be helpful for adjusting warfarin treatment dose, and shortening the initial attainment time of standard international normalized ratio (INR) index. The R value was significantly higher (P<0.05) in the liver injury group than that in the control group.ConclusionsKD Children complicated with CAL presented a hypercoagulable state, and the CAL was predictable with the R value. Warfarin metabolic gene detection and TEG can effectively evaluate and guide short- and long-term antithrombotic therapy in KD children.

Covid-19 ile ilişkili pnömoni şiddeti ile koagulopati ve mortalite arasındaki ilişki

Purpose: In the present study, the possibility of predicting mortality with the change in coagulation parameters depending on the severity of Covid-19-associated pneumonia was investigated. &#x0D; Materials and Methods: A total of 137 patients with Covid-19-associated pneumonia were included in the study. The patients were divided into three groups according to the severity of pneumonia as mild, moderate and severe. According to the severity of pneumonia, the parameters of complete blood count and the levels of biochemical parameters were compared between the groups. By examining blood parameters according to mortality, ROC analysis and regression analysis were performed to determine the net effect of these parameters on mortality. &#x0D; Results: As the severity of pneumonia increased, Prothrombin time (PT), International normalized ratio (INR) and Activated partial thromboplastin time (aPTT) values were also increased, and a statistically significant difference was found between the groups in PT and INR values. PT, INR and aPTT levels were higher in cases with mortality. Mortality can be predicted with 93.5% sensitivity and 97.5% specificity. according to the &gt;45.1 seconds(sec) cut-off value of the coagulation parameter (aPTT+PT.&#x0D; Conclusion: The coagulation parameter (aPTT + PT), whose level increases secondarily to the increase in Covid-19-associated pneumonia severity, provides successful results in predicting mortality, and may be a parameter that we can recommend in clinical use.

Dynamic changes in coagulation parameters and correlation with disease severity and mortality in patients with COVID-19.

Objective: This study aimed to describe the dynamic changes of coagulation parameters and evaluate the relationship between longitudinal coagulation parameters abnormalities and prognosis of COVID-19 patients.Methods: We performed a retrospective study of 1131 COVID-19 patients. Longitudinal coagulation parameters and clinical outcomes were analyzed.Results: Abnormal coagulation parameters were observed in patients with COVID-19, both at hospital admission (INR 2.3%, PT 7.9%, APTT 15.4%, TT 0.9%, FDP 2.3%, D-dimer 19.7%) and peak hospitalization (INR 4.8%, PT 13.4%, APTT 25.6%, TT 2.7%, FDP 10.4%, D-dimer 31.5%). Compared with non-severe patients with COVID-19, severe patients had a slightly higher INR, PT, APTT, whereas remarkably higher FDP and D-dimer (p < 0.05). On multivariate analysis, age > 60 years, male, obesity, comorbidity, abnormal D-dimer on hospital admission, and abnormal peak hospitalization PT, APTT, FDP and D-dimer were associated with COVID-19 severity. The extreme coagulation parameters abnormalities (PT > 16s, FDP > 50 ug/ml, and D-dimer > 5 ug/ml) were associated with a significantly higher mortality.Conclusion: Longitudinal coagulation parameters abnormalities are common in patients with COVID-19, and associated with disease severity and mortality. Monitoring coagulation parameters is advisable to improve the management of patients with COVID-19.

RETRACTED: Two Cu(II) coordination polymers: Heterogeneous catalytic Knoevenagel condensation reaction and treatment activity on atherosclerosis via regulating the expression of the COX-2 in vascular endothelial cells

By altering auxiliary nitrogen-donor ligands, two novel coordination polymers (CPs) containing Cu(II) formulated as [Cu2.5(L)(trz)2(H2O)2]·2H2O (1) (Htrz=1,2,4-triazole and H3L=5-(4-carboxybenzyloxy)isophthalic acid) and [Cu(HL)(Hbiz)] (2, Hbiz=benzimidazole) have been produced under the hydrothermal conditions. The complex 2 with both acidic and basic sites was investigated as heterogeneous catalyst, which reveals highly efficient catalytic property of the Knoevenagel condensation reaction. Dynamic changes of coagulation parameters during atherosclerosis was also explored via detecting activated partial thromboplastin time (APTT) and prothrombin time (PT), and the results showed that compared with CP 2, CP 1 has a stronger improvement on the coagulation parameters during atherosclerosis. Then, the high-sensitivity C-reactive protein and matrix metalloproteinase-1 released by the atherosclerotic segment was detected with enzyme linked immunosorbent assay (ELISA) detection, which also revealed that CP 1 could obviously decrease the inflammatory mediator released by the atherosclerotic segment, but not CP 2. And, the cyclooxygenase-2 (COX-2) relative expression level in vascular endothelial cells was detected via the real time RT-PCR. The results of the real time reverse transcription-polymerase chain reaction (RT-PCR) indicated that CP 1 has stronger activity on inhibiting the Notch signaling pathway than CP 2. Finally, we got this information, CP 1 has excellent application values on the coagulation parameters during atherosclerosis via regulating the expression of the COX-2 in vascular endothelial cells.

Evaluation of the Effects of Melatonin Supplementation on Coagulation in Patients with Haemorrhagic Stroke; A Randomized, Double-Blind, Controlled Trial

Introduction: Considering that hemorrhagic stroke patients are at higher risk for bleeding, administration of higher doses of melatonin with a controversial coagulation profile is a serious concern. Objective: This study aimed to investigate the possible effects of high doses of melatonin on bleeding parameters and blood hemostasis in hemorrhagic stroke patients. Methods: This study is a randomized, double-blind, prospective, controlled trial. Confirmed hemorrhagic stroke patients were divided into two groups. Participants were randomly assigned into the melatonin group (30 mg daily via gastric tube gavage for 5 consecutive days) or the control group. Each patient was monitored for 5 days, and 2 blood samples were taken and the effect of the intervention on coagulation factors and blood hemostasis were investigated. Result: In total, 30 patients were randomly assigned to melatonin (n=15) or control groups (n=15). there was no significant difference between the two groups in demographic and clinical characteristics. There was a significant decline in prothrombin time (PT) and fibrinogen levels in the melatonin group (p=0.011 &amp; p&lt;0.001, respectively). P-values for VII and VWB factors showed a significant increment in these two factors in the melatonin group after the intervention (p=0.035 &amp; p=0.002, respectively). No significant changes in serum levels of D-dimer factor, APACHE II, and GCS scores were evident in the two groups after the intervention (p&gt;0.05). Conclusion: Considering the favorable changes in coagulation parameters observed in this study, it could be concluded that melatonin can have both procoagulant and antithrombin properties.

Coagulopathy after snake envenomation in South Korea

Objective This retrospective study investigated the nature and severity of venom-induced consumption coagulopathy (VICC) and determined the clotting factors involved in VICC in patients after envenomation by South Korea’s snakes. Additionally, we studied the effectiveness of antivenom for the treatment of VICC after envenomation. Methods Included patients were divided into three groups according to the severity of VICC (no VICC, partial VICC, and complete VICC). Data, including changes in coagulation parameters during hospitalization and clotting factors at presentation, were collected and analyzed. Results One hundred nineteen patients who presented at our emergency department within 3 h after snake envenomation were included. VICC developed in 34 patients (27 patients with partial VICC and 7 patients with complete VICC). Two of 34 patients with VICC required blood transfusions. Five patients with complete VICC had an undetectable fibrinogen concentration at presentation. Three patients with complete VICC had an unmeasurable INR and aPTT within 24 h. The median times of the most extreme values were 10 h for INR, 12 h for aPTT, and 16 h for fibrinogen after presentation in the VICC group. The D-dimer concentration peaked at a median of 63.5 h after presentation. The activities of factors II and X were significantly reduced in the complete VICC group (factor II: 88 (84-99.3)% in the non-VICC group vs. 69 (49.5–83.5)% in the complete VICC group; factor X:94 (83–102) in the non-VICC group vs. 70 (66.5–79.8)% in the complete VICC group), while there was no difference in factor V activity at presentation. The time from bite to first antivenom administration did not correlate with the time course and most extreme concentrations for fibrinogen and D-dimer within the VICC groups. Discussion and conclusion VICC occurs in approximately one-quarter of snakebite patients in South Korea; however, VICC itself does not appear to lead to clinical deterioration. Fibrinogen is an early diagnostic maker for complete VICC. Clotting factors II and X are involved in VICC. Future investigations should explore the mechanism of VICC from Korean snakebites and the effect of antivenom on VICC.

Changes in levels of coagulation parameters in different trimesters among Chinese pregnant women.

BackgroundThis article is to explore changes in levels of coagulation parameters in different trimesters among healthy pregnant women in China.MethodsA total of 760 eligible women were enrolled (first‐trimester group: n = 183, second‐trimester group: n = 183, third‐trimester group: n = 263, non‐pregnant group: n = 131). Seven parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D‐dimer (DD), fibrinogen degradation products (FDP), and antithrombin III (ATIII), of all participants were collected. The non‐parametric 2.5th–97.5th percentiles reference intervals were calculated for each parameter.ResultsThe reference intervals for FIB, PT, APTT, TT, FDP, DD, and ATIII at first trimester were 2.11–4.32 g/L, 10.90–13.85 s, 24.60–39.28 s, 12.95–15.88 s, 0.04–2.55 μg/mL, 0.03–1.15 μg/mL, and 75.57%‐125.31%, respectively. The reference intervals at second trimester were 2.31–4.77 g/L, 9.70–12.64 s, 24.16–35.43 s, 12.95–15.88 s, 0.15–7.40 μg/mL, 0.08–2.13 μg/mL, and 74.35%‐119.28%, respectively. For the third‐trimester, the intervals were 2.39–4.96 g/L, 9.20–11.95 s, 23.90–35.51 s, 13.41–18.00 s, 0.55–13.43 μg/mL, 0.15–3.60 μg/mL, and 71.61%‐118.29%, respectively. The third‐trimester group showed decreased PT, APTT, and ATIII and increased FIB, TT, DD and FDP as compared with the other groups.ConclusionIn this study, level changes of coagulation parameters in different trimesters were observed. And the ranges for coagulation parameters were presented, which may provide some reference for clinicians to more accurately monitor the coagulation and fibrinolytic system in pregnant women.

Coagulation Abnormalities in Light Chain Amyloidosis

ObjectiveTo assess the prevalence of coagulation abnormalities in patients with systemic light chain (AL) amyloidosis and their association with disease-related characteristics, disease progression, and survival. Patients and MethodsThis is a retrospective study of patients with AL amyloidosis seen at Mayo Clinic, Rochester, Minnesota, from January 1, 2006, to December 31, 2015. We studied the association between abnormal coagulation parameters and baseline characteristics and their association with survival outcomes. ResultsThe study included 411 patients. Abnormalities at diagnosis included prolonged clotting times and coagulation factor deficiencies; prolonged prothrombin time (PT) and factor X (FX) deficiency were found in 19% (73 of 390) and 43% (177 of 411) of patients, respectively. The FX deficiency was associated with higher Mayo stage, involvement of more than 1 organ, liver and cardiac involvement, and greater than 10% bone marrow plasma cells. On univariate analysis, the risk for disease progression or death was higher in patients with abnormal values for PT and factor V, factor VII (FVII), FX, and factor XII compared with those with normal values. Prolonged PT and FVII and FX deficiencies were independent predictors of death after adjusting for Mayo stage and more than 1 organ involvement. Only 106 patients had repeat testing after treatment; no clear relationship was found between treatment response and changes in coagulation parameters. ConclusionCoagulation abnormalities occur in a significant proportion of patients with AL amyloidosis and are associated with advanced disease and inferior outcomes. Larger studies are needed to establish whether a relationship exists between treatment response and improvement in individual parameters.