Venous thromboembolic (VTE) complications contribute substantially to perioperative morbidity and mortality. The decision for mechanical and/or chemo-prophylaxis is currently based on VTE risk assessment models since conventional laboratory assays of coagulation usually fail to detect changes indicating hypercoagulability. Rotational thromboelastometry is a novel assay of coagulation, that it could potentially be used in objectively selecting patients at risk for VTE, who should indisputably undergo prophylaxis. We evaluated the association of conventional and novel assays of coagulation and VTE risk. VTE risk was preoperatively assessed in 45 patients scheduled for endoscopic, open and laparoscopic urologic surgery, including transurethral resection of prostate, transurethral resection of bladder tumor, endoscopic vesical or ureteral stone lithotripsy, open prostatectomy, open cystectomy and urinary diversion, open or laparoscopic radical or partial nephrectomy, between March 2021 and October 2022, using three different risk assessment models (RAMs): the European Association of Urology (EAU) RAM, the American Urological Association (AUA) RAM, and the Caprini model. Patients under antiplatelet or anticoagulation agents were excluded. Patients' coagulation profile was determined by measuring PT, fibrinogen, aPTT, and rotational thromboelastometry analysis. For rotational thromboelastometry analysis, extrinsic rotational thromboelastometry and fibrinogen rotational thromboelastometry were examined in every patient. Statistical analysis was performed with ANOVA test and χ2 test. Mean values of all rotational thromboelastometry variables did not vary significantly among different EAU VTE categories. In extrinsic rotational thromboelastometry assessment, a significant difference was observed in the mean values of the Clotting time (CT) between the different risk groups based on AUA RAM. In the comparison between the risk groups defined based on the Caprini score, statistically significant differences were observed in the extrinsic rotational thromboelastometry clot formation time (CFT). In fibrinogen rotational thromboelastometry analysis, significant differences were identified in the clot amplitude after five minutes (A5) and maximum clot firmness (MCF) indices between the AUA risk groups, along with a significant difference in the mean clot formation rate (CFR) value between the risk groups defined based on the Caprini score. Rotational thromboelastometry can provide a detailed evaluation of the hemostatic status in patients undergoing urologic surgery that can be used as an adjunct to the VTE risk assessment models and thus, help to offer prophylaxis on a rather personalized basis. Future studies should assess the utility of thromboelastometry in identifying patients at high risk for VTE after major urological procedures.

Despite the technological advancement in blood-contacting biomedical devices, issues related to thrombosis remain a persistent challenge. These devices not only include implants such as artificial heart valves and stents but also surgical tools and instruments. This makes hemocompatibility an important parameter to be considered before developing any material for a blood-contacting device. The two oldest methods, including the mechanical tilting method and the free-hemoglobin method, lack temporal accuracy and quantitative analysis. Our work gives an accurate and quantitative analysis to measure the blood clotting time of various materials that can be used as implant devices. The system relies on measuring the change of reflectance as blood clots on a surface and measures the clotting time and rate by analyzing the time dependent reflectance curve. The system consists of an automated injection system, a heater and temperature controller, a red laser and polarizer assembly, and a highly sensitive photodetector. As the blood clotting process begins, the sample surface becomes turbid, causing a change in voltage in the detector. The time taken for this "voltage change" corresponds to clotting time. Our system shows a prothrombin time of 12.6s and an activated partial thromboplastin time of 31.16s on the PTFE surface, close to the control due to its hydrophobicity. The electronics and device configuration used in our system give a temporal resolution of 5.7 ± 0.6ms in the clotting time determination. Our design is compact, precise, accurate, and devoid of manual observation and errors.

In-stent restenosis (ISR) is a significant limitation of coronary stent implantation, but the exact mechanism of ISR remains unclear. Patients after percutaneous coronary intervention (PCI) are in a hypercoagulable state; however, there is less information on its association with chronic coronary artery disease (CAD) in patients with ISR after PCI. We aimed to clarify whether or not CAD patients with ISR after PCI are in a hypercoagulable state and whether or not PS exposure on extracellular vesicles (EVs), blood cells (BCs), and endothelial cells (ECs) is involved in the hypercoagulable state. Phosphatidylserine (PS) exposure to EVs, BCs, and ECs was analyzed using flow cytometry. Procoagulant activity (PCA) was analyzed by clotting time (CT), purified clotting complex assays, and fibrin production assays. Compared with pre-PCI or controls, levels of exposed PS on EVs, BCs, and ECs were significantly increased from 1 day, peaked at 3 months, and gradually decreased within 1 year in CAD patients after PCI, especially in CAD patients with ISR after PCI. Furthermore, their increased levels significantly decrease CT and enhance intrinsic/extrinsic FXa, thrombin, and fibrin generation. PCA was weakened by approximately 80% when lactadherin was used. Our results revealed that CAD patients after PCI, especially those patients with ISR after PCI, are associated with a hypercoagulable state in which PS exposure on EVs, BCs, and ECs plays a more important role than tissue factors. Therefore, blocking PS exposure to EVs, BCs, and ECs may provide a new target for preventing ISR in these patients.

Association between activated clotting time and TIMI flow in STEMI patients pre-treated with unfractionated heparin.

Congenital afibrinogenemia is an extremely rare coagulation disorder affecting 1-2 individuals per million. We report the case of a 15-year-old male with known congenital afibrinogenemia who developed hemorrhagic shock following minor soccer ball trauma to the abdomen. Clinical examination revealed hemodynamic instability with hypotension (90/40 mmHg) and tachycardia (140 bpm), associated with abdominal defense. Laboratory tests showed severe anemia (Hemoglobin 7 g/dL), undetectable fibrinogen (<0.2 g/L), and prolonged coagulation times. Abdominal computed tomography revealed massive hemoperitoneum with splenic involvement and a hematoma of the greater gastric curvature. Emergency exploratory laparotomy with gastrosplenic disconnection and surgical hemostasis was performed. The patient received blood transfusions, fresh frozen plasma, and 9 grams of fibrinogen concentrate, with full recovery and discharge on day 7. Splenic rupture occurs disproportionately in afibrinogenemia patients despite the rarity of the condition. Management requires prompt diagnosis, fibrinogen replacement therapy, and surgical intervention when indicated, along with preventive education regarding high-risk activities.

Rotational thromboelastometry (ROTEM) aims to measure the coagulation potential in whole blood. Concizumab, an anti-tissue factor pathway inhibitor (TFPI) antibody for prophylaxis in haemophilia, enhances tissue factor (TF)-initiated coagulation by preventing inhibition of activated factor X (FXa), thus increasing thrombin generation. To evaluate a modified ROTEM assay for monitoring patients on concizumab prophylaxis. The TF reagent (r_exTEM) was diluted 50,000-fold to make the ROTEM assay sensitive to haemophilia and to concizumab. The effect of concizumab was evaluated in the modified ROTEM in haemophilia A (HA)-like blood (normal blood with added anti-FVIII antibody). ROTEM analysis was performed in blood from patients participating in the explorer7/8 trials during 24 weeks of concizumab prophylaxis. Rotrol N plasma was used as quality control. In vitro experiments showed concizumab concentration-dependent reduction in clot time (CT) and increase in clot development (α-angle) in HA-like blood. At three of four clinical sites, CT and clot development were stable, variance of the control plasma was ≤12.4% and TF content of the diluted reagent (r_exTEM) was consistent. At these three sites, the correlation between CT versus concizumab exposure, free TFPI and thrombin generation assay parameters was weak (-0.508 to +0.359). Prothrombin time positively correlated with CT (0.523) and negatively correlated with α-angle (-0.659). Due to the poor correlation between ROTEM parameters, concizumab exposure, free TFPI and thrombin generation parameters and the lack of consistent and reliable performance of the modified ROTEM assay, it cannot be recommended for general monitoring of patients on concizumab prophylaxis.

Electrohydrodynamic discretized starch suspension after contacting with a crosslinker solution was subjected to solvent exchange in phased and optimal manner prior to lyophilization. The resulting nucleation and growth of new solvent crystals in the gelled droplet could provide a porous structure with internal surface area to the extent of 13.4 m²/g, and water absorption reaching 3.26 times the dry weight of particles. These properties promoted rapid plasma uptake, and aggregation of platelets, while the tranexamic acid (TA) loaded a priori in the precursor suspension stabilized the blood clot against fibrinolysis. In vitro clotting time was reduced from 155 s to 64 s due to presence of microparticles. The clot strength and formation kinetics from the thromboelastography data supports this observation. The experiments with rat injury models reveal a significant reduction in clotting time (to less than a minute), and cumulative blood loss in reference to those observed for a commercially available hemostat. The antimicrobial activity of these microparticles against S. aureus and E. coli was found superior than commercially available hemostat. These uniform microparticles of equivalent diameter on the order of 100 µm provided uniform coverage on hard to reach places of wound site, and were found to degrade to 90% of its initial weight within 6 days of exposure to PBS at 37 °C which conforms to the time scale of skin regeneration process.

Microplastic pollution has become a widespread environmental concern, particularly in aquatic ecosystems where filter-feeding organisms are highly vulnerable to contamination. This study examines the sublethal physiological effects of environmental microplastic exposure on the neurophysiological, immunological, and biochemical responses of the green mussel Perna viridis, a commercially important and widely consumed marine bivalve. Mussels were collected from two coastal sites in Tamil Nadu, India, N4 Beach, Chennai (Site 1), and Pulicat Lake, Thiruvallur (Site 2) previously reported to differ significantly in microplastic abundance. Acetylcholinesterase (AChE) activity in gill tissues, haemolymph clotting time, total haemocyte count (THC), and total protein levels in the gill and posterior adductor muscle were quantified using standard biochemical and immunological assays. Mussels from Site 1 exhibited significant inhibition of AChE activity, prolonged haemolymph clotting time, reduced THC, and markedly lower protein concentrations compared to those from Site 2 (p < 0.05). These alterations indicate neurotoxicity, immunosuppression, and metabolic stress associated with elevated microplastic exposure. The findings suggest that microplastics, either directly or as carriers of associated contaminants, interfere with critical physiological processes in P. viridis. This study highlights the suitability of green mussels as bioindicators of microplastic pollution and raises concerns regarding ecosystem health and potential human exposure through seafood consumption. Overall, the results provide valuable insights into the sublethal impacts of microplastics on marine bivalves and emphasize the need for sustained monitoring and risk assessment in coastal environments.

To report the use of cryosupernatant (CS) transfusion for the treatment of suspected vitamin K antagonist rodenticide (VKAR)-associated coagulopathy in dogs and its impact on coagulation times. Retrospective case series (2000-2017). University teaching hospital. Seven dogs with hemorrhage associated with suspected VKAR intoxication treated with CS transfusion. CS transfusion. The median age was 3.0years, with a median weight of 17.7kg. Initial coagulation testing revealed median one-stage prothrombin time and activated partial thromboplastin time of 697% and 393%, respectively, above control/average of the reference range (CARR). The median dose of CS was 11.0mL/kg. One-stage prothrombin time decreased (p=0.043) after CS transfusion to a median of 98% of CARR. Activated partial thromboplastin time (n=3) decreased to 114% of CARR (sample size precluded statistical analysis) upon recheck. All dogs received vitamin K supplementation, with an initial median subcutaneous dose of 4.11mg/kg. Initial median PCV and total plasma protein concentration were 27.0% and 4.5g/dL (45g/L), respectively, with posttransfusion PCV and total plasma protein concentration of 22.0% and 4.9g/dL, respectively. Six dogs showed resolution of observed clinical hemorrhage and were discharged. One dog was euthanized due to multi-organ dysfunction. No transfusion reactions were reported. Dogs with suspected VKAR intoxication showed resolution of clinical hemorrhage after CS transfusion. Compared with fresh frozen plasma, CS is an option for treating VKAR-associated coagulopathy, despite lower factor IX activity.

The aim of this study was to assess the influence of milk’s rennet coagulation properties (RCPs) on cheese yield and cheese-making losses in the production of Parmigiano Reggiano PDO cheese. Higher contents of citric acid (181.10 vs. 172.13 vs. 166.47 mg/100 g) and phosphorus (95.02 vs. 91.14 vs. 88.78 mg/100 g) in milk with optimal and sub-optimal RCPs, compared to milk with poor RCPs, respectively, positively affect the acidity of the milk, lowering the pH values (6.68 vs. 6.70 vs. 6.72, respectively), which results in a faster reaction between chymosin and casein and consequently a reduced time of milk coagulation. The lower values of curd firming time and the higher values of curd firmness, strength to cut (68.97 vs. 64.43 vs. 44.38 g), and strength to compression (31.48 vs. 30.49 vs. 25.70 g) for milk with optimal and sub-optimal coagulation, compared to milk with poor coagulation, result in a higher stress resistance across the technological steps of the cheese-making process, leading to lower fat losses (14.23 vs. 15.48 vs. 16.72%) in the whey and a higher cheese yield (8.79 vs. 8.56 vs. 8.08 kg/100 kg).

We report the case of a 67-year-old Saudi man with multiple comorbidities, including type 2 diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease, who presented with progressive shortness of breath, altered mental status, and fever. His symptoms began five days prior with productive cough, pleuritic chest discomfort, and generalized body aches, initially managed at home. On presentation, he was hypotensive, tachycardic, hypoxemic, and disoriented, with signs of respiratory distress and new ecchymoses. Laboratory evaluation revealed leukocytosis, elevated inflammatory markers, acute kidney injury, and coagulopathy. Chest radiography demonstrated new bilateral multifocal pneumonic patches compared with prior baseline imaging. Blood cultures grew Streptococcus pneumoniae, confirming pneumococcal sepsis. During intensive care unit admission, he developed gross hematuria, progressive thrombocytopenia, prolonged coagulation times, and evidence of disseminated intravascular coagulation. Acute neurological deterioration prompted urgent CT imaging, which revealed extensive intraventricular hemorrhage with early hydrocephalus. Despite aggressive supportive care, including hemodynamic stabilization, transfusions, renal replacement therapy, and tailored antibiotics, the patient developed refractory shock and multiorgan failure. After multidisciplinary discussion and family consultation, care was transitioned to comfort measures, and he subsequently died. This case illustrates the fulminant and often fatal nature of pneumococcal sepsis complicated by disseminated intravascular coagulation and intracranial hemorrhage, emphasizing the need for early recognition, close monitoring, and multidisciplinary management in high-risk patients.

This study evaluated the effects of varying dietary salt and boric acid addition doses on the milk quality of Savak Akkaraman sheep. A total of 120 animals were as-signed to six treatment groups (n = 20): control (C), rock salt (S; 10 g/day), boric acid 20 mg/day (B20), boric acid 40 mg/day (B40), BS20 (20 mg boric acid + 10 g/day rock salt), and BS40 (40 mg boric acid + 10 g/day rock salt). All analyses were performed in duplicate on six samples, taken on days 30 and 35 following the administration of the additives. Physicochemical analyses only showed significant variation in milk pH (p = 0.006), while acidity, dry matter, and ash remained unaffected. Strong positive correlations were found among protein, lactose, salt, and density (r > 0.95; p < 0.001). Coagulation times differed widely, with the longest being observed in BS20 (995.03 s) and the shortest in BS40 (141.73 s). Among mineral parameters, only selenium levels differed significantly between the treatment groups (p < 0.05). No significant differences were found for fat, solids-not-fat, lactose, freezing point, or electrical conductivity. Importantly, boron addition had a significant influence on total casein content (p < 0.001). Overall, dietary rock salt and boric acid did not markedly alter the basic milk composition but produced notable physicochemical changes, particularly in coagulation behavior and casein levels, which may influence the technological properties of sheep milk.

Quality of Life, Cost Effectiveness, and Cost Utility Analysis of Activated Clotting Time Guided Heparinisation vs. a Single Bolus of Heparin in Open Abdominal Aortic Aneurysm Repair.

Coagulopathy is a common complication and heterogeneous syndrome of sepsis. Longitudinal data are essential for capturing the complexity and heterogeneity of coagulopathy in sepsis. The dynamic changes in coagulation profiles, their characterization, and prognostic implications remain poorly understood. We hypothesized that sepsis patients develop distinct coagulopathy sub-phenotypes. Using longitudinal data, we first aimed to identify these sub-phenotypes, then characterize their trajectories, and finally evaluate their association with 28-day mortality and explore potential influencing factors. We conducted a retrospective analysis using Group-based Trajectory Modeling to investigate patterns of coagulation changes and their association with 28-day mortality in sepsis patients from West China Hospital of Sichuan University (2015-2022). The Cox proportional hazards regression model was used to investigate the relationship between trajectory groups and prognosis. Subgroup analyses were performed to explore potential influencing factors further. A total of 1649 patients were included, and 3 distinct trajectory sub-phenotypes were identified based on model fit indices and clinical interpretability. Group 1 (N = 818, 49.6%) exhibited the highest levels of D-dimer, a slight prolongation of clotting time, normal fibrinogen levels, and borderline-low platelet counts. Group 2 (N = 638, 38.7%) showed gradually increasing platelet counts, elevated fibrinogen levels, and normal clotting time. Group 3 (N = 193, 11.7%) displayed significantly prolonged clotting time, the lowest platelets and fibrinogen levels, and persistently high D-dimer levels. Group 2 showed lower 28-day mortality risk (HR 0.235, 95% CI 0.170-0.324) while Group 3 exhibited higher risk (HR 2.780, 95% CI 2.214-3.492) versus Group 1. Group 3 demonstrated the highest in-hospital mortality rates. Mechanical ventilation duration did not differ significantly across groups. Subgroup analysis identified an interaction between age and trajectory groups. Our study suggests that coagulopathy in sepsis patients can be classified into three distinct sub-phenotypes, each associated with different risks of 28-day mortality. Future prospective studies incorporating external validation and multiple specific parameters are needed to explore the mechanisms underlying these sub-phenotypes and validate their application in clinical practice.

An accurate and reproducible method to measure snake venom anticoagulant activity.

Viscoelastic coagulation testing in bleeding trauma patients: a retrospective analysis and development of a treatment algorithm.

Molecular regulation of coagulation by heparin-bound plasma Latexin.

Advanced polyelectrolyte complexes for ultrafast hemostasis and blood superabsorption.

Precise, timely, and personalized in vivo thrombus monitoring is critical for improving the treatment effectiveness and clinical outcomes of cardiovascular diseases (CVDs). Terahertz (THz) spectroscopy has become increasingly important as a novel tool in biomedical engineering due to its rapid analysis ability, high temporal resolution, and label-free measurement modality. However, achieving high thrombus sensing performance in real blood environments remains a significant challenge. In this work, a thrombus sensing platform is developed using an MXene-powered THz hybrid metamaterial, which substantially increases early thrombus detection sensitivity and real-time sensing ability by utilizing the highly sensitive THz response from the interfacial charge transfer between MXene and the thrombus. When applied to patients receiving extracorporeal membrane oxygenation therapy, the sensitivity (94.7%) and accuracy (92.3%) of diagnosing a thrombus using this platform surpassed the capabilities of current clinical methods, including the thromboelastogram and the activated clotting time (ACT) method. Furthermore, the platform provides faster assay performances for in vivo thrombus detection (6min in advance) and anticoagulant effectiveness feedback (2min in advance) than the ACT method. The proposed platform demonstrates the potential for tailoring clinical anticoagulation strategies for individual patients to substantially reduce the current high risk of thrombus complications among those with CVDs.

When More Monitoring Delivers Less Value: Lessons from Activated Clotting Time Guided Heparinisation during Open Abdominal Aortic Aneurysm Repair.