Clotting Time Research Articles

Correlation of predelivery Rotational Thromboelastometry readings with the risk of postpartum hemorrhage during delivery: The ROTEM Study

Background Inconsistency in defining postpartum hemorrhage (PPH), and the inability of current tools and approaches to accurately predict PPH have led to the exploration of innovative methods. Rotational thromboelastometry (ROTEM) point-of-care technology provides real-time assessment of the clotting process facilitating time-efficient hemostatic interventions. Our study investigates the utility of ROTEM parameters for predicting individual risk of PPH. Methods This multi-site, prospective observational cohort study recruited 92 women who underwent scheduled cesarean delivery and normal spontaneous vaginal delivery at university-affiliated hospitals from 2018 to 2023. We included women between 18 and 50 years old at ≥34 weeks of gestation. Subjects were approached in the hospital pre-admission testing unit during their routine pre-operative blood draws, typically at least 72 h in advance of their planned cesarean delivery. Participants were also enrolled at the hospital once they arrived for admission a few hours before their procedure. ROTEM parameters EXTEM clotting time (CT), clot formation time (CFT), alpha angle, A10, A20, maximum clot formation (MCF), maximum lysis, were measured preoperative. Results We found significant effects of age, blood loss type, delivery mode, gestational age, and maximum lysis on blood loss. The reduced model predicted that every one-percent increase in maximum lysis was associated with a 44-milliliter increase in blood loss and every one-year increase in age was associated with a 19-milliliter increase in blood loss. On average, cesarean deliveries resulted in 522 more milliliters of blood loss than normal spontaneous vaginal delivery. Conclusion The ROTEM EXTEM maximum lysis parameter has a significant effect on blood loss. Larger prospective clinical trials in conjunction with a prompt definition of the ranges of reference values will strengthen these advances to provide a rapid assessment and guide early interventions to prevent severe obstetric bleeding.

Abstract 226: Combined Delivery Catheter Systems Aspiration‐First Approach For Stroke Thrombectomy: A Single Center experience

Introduction In acute ischemic stroke management, rapid reperfusion is critical to improving patient outcomes. Previous multicenter studies of the novel Tenzing delivery catheter, designed to simplify stroke thrombectomies, have demonstrated more streamlined procedures, faster delivery times and superior clinical outcomes.[1‐5] Now with three combined delivery catheter systems available—Route 92’s Tenzing‐Freeclimb 70, Penumbra's SENDit‐Red 72 and Q'Apel's Cheetah‐Hippo—there is potential for further advancement. However, data on the Penumbra and Q'Apel systems are currently lacking, and the combined performance of these devices is unknown. Our study aims to evaluate whether these systems improve reperfusion times, outcomes, and complication rates compared to our traditional aspiration thrombectomy approach in our institutional cohort. Methods We retrospectively analyzed prospectively collected data from June 2023 to July 2024, the period when these devices first became available for our use. We compared the outcomes of using the Tenzing, SENDit, and Cheetah combined delivery systems first approach with our typical aspiration‐first approach cases during the same period, commonly a Zoom 71 aspiration catheter, 0.021‐0.027” microcatheter and 0.014‐0.018”” microguidewire. Primary outcomes measured included first on clot time, device deployment, reperfusion times, reperfusion success, and incidence of symptomatic intracranial hemorrhage. Secondary analyses assessed total thrombectomy passes and fluoroscopy times. Results Seventy‐seven patients met the inclusion criteria with a mean age of 68.3 ± 15.7 years; 43% were female. Occlusion sites were M1 (59.7%), ICA terminus (16.8%), basilar or distal vertebral (10.3%), tandem ICA‐M1 (6.5%), and proximal M2 (6.5%). Microwires were not used in 5.2% of cases (n=4). The combined delivery systems (n=20; Penumbra=13, Route 92=4; Q'apel=3) showed significantly faster mean groin‐to‐on clot times (19.95 vs. 23.98 mins, p=0.03) compared to the traditional systems (n=57). The combined systems had faster mean groin‐to‐first device times (25.25 vs. 28.16 mins, p=0.13) and faster mean groin‐to‐reperfusion times (46.16 vs. 49.48 mins, p=0.58). Successful reperfusion (TICI≥2b) was significantly higher with the combined systems (95% vs. 71.9%, p=0.03). Notably, total fluoroscopy times were nominally lower (25.9 mins vs. 29.9 mins, p=0.45), and fewer mean number of passes (1.94 vs 2.48, p=0.14) were nominally seen with the combined systems. The incidence of symptomatic intracranial hemorrhage was significantly lower with the combined systems compared to our conventional set up (0% vs. 8.8%, p=0.01). In addition, the lowest listed price of the combined delivery systems including a microwire was nearly $1,000 greater than our traditional aspiration thrombectomy system ($5,671 vs. $4,674). Eliminating the use of a microwire, which is outside of the Instructions for Use for the SENDit and Cheetah, but acceptable with the Tenzing delivery catheter, results in a marginal cost difference between the combined ($4,900) and traditional systems ($4,674). Conclusions The introduction of the combined delivery catheter systems has the potential to enhance mechanical thrombectomies for acute ischemic stroke. Our cohort's early use data shows promise in reducing reperfusion times and enhancing technical success and safety, allowing for better patient outcomes at a marginally increased financial cost. Further prospective studies are warranted to establish these devices as improved options for stroke intervention.

Point-of-care viscoelastic coagulation monitoring device shows promise for informing resuscitation strategies in a canine hemorrhagic shock model.

To use a point-of-care viscoelastic coagulation monitoring device (VCM-Vet; Entegrion) and traditional tests to assess hemostatic changes during hemorrhagic shock in dogs. 8 healthy, purpose-bred Beagles were enrolled in a hemorrhagic shock model conducted from September through December 2021. Dogs were anesthetized, had baseline hemostatic variables measured after blood pressure was stabilized at 70 to 80 mm Hg for 10 minutes (T1), had blood withdrawn from a jugular vein to achieve a mean blood pressure of 40 ± 5 mm Hg for 10 minutes (T2), were resuscitated with 100% shed blood, and then had hemostatic variables evaluated 10 minutes later (T3). At each time point, hemostatic variables were measured with traditional tests (Hct, WBC count, platelet count, mean platelet volume, prothrombin time, activated partial thromboplastin time [aPTT], and concentrations of fibrinogen, antithrombin, and D-dimer) and the VCM-Vet device (clot time, clot formation time, α-angle, maximum clot formation, amplitude at 10 minutes [A10], amplitude at 20 minutes [A20], clot lysis index at 30 minutes [LI30], and clot lysis index at 45 minutes [LI45]). All dogs survived without complication. At T2 and T3 (vs T1), samples had significantly higher coagulability (increased median α-angle, A10, and A20) and fibrinolysis (decreased median LI30 and LI45) and significantly longer aPTT; however, all values remained within reference limits. The use of VCM-Vet helped identify complex hemostatic disturbances in dogs with hemorrhagic shock. The use of VCM-Vet shows promise in aiding veterinarians in optimizing resuscitation strategies based on real-time clotting data.

The quality and technological parameters of milk obtained from dairy cows with subclinical mastitis

Mastitis is one of the most common diseases in dairy cattle. It significantly reduces milk quality and yield, thus incurring economic losses for farmers. This study investigates the impact of various bacterial pathogens on the somatic cell count, milk composition, and technological properties of milk samples from 302 clinically healthy Polish Holstein-Friesian cows kept under intensive rearing conditions. Of the 462 milk samples analyzed, 85.06% were contaminated with bacteria. The majority were coagulase-negative staphylococci (52.60%).-Escherichia coli, Streptococcus dysgalactiae, Streptococcus uberis, or Staphylococcus aureus, or Streptococcus agalactiae, a major pathogen, were identified in 16.66% of samples; their presence was associated with higher SCC levels. Additionally, contamination with S. aureus or S. agalactiae had prolonged clotting time, adversely affected curd and whey quality, with curd yield remaining unaltered. Bacterial contamination did not appear to significantly impact the yield of milk or its main components, viz. protein, casein, lactose, fat, total solids, solid nonfat, free fatty acid or citric acid. Although pH, freezing point depression (FDP), and acidity also remained unaffected by bacterial contamination, they were significantly influenced by herd-year-season of calving and herd-year-time of sampling interaction effects. The results indicate that the presence of bacteria causing subclinical mastitis negatively influences milk processing potential. However, fixed linear regression indicated that the number of colony-forming units (cfu/ml) only had a significant influence on FPD and clotting time, and as such, the number of bacteria in a sample did not influence milk yield or quality during subclinical chronic mastitis.

Association between Abnormal Systemic Coagulation Inflammation Index and Recurrence of Deep Venous Thrombosis as well as Quality of Life: A Retrospective Study.

BackgroundDeep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. This study aimed to identify factors associated with the recurrence of lower limb DVT by analyzing clinical, demographic, and biological markers, including the systemic coagulation-inflammation (SCI) index. MethodsA retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. Statistical analyses included differential analysis, correlation analyses, logistic regression, and receiver operating characteristic (ROC) analyses to identify predictive factors for DVT recurrence. ResultsThe recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. ConclusionThe study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Abstract 195: Assessing the Safety and Efficacy of Heparin in Ruptured Intracranial Aneurysms

Introduction Our study aims to retrospectively assess the safety of heparin during endovascular treatment of ruptured intracranial aneurysms. Methods A retrospective analysis of 56 patients who underwent endovascular aneurysmal repair for both ruptured and unruptured aneurysms was performed to examine outcomes. Results This series included 41 females (73.2%) and 15 males (26.8%) with a mean age of 55.9 ± 15.2 years treated with endovascular embolization of which there were 30 ruptured and 26 unruptured aneurysms. A total of 22 patients received an intraoperative heparin load before the procedure ranging from 3000‐7000 units. Therapeutic‐activated coagulation times were measured and maintained in all patients. Of the ruptured aneurysm cohort that received a heparin load (8/30, 26.7%), there was 1 thromboembolic complication intra‐procedurally, 1 thromboembolic complication post‐procedurally, and 1 hemorrhagic complication post‐procedurally. Of the unruptured aneurysm cohort (14/26, 31%) that received a heparin load, there was 1 thromboembolic intra‐procedurally and 0 hemorrhagic complications post‐procedurally. Conclusion This study suggests that heparin during endovascular treatment for ruptured intracranial aneurysms carries similar safety to those untreated with heparin pre‐procedurally warranting larger studies and further investigation.

Post-Neutralisation Activated Clotting Time and Postoperative Transfusions in Cardiac Surgery Outcome.

To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery. Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023. Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test. The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05). Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery. Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.

Post-Neutralisation Activated Clotting Time and Postoperative Transfusions in Cardiac Surgery Outcome.

To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery. Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023. Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test. The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05). Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery. Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.

Discovery of a new lead molecule to develop a novel class of human factor XIIa inhibitors.

Factor XIIa (FXIIa) is a plasma serine protease within the contact activation pathway. Inhibiting FXIIa could offer a viable therapeutic approach for achieving effective and safer anticoagulation without the bleeding risks that accompany the use of existing anticoagulants. Therefore, we investigated the anticoagulant properties of an amidine-containing molecule (inhibitor 1) to identify a potential lead molecule for subsequent development of FXIIa inhibitors. Results indicated that inhibitor 1 primarily inhibits human FXIIa with an IC50 value of ~30 µM. The inhibitor demonstrated variable selectivity against thrombin, factor IXa, factor Xa, factor XIa, and activated protein C. Michaelis-Menten kinetics indicated that the molecule is an active site inhibitor of FXIIa. Molecular modeling studies revealed that the molecule recognizes residues His57, Asp189, and Ala190 in FXIIa's active site. The inhibitor selectively and concentration-dependently prolonged the clotting time of human plasma under activated partial thromboplastin time assay conditions. The inhibitor did not exhibit significant cytotoxicity in human HEK293 cells and the in silico pharmacokinetics and toxicology data were comparable to known anticoagulants. This study introduces inhibitor 1 as a lead platform for further development as an anticoagulant to provide a more effective and safer approach to preventing and treating thromboembolic diseases.

Intraoperative bleeding model for swine gastric endoscopic submucosal dissection via heparinization.

Background and study aims: Live swine have a high degree of coagulation and aggregation and using them for training about how to manage intraoperative bleeding during endoscopic submucosal dissection (ESD) is unsatisfactory. This study aimed to identify the appropriate heparin dose in an intraoperative bleeding model and validate its applicability. Methods: First, we explored the dose of heparin required for a swine bleeding model in which the activated clotting time reached and maintained the upper limit of measurement (1500 s) after 10 minutes. Second, we compared intraoperative bleeding and hematoma frequency during ESD for 2-cm lesions between the heparinized bleeding model and control groups. Intraoperative bleeding was classified according to the Forrest classification. Results: The combination of a bolus (300 U/kg), continuous infusion (300 U/kg/h), and a bolus dose (150 U/kg) of heparin 10 minutes after the first infusion was identified as the dose for the bleeding model. Five ESDs were performed in each heparinized bleeding model and the control group. The median number of intraoperative bleeds was significantly higher in the heparinized model than in the control group (5 interquartile range [IQR] 4-7 vs. 3 [IQR 0-4, P = 0.028). All of the intraoperative bleeding events oozing (Forrest Ib) rather than spurting (Forrest Ia). The median number of hematomas was significantly higher in the heparinized model group than in the control group (3 [IQR 1-4] vs. 0 [IQR 0-1], P = 0.023). Conclusions: High doses of heparin significantly increased intraoperative bleeding and hematoma during swine ESD.

Effects of Variable Doses of Neurokinin B on Hematological and Coagulation Parameters in Adult Male Rats

Objective: To evaluate the dose-dependent effects of Neurokinin B on hematological and coagulation parameters in adult male Sprague Dawley rats. Study Design: Laboratory-based experimental study Place and Duration of Study: Gomal University and KMU Institute of Medical Sciences from February 2019 to April 2021. Methodology: Adult male Sprague Dawley rats (n=5 per group) were administered intraperitoneally with Neurokinin B at doses of 1 µg, 1 ηg and 1 ρg for 12 days consecutively. Control rats received distilled water injections. After 12 days, rats were sacrificed, and blood samples were collected from the left ventricle for hematological and coagulation analysis. Results: Bleeding time was significantly prolonged in NKB-µg (114±17.10sec) and Neurokinin B -ηg (72±22.25sec) compared to control (33±12.55sec). Clotting time (CT) was also increased (NKB-µg: 111±17.10sec; NKB-ηg: 69±17.10sec, control: 42±12.55sec), as did prothrombin time (PT) [NKB-µg: 93.60±10.92sec; NKB-ηg: 63.40±12.66sec, control: 15±4.12sec] and activated partial thromboplastin time (APTT) [NKB-µg: 94.80±14.04sec; NKB-ηg:68.60±13.74sec, control: 19.40±2.97sec]. Additionally, mean platelet volume [NKB-µg:8.94±0.36fl, control: 8.04±0.48fl] and leukocyte count (×103/µl) [NKB-µg: 12.14±0.69, control: 8.87±1.32] were significantly increased in NKB-treated animals compared to control. There was a significant increase in international normalized ratio in NKB-µg (6.86±0.80) and NKB-ηg (4.65±0.93) compared to control group (1.10±0.30). Conversely, platelet count (×103/µl) was decreased significantly in NKB-µg group (787.80±48.51) compared to the control group (960.60±58.71). Conclusion: NKB administration led to leukocytosis, thromboctopenia, and affected coagulation pathways with prolonged BT, CT, PT, APTT and INR dose-dependently.

Testosterone replacement has a beneficial effect on the hemostatic system by altered gene expression of coagulation factors

This study aimed to investigate the effects of testosterone replacement therapy on hemostasis and some procoagulant gene expression in mice. 42 mice were randomly divided into two groups of non-orchiectomized (non-ORX) and orchiectomized (ORX) with three subgroups (n = 7) each, were subcutaneously administered with sesame oil (control), 2 and 20 mg/kg/week testosterone enanthate. Orchiectomized mice were allowed to recover for one week before treatment. On the 7th week of treatment, blood samples were collected for coagulation parameters analysis and measurement of plasma testosterone levels. Moreover, quantitative real-time PCR analysis was performed on liver samples to assess the expression of factor IX, factor X, and prothrombin genes. The results showed that supraphysiological doses (20 mg/kg) of testosterone significantly increased plasma testosterone levels in all groups, while physiological doses (2 mg/kg) only increased testosterone levels in non-ORX animals. Although testosterone administration had no effect on prothrombin time (PT) and activated partial thromboplastin time (aPTT), supraphysiological doses reduced bleeding time and clotting time. Furthermore, platelet count increased in a dose-dependent manner with testosterone enanthate treatment. The expression of coagulation factors was also decreased with supraphysiological doses of testosterone. In conclusion, testosterone had significant effects on primary hemostasis and common coagulation pathway, including increased platelet number and aggregation, decreased clotting time, and altered gene expression of coagulation factors.

European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: insights from an international survey

Abstract Background Bleeding and thrombotic complications remain a major concern in cardiogenic shock (CS) patients undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like the Impella. Antithrombotic practices strongly determine the coagulopathic risk, but standardized protocols are lacking in this context. Purpose This survey outlines European practices on antithrombotic management in adults on pMCS for CS, making an initial effort to standardize practices, inform future trials, and enhance outcomes. Methods This online cross-sectional survey was distributed through digital newsletters and social media platforms by the Association of Acute Cardiovascular Care (ACVC) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). The survey was accessible from April 17th to May 23rd, 2023. The target population were European clinicians involved in care for adults on pMCS. Results We included 105 responses from 26 European countries. In 72.4% of the European respondents’ institutions, a standardized local anticoagulation protocol is present, with unfractionated heparin (UFH) being the predominantly used anticoagulant (Impella: 97.0%; V-A ECMO: 96.1%). Similarly, the purge solution during Impella support is most frequently UFH-based (84.1%). A bicarbonate-based purge solution (BBPS) as standard purge is reported by only 1.6%. UFH titration based on the activated partial thromboplastin time (APTT) alone is the most common practice either for Impella (43.1%) and for V-A ECMO (32.9%). A minority of 16.9% and 13.2% indicate relying on activated clotting time (ACT) for UFH-titration during Impella and V-A ECMO support, respectively. UFH-titration protocols are anti-Xa based for 12.3% (Impella) and 10.5% (V-A ECMO) of the respondents. An UFH anticoagulant protocol based on APTT and anti-Xa in parallel is the preferred option for 10.8% (Impella) and 14.5% (V-A ECMO) of the respondents. Anticoagulant targets for APTT, ACT and anti-Xa varied across institutions. The majority (83.8%) does not alter their anticoagulation management in case of combined Impella plus V-A ECMO-approach (ECMELLA). Typical thresholds for transfusion or administration of blood products without acute bleeding as indication vary substantially and are frequently not predefined. Following acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0% and 42.7% administered dual antiplatelet therapy during Impella and V-A ECMO support, increasing to 93.7% and 84.0% after PCI. Conclusions Our survey validated the considerable variation in antithrombotic management in adults in CS on pMCS across European centres. There is a pressing demand for a standardized approach to antithrombotic management in this context to mitigate the impact of coagulopathic complications and, consequently, enhance outcomes.Figure 1.Figure 2.

Lupus anticoagulant and valvular cardiac surgery.

Despite its name, lupus anticoagulant (LAC) neither exclusively occurs in lupus nor induces anticoagulation. It is an antiphospholipid antibody found in 2%-4% of the population that promotes clot formation by targeting phospholipid-protein complexes in cell membranes. However, in vitro, LAC exhibits paradoxical effects, prolonging clotting times in phospholipid-dependent assays such as Activated Partial Thromboplastin Time (APTT). This unpredictability extends to point-of-care tests like Activated Clotting Time (ACT), which are frequently used to monitor anticoagulation during cardiac surgeries involving cardiopulmonary bypass (CPB). High doses of unfractionated heparin (UFH) are administered in these procedures, but the presence of LAC complicates ACT measurements, creating challenges for both anesthesiologists and surgeons. This case report highlights the clinical implications of LAC in perioperative management, underscoring the difficulties in ensuring adequate anticoagulation during CPB.

Epidemiological Aspects, Clinicopathology, Hemato-biochemistry and Therapeutic Management of Viperine Snake Envenomation in Buffaloes (Bubalus bubalis)

Background: Poisonous snakebite is a neglected tropical disease, frequently reported in animals including buffaloes. Snakebites are responsible for considerable morbidity and mortality in animals causing economic losses to dairy farmers. Methods: To establish the baseline data of epidemiology, clinical syndrome, hemato-biochemistry and diagnosis of viper snakebites and to standardize the treatment of viper snakebite in buffaloes. Result: The highest incidence of viper envenomation was observed during the monsoon and post-monsoon season in female buffaloes above 4 years of age. The clinical signs such as tachycardia, increased respiration rate, ascending swelling of affected limbs, asymmetrical swelling with dyspnea in case of bite over face and bleeding at the site of bite were observed in envenomed buffaloes. Hemato-biochemical analysis revealed neutrophilic leukocytosis, thrombocytopenia, prolonged capillary blood clotting time, elevated values of blood urea nitrogen (BUN) and creatinine. Post-mortem examination showed hemorrhages and blood-stained serous fluid in subcutaneous tissue and skeletal muscles of the affected limbs. The histopathological changes such as extensive myonecrosis and hemorrhages with marked edema in skeletal muscles, widespread interstitial and intra-alveolar hemorrhages and fibrinous microthrombi in pulmonary vasculature, multifocal to coalescing areas of massive hemorrhages and coagulative necrosis within hepatic parenchyma and marked degeneration of renal tubular epithelium were evident. Therapeutic regimen consisting of polyvalent anti-snake venom, with antibiotics, diuretics, vitamin B complex, styptics, fluids and corticosteroids in non-pregnant while non-steroidal anti-inflammatory drugs in pregnant buffaloes was used. The present treatment strategy showed subsidence of clinical signs, restoration of platelet count, blood clotting time, urea nitrogen and creatinine values depicting clinical recovery with 88.15% survival rate in treated buffaloes.

Влияние уровня «защищенных» жиров в рационах высокопродуктивных коров на молочную продуктивность

The amount of fat in the diets of Kholmogory dairy cows is known to affect milk yield and its quality, as well as the economic efficiency of milk sales. In this research, the content of protected fats in the diets of high-yielding dairy cows was raised from 771.9 g to 1,023.9 g (32.6%) during full lactation by adding 300 g calcium salts of fatty acids per day. As a result, the milk yield increased by 8.0% (P = 0.95). The mass fraction of fat increased by 0.05% while that of protein rose by 0.03%, which improved the overall quality of milk. The experimental milk samples demonstrated a slight increase in non-fat milk solids (0.052%). The level of urea rose slightly (2.9 mg/100 mL) and reached 21.1 mg/100 mL, which corresponded to official standards and was a marker of a balanced diet. The study revealed a moderate positive correlation (r = 0.35) between the feed energy and the lactation performance. Protected fats had no significant effect on coagulation time and cottage cheese yield. The experimental diet demonstrated economic efficiency by increasing the potential profits from milk sales by 15.5%.

Viscoelastic Hemostatic Testing as a Diagnostic Tool for Hypercoagulability in Liver Transplantation: A Narrative Review.

Liver transplantation is a complex surgical procedure in which various forms of coagulation dysfunction can occur, including perioperative hypercoagulability. The hemostasis balance in liver graft recipients with end-stage liver disease can shift to thrombosis or haemorrhage, depending on the associated risk factors and clinical conditions. Hypercoagulability can result in serious complications such as thromboembolism, which can affect the vessels of the newly transplanted liver graft. Standard coagulation tests (SCTs), such as prothrombin time and activated partial thromboplastin time (aPTT), have a poor ability to diagnose and monitor an early stage of hypercoagulability. Recent studies demonstrated that viscoelastic hemostatic elastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are promising alternative tools for diagnosing hypercoagulability disorders. VETs measure clotting and clot formation time, clot strength (maximum clot firmness), fibrin and platelet contribution to clot firmness, and fibrinolysis, which makes them more sensitive in identifying liver graft recipients at risk for thrombosis as compared with SCTs. However, developing evidence-based guidelines for the prophylaxis and treatment of hypercoagulability based on VET results is still needed.

A Case of Snake Bite in a One-Year-Old Cross-Breed Cow – A Case Report

This clinical article reports a case of snake bite in a -year-old Friesian and white Fulani cross-breed cow at the Livestock Investigation Division of the National Veterinary Research Institute, Vom, Nigeria. The clinical signs observed during the physical examination are as follows: swollen brisket region and left forelimbs, anorexia, fever (39.2°C), and difficulty walking. The whole blood clotting time was positive (Absence of clotting for more than 2 h). The affected cow was treated using antibiotics, diuretics, and anti-inflammatory agents without the administration of anti-venom. The recovery was uneventful within 3 days following treatment.

Synergistic effects of rivaroxaban and hypothermia or acidosis on coagulation initiation measured with ROTEM®: a prospective observational study

BackgroundHypothermia and acidosis individually inhibit haemostasis. We designed this study with the aim to investigate whether rivaroxaban combined with hypothermia or acidosis exhibit synergistic inhibitory effects on haemostasis using ROTEM®.MethodsPatients with a clinical indication to start rivaroxaban treatment were prospectively included. Blood samples were collected before initiation of treatment and the day after. All blood samples were in vitro modified with respect to temperature (incubated and analysed at 28, 33, 37 and 40 degrees Celsius (°C)) and pH (6.8, 7.0, 7.2 and 7.4). The temperature and acidosis effects on the ROTEM EXTEM variables clotting time (CT), clot formation time (CFT) and alpha-angle (AA) were measured along with the individual effect of rivaroxaban on the same variables. The additive effect was calculated. The observed (potential synergistic) effects for the temperature and pH modified rivaroxaban samples on the same ROTEM variables, were registered. Differences between the additive and observed (potential synergistic) effects were analysed using matched non-parametric hypothesis testing.ResultsIn total, 13 patients were included. Hypothermia and rivaroxaban exhibited a synergistic effect on CT at 28 °C (p = 0.0002) and at 33 °C (p = 0.0007). The same applied for acidosis at pH 6.8 (p = 0.003) and pH 7.0 (p = 0.003). There were no signs of synergistic effects of rivaroxaban and temperature or acidosis on CFT. In AA there were signs of synergism at 28 °C (p = 0,001), but not at other tested temperatures or pH levels.ConclusionsThe combination rivaroxaban together with hypothermia or acidosis demonstrated inhibitory synergistic effects on haemostasis.Trial registrationThe study was retrospectively registered 2023-03-01 at ClinTrials.gov with NCT05669313.

Properties of Rennet Gels from Retentate Produced by Cold Microfiltration of Heat-Treated and Microfiltered Skim Milk.

This study investigated the production of rennet gels from β-casein-depleted retentates obtained through cold microfiltration (MF) of skim milk (SM) that was treated beforehand to ensure microbial safety. The treatments included thermization (65 °C, 20 s), pasteurization (72 °C, 15 s), and microfiltration (50 °C; 1.4 μm pore size). The reduction in β-casein content was 0.98, 0.51 and 0.90%, respectively. All treatments resulted in the partial aggregation of serum proteins, which were slightly concentrated in the retentates obtained post cold MF process. This aggregation, along with concentration effect, likely inhibited β-casein dissociation from casein micelles and permeation, particularly in pasteurized milk. Renneting and coagulation properties of the retentates were comparable to those of the respective SM samples, with no significant differences in syneresis, water-holding capacity, or protein hydration. Notably, the retentate from thermized SM, which showed the best performance with the highest β-casein reduction (0.98%), demonstrated shorter coagulation time compared to retentate from pasteurized milk or the corresponding unfiltered SM. Textural analysis revealed greater firmness, cohesiveness, and viscosity of retentate-based rennet gels compared to gels made from unfiltered SM, attributed to protein concentration during cold MF. Overall, this study successfully produced rennet gels from cold MF retentates without compromising their physicochemical properties.