Coagulation Function In Patients Research Articles

Effect of vitamin K1 on survival of patients with chronic liver failure: A retrospective cohort study.

The effectiveness of vitamin K1 for the treatment of liver failure has been controversial, and no studies have investigated the effect of vitamin K1 on the risk of death and coagulation function in patients with chronic liver failure. This study aimed to explore the effect of vitamin K1 on death risk and international normalized ratio in patients with chronic liver failure.From December 2013 to August 2017, this retrospective cohort study screened patients hospitalized for chronic liver failure (n = 80) who received routine treatment. The patients were categorized into the vitamin K1 and control groups according to whether they had received intramuscular injection of vitamin K1 on the basis of conventional treatment. Baseline data were analyzed with χ2 test and independent sample t-test; the survival curve of 48 weeks was created with Kaplan–Meier estimator. Correlation between death event and vitamin K1, age, sex, albumin (ALB), total bilirubin (TBIL), and alkaline phosphatase (ALP) was determined with the Cox proportional risk regression model.Fifty-seven Chinese patients were finally included in the analysis. Patients treated with vitamin K1 had a lower risk of death (hazards ratio [HR] 0.37, P = 0.009) than the control group (P = 0.006). Men had a higher risk of death (HR 2.97, P = 0.005). Age, ALB, TBIL, and ALP had a certain correlation with risk of death. Vitamin K1 reduced the international normalized ratio levels [P < 0.01 (95% confidence interval 0.000–0.002)].Vitamin K1 may reduce the risk of death in patients with chronic liver failure. Male sex, age, ALB, TBIL, and ALP are potential risk factors for increased risk of death in these patients. Based on these findings, vitamin k1 can be used in patients with chronic liver failure. Prospective studies are still needed, however, to validate the role of vitamin K1 in the chronic liver failure.

Impact of diabetes mellitus on coagulation function before and after off-pump coronary artery bypass grafting.

This study aims to explore the influence of off-pump coronary artery bypass grafting (OPCABG) on coagulation function and the effects of diabetes on coagulation function during OPCABG. Patients who met the inclusion and exclusion criteria were divided into two groups: diabetes mellitus (DM) and non-diabetes mellitus (NDM) groups. Thromboelastography (TEG) was tested at the following time points: T0, five days after aspirin and clopidogrel therapy, and before OPCABG; T1, returning to care unit after OPCABG; T2, 5 days after aspirin and clopidogrel therapy, and after OPCABG. A total of 56 patients were involved. There were no deaths, or no early postoperative thrombotic events and abnormal bleeding after OPCABG. Intra-group comparison: Compared with T0, the R and K value decreased, while the α angle and MA value increased at T1 and T2, in both groups (P<0.05). A significantly statistical difference was found in the multiple comparison at T0, T1 and T2 (P<0.05). The results are as follows: the R value decreased at T1 and increased at T2, but the value remained less than that at T0. After the OPCABG, the K value gradually decreased, while the MA value and α angle gradually increased. Comparison between groups: T1: the R values were lower in the DM group, when compared to the NDM group (t=3.611, P=0.001). The differences in the MA, K and α angle were not statistically significant. T0 and T2: there were no statistically difference in the R, MA, K, α angle and LY30 between the two groups (P>0.05). The coagulation function of patients was at a hypercoagulable state at the early stage after OPCABG. The coagulation function was affected by diabetes at the day of OPCABG. However, there was no statistical difference after 5 days of aspirin and clopidogrel therapy following OPCABG.

Advances in the perioperative blood management of traumatic brain injury patients

Traumatic brain injury (TBI) is a kind of serious traumatic disease. It is still controversial about perioperative blood management of TBI patients. This article intends to review advances in perioperative blood management of patients with TBI. The hemoglobin threshold of blood transfusion, the transfusion of stored red blood cell and the coagulation function in patients with TBI are discussed. So far, it is still lack of multi-center cooperated large-scale random clinical trials on perioperative blood management in TBI patients. Further studies will be important for improving the long-term prognosis of patients with brain trauma. Key words: Craniocerebral injury; Perioperation; Blood management

Value of Thromboelastography in Judging Abnormal Coagulation Function in Patients with Early Hemorrhagic Shock

Objective: To detect the changes of coagulation function in patients with early hemorrhagic shock by thromboelastography (TEG). Methods: TEG was performed in 50 patients with early hemorrhagic shock and surgical indications. The TEG parameters were compared with 50 healthy people. The coagulation and fibrinolysis in patients with early hemorrhagic shock were observed. Results: In terms of coagulation parameters, the R value decreased, the α angle increased, and the K value and MA value did not change significantly in patients with early hemorrhagic shock. Fibrinolytic aspects: EPL, LY30 observations have no significant changes compared to normal values. Conclusion: The plasma coagulation factor activity is increased in patients with early hemorrhagic shock; the fibrin level is increased; the blood is in a hypercoagulable state; and the fibrinolysis function is not changed. The timely detection of TEG can be used for coagulation function monitoring and blood transfusion therapy in patients with surgical hemorrhagic shock. It provides an important basis for preventing the formation of deep vein thrombosis.

Diagnosis effect of thrombelastography in chronic kidney disease

Objective To discuss the diagnosis effect and clinical significance of thrombelastography in chronic kidney disease. Methods From June 2016 to February 2017, two hundred and seventy non-dialysis patients with chronic kidney disease (CKD) treated in the Fourth Hospital of Hebei Medical University were divided into non-hypercoagulable group and hypercoagulable group according to TEG comprehensive coagulation index.The changes of related clinical indexes between the two groups were analyzed and the related factors affecting the differences between the two groups were studied. Results The correlation between the two groups showed that the coagulation reaction time (R), coagulation formation time (K) and albumin in the hypercoagulable group were significantly lower than those in the non-hypercoagulable group ((4.69±0.94) min vs.(6.29±1.63) min, (0.93±0.13) min vs.(1.51±0.58) min, (27.54±7.81) g/L vs.(34.26±8.39) g/L, P=0.000) Angle angle, maximum thrombus strength (MA), fibrinogen, D-dimer, platelet count, protein/creatinine and protein content in hypercoagulable group were significantly higher than those in non-hypercoagulable group((76.76±2.23)°vs.(68.19±7.65)°; (75.13±3.81)mm vs.(66.35±7.81)mm; (4.28±0.93) g/L vs.(3.56±1.10) g/L ; 0.4(0.15, 0.91) mg/L vs.0.22(0.12, 0.52) mg/L; (276.03±127.15)×109/L vs.(198.18±78.46)×109/L; 5 430(2 579, 9 634) mg vs.2 620(692, 5 286) mg; 4 864(2 341, 7 712) mg/g vs.2 557(840, 5 805) mg/g, P 0.05). Correlation analysis of common clinical indicators showed that the comprehensive coagulation index (CI) was positively correlated with Angle angle, maximum thrombus strength, fibrinogen, platelet count, protein/creatinine and protein quantification (r=0.532, 0.522, 0.307, 0.354, 0.293, 0.216, P<0.05), was negatively correlated with coagulation reaction time, coagulation formation time and albumin (r=- 0.462, - 0.496, - 0.360, P<0.05). Logistic regression analysis showed that platelet count, albumin and fibrinogen were the influencing factors for the grouping of comprehensive coagulation index (OR (95%CI) : 1.007 (1.002-1.013), 0.868 (0.827-0.912), 1.510 (1.042-2.187), P<0.05). Conclusion TEG is a more sensitive indicator to reflect the coagulation status of patients with CKD, and has a certain guiding significance for anticoagulation treatment of patients with CKD; platelet count, albumin, fibrinogen are the factors affecting coagulation function of patients. Key words: Kidney diseases; Thrombelastography; Albumin; Platelet count

Congenital dysfibrinogenaemia assessed by whole blood thromboelastography.

Congenital dysfibrinogenaemia (CD) is a rare hereditary blood disorder, and thromboelastography (TEG) can comprehensively assess the clotting function of patients. However, only few studies have focussed on the application of TEG in CD. We aim to investigate the clinical value of TEG in congenital CD. We performed TEG and routine coagulation tests, including plasma prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), functional fibrinogen (Fg) concentration (Clauss method) and Fg concentration (PT-derived method) tests, in 17 patients with CD (experimental group) and 28 healthy individuals (control group). In the TEG test, the coagulation time was significantly longer and the angle value was significantly smaller in the experimental group than that in the control group (3.73±1.73minutes vs 1.99±0.49minutes; 52.39°±11.6° vs 65.69°±4.43°; P<.05 for both); the coagulation index was significantly decreased in the experimental group when compared to the control group (-0.86±2.85 vs 1.29±1.53) (P<.05), but the maximum amplitude was not significantly different (P>.05). In the coagulation test, compared with the control group, TT was significantly longer (11.59±0.93minutes vs 32.34±7.1minutes; P<.05) and the functional Fg concentration was significantly lower (3.17±0.59g/L vs 0.56±0.18g/L; P<.05) in the experimental group, whereas there were no differences in APTT, PT and Fg concentrations (P>.05). TEG is highly accurate for detecting coagulation function in patients with CD, with the thromboelastographic coagulation time and angle reflecting a reduced Fg activity, thereby facilitating diagnosis and differential diagnosis of CD and coagulation status evaluation of patients with CD.

Effect of aspirin combined with clopidogrel in the treatment of transient ischemic attack and its influence on coagulation function

Objective To investigate the effect of aspirin combined with clopidogrel in the treatment of transient ischemic attack(TIA), and its influence on blood coagulation. Methods Ninety-six patients with TIA were selected and divided into observation group and control group by random number table method, with 48 cases in each group.The control group was treated with aspirin, and the observation group was treated with aspirin and clopidogrel.The treatment effect, coagulation index changes and adverse reactions were compared between the two groups. Results The effective rate of the observation group was 91.67%(44/48), which was higher than 68.75%(33/48) of the control group (χ2=7.941, P 0.05). Conclusion The curative effect of aspirin combined with clopidogrel is superior to aspirin alone in the treatment of TIA, and it can improve the coagulation function of patients, which has high security. Key words: Aspirin; Clopidogrel; Ischemic attack, transient; Fibrinogen; Prothrombin time; Activated partial thromboplastin time

Coagulation Alteration and Deep Vein Thrombosis in Brain Tumor Patients During the Perioperative Period.

To explore coagulation function in patients with brain tumors before and after craniotomy and tumor resection and to analyze its correlation with deep vein thrombosis (DVT). This study enrolled 133 consecutive patients with brain tumors. Coagulation evaluation and limb venous ultrasonography were performed before and after surgery. Clinical characteristics and dynamic changes in coagulation parameters were recorded, and their correlations with DVT were analyzed. The incidence of postoperative DVT in patients with brain tumors was 10.5%. The average age of patients with DVT was older compared with patients without DVT (63.21 ± 11.21 years vs. 50.24 ± 11.95 years, P < 0.001), and the incidence of hepatitis B (21% vs. 4%, P= 0.035) was higher in patients with DVT compared with patients without DVT. D-dimer and fibrinogen were the most variable parameters during the perioperative period. In patients with DVT, D-dimer levels displayed a "zigzagging-rise" trend and were significantly higher than levels in patients without DVT. Platelet levels displayed a "first-descend-then-rise" trend and were significantly lower in patients with DVT on the second and third postoperative days. In patients with brain tumors, D-dimer and fibrinogen were elevated postoperatively, manifesting as hypercoagulability. Postoperative DVT was correlated with aging and hepatitis B. A "zigzagging-rise" trend of D-dimer and a "sharp-descent" trend of platelets in the early postoperative period might predict DVT in patients with brain tumors.

The changes of plasma coagulation function in patients with glioma and its correlation with malignant grade of glioma

Objective: To investigate the changes of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time(TT), fibrinogen(FIB) and platelet counts(PLT) in plasma of patients with glioma, and to explore the correlations between PT, APTT, TT, FIB and PLT with malignant grades of glioma. Methods: One hundred and seventy-two patients with glioma and 47 health controls were investigated in a retrospective analysis. All patients were diagnosed and identified the WHO grade by pathologist after operation. Including 40 cases with glioblastoma multiforme, WHO Ⅳ grade, 45 cases with anaplastic astrocytoma, WHO Ⅲ grade, 46 cases with astrocytoma and oligodendroglia astrocytoma, WHO Ⅱ grade, and 41 cases with pilocytic astrocytoma. Results: PT was significantly shorter in patients with WHO Ⅰ-Ⅳ grade glioma than that in normal controls (P<0.05); APTT was significantly shorter in patients with WHO Ⅲ and Ⅳ grade glioma than that in normal controls and WHO Ⅰ grade glioma patients (P<0.05); FIB of WHO Ⅳ grade glioma was higher than that in normal control and WHO Ⅰ to Ⅲ grade glioma (P<0.05). While, there was no significant difference of TT and PLT among patients with WHO Ⅰ to Ⅳ and normal controls (P>0.05). Spearman correlation analysis showed that there was negative correlation between APTT and WHO grade (r=-0.200, P=0.007) as well as positive correlation between FIB and WHO grade (r=0.175, P=0.020); Pearson linear correlation analysis showed that there was negative correlation between APTT and Ki67 in patients with glioma. Conclusions: the levels of FIB and APTT in patients with glioma were correlated with WHO grade of glioma, and higher FIB, shorter APTT and PT in patients with WHO Ⅳ grade glioma indicated that there exist hypercoagulation states.

Value of thromboelastography in evaluating coagulation function and prognosis in patients with acute-on-chronic liver failure

Objective: To investigate the coagulation function in patients with acute-on-chronic liver failure (ACLF) patients using thromboelastography (TEG), and to comprehensively and dynamically evaluate patients' bleeding and coagulation status. Methods: The clinical data of ACLF patients were collected, and TEG was used to evaluate whole blood clotting kinetics in these patients. Routine biochemical parameters were measured, and complications were evaluated. The t-test was used for comparison of continuous data, the chi-square test was used for comparison of categorical data, and the Pearson correlation coefficient was used for correlation analysis. P < 0.05 was considered statistically significant. Results: A total of 60 patients (39 male and 21 female patients) were enrolled, with a mean age of 47.20±16.20 years. The TEG results showed that all patients had normal thrombokinetics, but TEG parameters were correlated with coagulation function, markers of systemic inflammatory response syndrome, laboratory markers, and prognosis. The patients with a higher R value had higher risks of infection (6.23±2.91 vs 4.74±1.12, P = 0.009), hepatorenal syndrome (5.64±2.54 vs 3.21±1.43 P < 0.01), and bleeding (6.71±3.51 vs 4.80±1.63, P = 0.01), and the patients with a lower K value (0.72±1.36 vs 1.64±1.43, P = 0.02), an increased α-angle (63.33°±10.02° vs 56.62°±12.13°, P = 0.03), and an increased MA (56.83±11.07 vs 50.40±10.81, P = 0.03) had increased risks of hepatic encephalopathy. Conclusion: ACLF patients have low coagulation function, and TEG truly reflects the "rebalance" status of this low level. Abnormal TEG parameters suggest increased risk of complications in these patients, indicating a poor prognosis.

Inflammation Is Associated With Platelet Coagulation Function Rather Than Enzymatic Coagulation Function in Patients With Takayasu Arteritis.

The integral changes of coagulation and fibrinolysis, and their relationships with inflammation in patients with Takayasu arteritis (TA) remain undetermined. The purpose of this study was to analyze the changes of coagulation and fibrinolysis process in patients with TA by thrombelastography (TEG).A total of 127 patients with TA and 55 healthy controls were enrolled. Patients with TA were grouped according to disease activity. The routine hematological parameters, traditional coagulation assays, and TEG parameters were summarized retrospectively.A shorter K time, larger alpha angle, and higher levels of MA, MA(A), G, and TPI were found in patients with TA, especially in those at the active stage. The R time, EPL, LY30, and CL30 were similar between patients with TA and healthy controls, as well as TA patients with different disease activity. Spearman's correlation showed that ESR was correlated with PLT (r = 0.206, P = 0.020), K (r = -0.353, P < 0.001), alpha angle (r = 0.328, P < 0.001), MA (r = 0.474, P < 0.001), MA (A) (r = 0.623, P < 0.001), G (r = 0.475, P < 0.001), and TPI (r = 0.458, P < 0.001).In conclusion, inflammation was associated with platelet coagulation function rather than enzymatic coagulation function in patients with TA. Physicians should focus on antiplatelet treatment for improving the prognosis of patients with TA.

Effect of Changningfang enema combined with mesalazine on inflammatory factors and coagulation function in patients with ulcerative proctitis

Effect of Changningfang enema combined with mesalazine on inflammatory factors and coagulation function in patients with ulcerative proctitis

Study on the difference of blood coagulation function in patients with traumatic brain injury in plain and plateau area

Objective: In this study, we tested platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), and other indicators of coagulation function, and revealed their difference in patients with traumatic brain injury (TBI) between plain and plateau area. Base on the results, we may provide research basis for the therapy of TBI associated coagulopathy in different areas. Methods: 151 TBI patients from Tianjin Medical University General Hospital, and 74 from People's Hospital of Tibet Autonomous Region in the period from Dec 2013 to Dec 2015 were enrolled.Coagulation function, including PC, platelet distribution width (PDW), mean platelet volume (MPV), platelet - large cell ratio (P- LCR), PT, APTT, fibrinogen (FIB), and D- Dimer were tested within 8 h. The difference in patients with TBI between plain and plateau areas were compared and analyzed. Results: Compared with plain area, the PC of patients with TBI in plateau area is lower [(168±49)×109/L vs (196±72)×109/L, P<0.05], while PT and APTT were extended [(13.5±1.3) s vs (12.0±4.0) s, (38±4) s vs(27±6) s, P<0.01]. On the other hand, FIB increases [(3.1±1.2) g/L vs (2.6±1.0) g/L, P<0.01] and D-Dimer decreases [(3.1±3.3) μg/L vs (4.7±3.6) μg/L, P<0.01] in plateau area compared with plain area. Conclusion: Due to the people of plateau area living in hypoxia state, the coagulation function is activated for a long time.Once TBI happens, the platelets and coagulation factors may be excessive consumption, resulting in hypocoagulable state and high risk of rebleeding, while the fibrinolysis system in patients with TBI of plateau area is not activated obviously.Therefore, it should give full consideration to these differences in the treatment of patients with TBI in plateau area, instead of directly copying the standard therapy of the people in plain area.The treatment recommendations should primarily supplement coagulation materials, and antifibrinolytics may unlikely have the therapy effect.

Arthroscopic Glenoid Labrum Repair of Left Shoulder in a Male With Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder that has been classified into several primary types. The clinical characteristic of EDS is hypermobility of the joints, hyperextensibility and fragility of the skin, and hemorrhage tendency. For many patients, the hypermobile joints become a serious problem. We present the case of a 19-year-old male diagnosed with EDS, with recurrent dislocations of his left shoulder, hyperextensibility and fragility of the skin, and a carp-mouth–shaped scar of the forearm. After 4 years of nonoperative treatment, we performed an arthroscopic glenoid labrum repair of left shoulder. At a 6-year follow-up, the patient has no instability in the left shoulder. We believe that glenoid labrum repair is a viable method for treating recurrent dislocations for patients with EDS. It is strongly suggested to check coagulation function of patients to avoid substantial bleeding when decorticating the glenoid rim, to ensure a conservative postoperative rehabilitation.

The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement: A prospective study on 60 patients

BackgroundPreoperative platelet rich plasma (PRP) harvest has been used in cardiopulmonary surgery for more than 10 years. There is no previous study dealing with PRP in bilateral total hip replacement. This study was to investigate the effects of PRP on blood saving and blood coagulation function in patients with bilateral total hip replacement. Patients and methodsA prospective, randomized, clinical trial was conducted. Sixty patients were enrolled, including 30 patients undergoing PRP in the PRP group and 30 controls. The surgery time, total transfusion volume, blood loss, allogenic blood transfusion, autologous blood transfusion, urine volume, drainage volume, some blood parameters (including Fibrinogen, D-dimer, Prothrombin time, international normalizedratio, activated partial thromboplastin time, Platelet, Haemoglobin B), thrombelastogram (TEG) and blood-gas parameters were studied in the perioperative stage. The measurement data were analyzed statistically. ResultsThere was no statistical difference between the two groups in baseline characteristics, surgery time, total transfusion volume, blood loss, autologous blood transfusion, etc. Allogenic blood transfusion in the PRP group was less than the control group with statistical difference (p = 0.024). Fibrinogen in the PRP group was higher than the control group (p = 0.008). Among the TEG indicators, activated clotting time and coagulation time K in the PRP group were less than the control group. Clotting rate and maximum amplitude in the PRP group were higher. The blood-gas parameters presented no statistical difference. ConclusionThe results suggested that PRP probably played a positive role in blood coagulation function as well as blood saving in patients with bilateral total hip replacement.

Change in endogeous hydrogen sulfide in patients with acute pancreatitis and its relationship to coagulation function

To study the change in endogenous hydrogen sulfide (H2S) in patients with acute pancreatitis and its relationship to coagulation function. A prospective case control study was conducted. Forty patients with mild acute pancreatitis (MAP group) and 40 with severe acute pancreatitis (SAP group) admitted to Yiwu Central Hospital in Zhejiang Province from December 2002 to March 2015 were enrolled. Forty healthy persons served as control (healthy control group). Blood was collected to determine the levels of H2S, blood coagulation factor Ⅷ (FⅧ), von Willebrand factor (vWF), plasminogen (PLG), antithrombin (AT), platelet count (PLT), tissue factor (TF), tumor necrosis factor-α (TNF-α), and protease activated receptor-1 (PAR-1). The correlations among the above parameters were analyzed. There was no statistical significance in sex, age, body weight and time of disease among three groups, indicating it was comparable among the groups. Compared with healthy control group, the levels of H2S, FⅧ, vWF, TF, TNF-α, and PAR-1 in MAP and SAP groups were significantly elevated [H2S (μmol/L): 67.42±6.34, 112.47±12.69 vs. 42.57±4.18, FⅧ: (67.5±5.8)%, (82.3±4.7)% vs. (57.2±6.4)%, vWF: (112.6±9.7)%, (142.5±12.5)% vs. (76.4±8.2)%, TF (ng/L): 45.27±4.34, 64.76±6.25 vs. 18.15±1.89, TNF-α (ng/L): 197.67±13.62, 324.72±25.54 vs. 20.08±2.57, PAR-1 (fluorescence intensity): 32.16±4.43, 56.12±7.07 vs. 12.27±2.12, all P < 0.01], and PLG and AT activity were significantly decreased [PLG: (52.4±4.7)%, (36.7±3.2)% vs. (62.1±5.6)%, AT: (43.2±6.9)%, (35.5±5.4)% vs. (53.6±6.1)%, all P < 0.01]. The changes in the parameters in SAP group were more remarkable than those in MAP group (all P < 0.01). PLT in SAP group was significantly lower than that in healthy control and MAP groups (×109/L: 8.5±1.1 vs. 15.7±2.8, 12.4±1.9, both P < 0.01). H2S was positively correlated with FⅧ, vWF, TF, TNF-α, and PAR-1 (r value was 0.56, 0.61, 0.72, 0.66, 0.64, respectively, all P < 0.01), and it was negatively correlated with PLG and AT (r value was -0.64, -0.57, both P < 0.01). As an inflammatory factor, endogenous H2S deteriorates coagulation function in patients with acute pancreatitis by up-regulating TF, TNF-α, and PAR-1.

Elevated Level of Circulating Platelet-derived Microparticles in Oral Cancer

Numerous studies have demonstrated that circulating microparticles (MPs) play important roles in a variety of diseases (e.g., atherosclerosis, hypertension, and diabetes), but the association between circulating MPs and oral squamous cell carcinoma (OSCC) remains largely unknown. In the present study, the circulating platelet-derived MPs (PMPs) in 63 patients with OSCC, 22 patients with infected keratocystic odontogenic tumor, and 31 healthy volunteers were characterized and quantified by flow cytometric analysis. The coagulation function of patients with OSCC was correspondingly evaluated. Meanwhile, the inflammation-related cytokines were detected in plasma by enzyme-linked immunosorbent assay and in tumor tissues by immunohistochemistry. Our results showed that the plasma level of circulating PMPs was significantly higher in OSCC patients compared with healthy volunteers and patients with infected keratocystic odontogenic tumor, and they showed positive correlation with the increased level of fibrinogen. Moreover, the coagulation time was significantly shorter after the MPs were added to the MP-free plasma. Most important, the levels of interleukin 6 and tumor necrosis factor α in plasma and tumor tissues were significantly increased in OSCC patients, which were closely correlated with the elevated level of circulating PMPs. In summary, this study suggests that the elevated level of circulating PMPs, showing close correlation with the secretion of inflammation-related factors, may contribute to the increased procoagulant activity in patients with OSCC.

Calibrated automated thrombography for monitoring coagulation function in patients with intracerebral haemorrhage.

To monitor coagulation function in patients with intracerebral haemorrhage (ICH) using calibrated automated thrombography. Patients admitted to hospital with ICH (confirmed within 18 h of symptom onset) were enrolled. Patient history and blood samples were obtained within 6 h of admission; further blood samples were collected on days 4, 8 and 15 (or on discharge between days 9-15: grouped with day 15 data). Blood samples were also collected from age- and sex-matched healthy controls. All samples underwent calibrated automated thrombography. At admission, thrombin lag time and time to peak was longer, and endogenous thrombin potential and peak height were lower, in patients with ICH (n = 20) than in healthy controls (n = 29). Lag time in patients with ICH gradually decreased, but remained significantly longer than in controls until day 8. Time to peak also gradually decreased, but remained longer in patients than in controls by day 15. Endogenous thrombin potential and peak height gradually increased in patients, but remained lower than in controls on day 15. Patients with ICH have poorer coagulation function than healthy individuals, but this function gradually recovers during hospitalization.

Analysis of the factors associated with abnormal coagulation and prognosis in patients with non-small cell lung cancer

背景与目的凝血及纤溶系统激活在肺癌患者中较为常见，与肺癌侵袭、转移的高风险和预后差相关。非小细胞肺癌（non-small cell lung cancer, NSCLC）占肺癌的80%-85%，本研究旨在回顾性分析凝血功能指标对NSCLC的预后价值，为目前NSCLC患者高凝状态的预防及治疗提供参考。方法回顾性分析2009年1月-2012年12月首次就诊于河北医科大学第四医院的604例经病理学证实的NSCLC患者的临床资料。资料内容包括患者治疗前凝血功能相关指标[血浆凝血酶原时间（prothrombin time, PT）、凝血酶原活动度（prothrombin time activity, PTA）、国际标准化比率（international normalized ratio, INR）、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、纤维蛋白原（fibrinogen, Fib）、D二聚体（D-dimer, D-D）、血小板计数（platelet count, PLT）]、性别、年龄、病理分型、TNM分期、淋巴结状态等。本研究选择了50例同期就诊于河北医科大学第四医院的非癌症患者作为对照组。采用SPSS 13.0统计软件进行分析。结果NSCLC组与对照组之间所有的凝血功能指标（包括PT、PTA、INR、APTT、Fib、D-D、血小板计数）的血浆水平显示均有统计学差异[除了Fib（P=0.001, 5）、Plt（P=0.004, 5），其余指标（P＜0.001）]。纤维蛋白原水平与NSCLC的组织学亚型之间相关，鳞癌比腺癌的Fib水平明显升高（P＜0.001）。Ⅲ期、Ⅳ期期比Ⅰ期-Ⅱ期患者的Fib、PLT水平升高（P＜0.001, P=0.014），APTT缩短（P＜0.001）。与N0患者相比，N1-N3患者的APTT，明显缩短（P＜0.001），Fib、D-D水平升高（P＜0.001, P=0.048）。对生存率的比较研究显示，PT、INR延长（P=0.032, P=0.001），Fib升高（P＜0.001），PTA下降（P=0.005），在统计学上对总生存有明显的不利影响。多因素生存分析显示，在凝血功能指标中INR是唯一的独立预后因素（P=0.017）。结论NSCLC患者往往存在凝血纤溶系统的激活，导致凝血纤溶指标的亚临床改变。肺腺癌患者以及分期为晚期、淋巴结存在转移的NSCLC患者更易出现高血凝状态。PT、INR的延长与NSCLC患者生存率的下降密切相关，INR是NSCLC的独立预后因素，PT、INR可能成为NSCLC的预后指标。

A double-blind, randomized, controlled study to explore the efficacy of rFVIIa on intraoperative blood loss and mortality in patients with severe acute pancreatitis

Severe acute pancreatitis is a life-threatening disease. Patients with peripancreatic necrotic infection often require surgical removal of necrotic infected tissue and a wide debridement will cause blood loss and worsen the condition. To assess whether treatment with NovoSeven, a recombinant activated FVII (rFVIIa), could improve coagulation function and therefore reduce blood loss, blood transfusion and all-cause mortality during necrosectomy in patients with infected necrosis secondary to severe acute pancreatitis. Severe acute pancreatitis patients admitted to Nanjing Jinling Hospital for necrosectomy were enrolled and randomized to receive either standard treatment or standard treatment plus an intravenous infusion of rFVIIa (40μg per kilogram of body weight per hour) before operation. The prospectively defined primary end points were perioperative coagulation parameters (prothrombin time, activated partial thromboplastin time), blood transfusion unit and blood loss. The secondary end points were operation time, ICU stay and all-cause mortality at 28days after the operation. A total of 64 patients were enrolled (31 in the rFVIIa group and 33 in the control group). Treatment with rFVIIa was associated with a reduction in operation time, red blood cell and fresh froze plasma transfusion, blood loss and prothrombin time compared to the control group (p<0.05 for all). Activated partial thromboplastin time and mortality were similar between the two groups (P>0.05). Treatment with rFVIIa significantly improved the extrinsic coagulation function in patients with severe acute pancreatitis and was associated with decreased risk of bleeding. However, rFVIIa did not improve intrinsic coagulation or reduce over-cause mortality. ChiCTR-TRC-1300389.