Coagulopathy Disorders Research Articles

Preoperative SSRI use increases perioperative transfusion need in patients undergoing surgical procedures on the hip joint.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery.

The role of scoliosis on the comorbidity and demographics of neurofibromatosis type 1 patients: A retrospective analysis of the National Inpatient Sample database.

Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome in the United States, affecting every 1 in 3000 individuals. NF1 occurs due to non-functional mutations in the NF1 gene, which expresses neurofibromin, a protein involved in tumour suppression. As a result, NF1 typically presents with non-cancerous neoplasm masses called neurofibromas across the body. Out of all NF1 abnormalities, the most common skeletal abnormality seen in around 10%-30% of NF1 patients is scoliosis, an improver curvature of the spine. However, there is a lack of research on the effects of scoliosis on demographics and morbidities of NF1 patients. We performed a national analysis to investigate the complex relationship between NF1 and scoliosis on patients' demographics and comorbidities. We conducted a retrospective cross-sectional analysis of the 2017 US National Inpatient Sample database using univariable Chi-square analysis and multivariable binary logistic regression analysis to determine the interplay of NF1 and scoliosis on patients' demographics and comorbidities. Our query resulted in 4635 total NF1 patients, of which 475 (10.25%) had scoliosis and 4160 (89.75%) did not. Demographic analysis showed that NF1 patients with scoliosis were typically younger, female and white compared to NF1 patients without scoliosis. Comorbidity analysis showed that NF1 patients with scoliosis were more likely to develop malignant brain neoplasms, epilepsy, hydrocephalus, pigmentation disorders, hypothyroidism, diabetes with chronic complications and coagulopathy disorders. NF1 patients with scoliosis were less likely to develop congestive heart failure, pulmonary circulation disease, peripheral vascular disease, paralysis, chronic pulmonary disease, lymphoma and psychosis. NF1 patients with scoliosis were predominantly younger, female, white patients. The presence of scoliosis in NF1 patients increases the risks for certain brain neoplasms and disorders but serves a protective effect against some pulmonary and cardiac complications.

USE OF ANTICOAGULANT IN COVID-19 PATIENTS AT PKU MUHAMMADIYAH GAMPING HOSPITAL YOGYAKARTA

Based on WHO data, there is about 14% average of patients who suffer from a severe level of Covid-19 disease and 5% of patients admitted to the ICU (Intensive Care Unit) are known to have symptoms of thromboembolism and coagulopathy disorders. The current management of Covid-19 therapy requires heparin. This research aims to find out the accuracy of the heparin regimen, to determine the improvement of the patient's clinical condition, the side effects of heparin based on clinical response, to analyze the relationship between the accuracy of the therapeutic regimen and the improvement of the patient's clinical condition, and also to know the incidence of side effects after heparin use. The type of this research was descriptive-analytic with a cohort design with retrospective data collection. The data were collected by taking medical records at PKU Muhammadiyah Gamping Hospital Yogyakarta. Moreover, the data were collected including heparin therapy regimens with subjective condition and patient objective during the therapy. The data obtained were analyzed by using univariate analysis technique and bivariate analysis technique. The results showed there were 61 patients who fulfilled the inclusion criteria. The evaluation of the accuracy the heparin therapy regimen obtained 95.08% correct results and 4.92% incorrect results. The analysis result of the accuracy the therapeutic regimen showed a significant relationship with clinical improvement with parameters APTT number (p=0.006; RR=0.155; CI = 0.085-0.283). Whereas, there was not found a significant relationship between the accuracy of the therapeutic regimen with the incidence of side effects (p&gt;0.05).

Fibrinogen level among children with liver cirrhosis

IntroductionThe liver has a major role in the production of coagulation factors, and cirrhotic patients have a series of coagulopathy disorders. The present study aimed to measure plasma fibrinogen levels in children with hepatic cirrhosis.MethodPatients younger than 18 years old after diagnosis of liver cirrhosis by biopsy were enrolled in the study. Laboratory data including hemoglobin, PT, PTT, INR, and liver function tests were recorded. Fibrinogen levels were measured using the Clauss method. PELD score for children less than 12 years and MELD Na for children over 12 years were used to measure the severity of the liver disease.ResultsFifty children with cirrhosis were studied. The mean fibrinogen level in the “PELD < 15” group was significantly higher than the other group (P < 0.001). There was no significant relationship between bleeding and fibrinogen levels. There was no significant relationship between PELD and bleeding in subjects (P = 0.87). The results of the study showed neither of these two factors (fibrinogen level and PELD) can play a predictive role in causing hemorrhage in patients.ConclusionOur study has shown that fibrinogen level is significantly associated with severity of liver cirrhosis and decreases with more severe disease (PELD levels), but platelet and fibrinogen cannot predict the severity of bleeding in these patients.

COVID-19 patients’ lung involvement severity as a predictor of kidney dysfunction and coagulopathy disorders

Introduction: Kidney dysfunction, coagulopathy disorders, and lung involvement are the most common disorders caused by the COVID-19 virus. Objectives: This study aimed to investigate the correlation of lung involvement severity with kidney dysfunction and coagulopathy disorders in COVID-19 patients. Patients and Methods: This descriptive-analytical study was conducted on 97 patients with COVID-19 referred to Imam Reza hospital in Kermanshah from December 2020 to June 2021. Lung involvement severity, kidney function tests, and coagulation laboratory data were collected. Logistic regression test was conducted to explore the correlation between lung involvement with kidney dysfunction and coagulopathy disorders. Results: Out of 97 patients, 53 (54.6%) were male, with a mean age of 59.31 ± 16.44 years. The correlation between lung involvement severity with kidney function tests, including, blood urea nitrogen, serum creatinine, and coagulation factors, including prothrombin time (PT), partial thromboplastin time (PTT), and D-dimer, were significant (P &gt; 0.05). Lung involvement severity significantly predicted kidney dysfunction and coagulopathy disorders. Conclusion: Lung involvement severity would be able to predict kidney dysfunction and coagulopathy disorders in patients with COVID-19.

"True" Antiphospholipid Syndrome in COVID-19: Contribution of the Follow-up of Antiphospholipid Autoantibodies.

COVID-19 has led to more than 5 million deaths to date.[1] COVID-19 presentation can range from a simple asymptomatic viral infection to acute respiratory distress syndrome (ARDS)[2]; 15 to 20% of patients develop severe pneumonia and experience coagulopathy disorders. Severe COVID-19 occurs in the context of hyperinflammation that could potentially generate autoimmune disease.[3] We and others have shown the presence of antiphospholipid (aPL) autoantibodies in patients with COVID-19.[4] However, there remains contention if these aPLs represent transient antibodies associated with infection, or “true” aPL reflective of potential autoimmune-associated coagulopathy, namely, antiphospholipid syndrome (APS).[5] [6] Thus, only if they can be shown to persist for at least 12 weeks, can they be considered essential markers for the diagnosis of APS.[7] [8]

A Review Study of the Influences of Dendrimer Nanoparticles on Stored Platelet in Order to Treat Patients (2001-2020)

Background: Platelets are sensitive to chilling, so the optimal storage temperature for maintaining normal function and structure in platelets is 22-24 °C up to 3-5 days. Introduction: Platelets are important blood cells involved in immunity, inflammation, and thrombosis. Today, platelet products are widely used to prevent bleeding in patients with thrombocytopenia and coagulopathy disorders. As a result, maintaining the quality of these products is very important. Method: In this review study, the reported influences of various dendrimers on platelets from 2001 to 2020 were investigated. Result: The results showed that positively charged dendrimers can cause platelet aggregation and activation during platelet storage time through their amine residues. In addition to surface charge, high generations, molecular weight and concentration are not recommended in the field of platelet storage and treatment. In contrast, negatively charged dendrimers, usually used at lower generations with proper molecular weight, lower size (less than 100 nm) and their carboxyl residues, cannot induce adverse effects on platelets during storage time. In addition, the results of this study revealed that PEGylation of dendrimers and platelets can improve platelet storage conditions. Conclusion: As anionic dendrimers can improve platelet storage time without inducing significant changes in morphology and function of platelets, they are recommended in the field of platelet storage and treatment.

Abstract EP14: Traditional And Non-traditional Cardiometabolic Risk Factors For Type 2 Myocardial Infarction Compared To Type 1 Myocardial Infarction In Young Women (18-44 Years): A National Inpatient Analysis

Background: There has been growing interest in studying demand ischemia as a cause of type 2 myocardial infarction (T2MI) in younger patients. Conventional cardiovascular risk factors and their association (and degree) are vaguely defined as predictors of T2MI. Women may be noted to have different predictors given their underrepresentation in clinical trials. Methods: We analyzed young female (18-44 years) hospitalizations from the National Inpatient Sample 2018 for multivariate-adjusted predictors (aOR, 95% confidence interval) of T2MI, STEMI and NSTEMI admissions, and divided the significance level into p&lt;0.01, p&lt;0.05 &amp; p&lt;0.1. Results: Young females (n=6,152,028) had 0.05% STEMI, 0.16% NSTEMI and 0.08% T2MI admissions. Predictors (Table 1) with the highest significance level of association for T2MI (p&lt;0.01), compared to ST/NSTEMI (either 0.01&lt;p&lt;0.05 or not significant), were black race (aOR 1.49) and CHF (aOR 1.97), pulmonary circulation disorder (aOR 1.83) and OSA (aOR 1.62). Valvular heart disease, paralysis, COPD, deficiency anemia predicted a higher risk of T2MI admissions in young women (p&lt;0.05) but not STEMI/NSTEMI admissions. Hypertension, prior MI, dyslipidemia, family history of coronary artery disease, peripheral vascular disease, coagulopathy and fluid-electrolyte disorder predicted a higher risk of T2MI or STEMI/NSTEMI. Collagen vascular disorders and obesity had a higher risk of T2MI/NSTEMI (p&lt;0.01) but not of STEMI (p=0.07). DM, and cocaine abuse predicted higher odds of STEMI/NSTEMI but not of T2MI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol abuse and cannabis abuse did not predict a higher risk of T2MI or STEMI/NSTEMI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol and cannabis abuse did not predict higher odds of T2MI or STEMI/NSTEMI in young women. Conclusion: Predictors associated with T2MI in young females with a higher order of significance than ST/NSTEMI can be utilized to build a risk score for T2MI in young females.

Abstract TP211: Identifying Factors Associated With Higher Risk Of Stroke In Patients With Infective Endocarditis Using The National Inpatient Sample

Background: Cerebrovascular complications (ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)) of infective endocarditis (IE) are common and substantially increase morbidity and mortality. We aimed to identify risk factors for stroke in a nationally representative population of hospitalized IE patients from the US. Methods: Patient hospitalizations for IE and stroke were identified using validated International Classification of Diseases 10 diagnosis codes from the Q4 2015-2018 National Inpatient Sample. We evaluated the association between demographics, known risk factors (opioid use, cardiac valve replacement, and mitral valve disease), and Elixhauser comorbidity index-defined factors with the diagnosis of stroke using logistic regression. Results: Of the 53,557 patients with a diagnosis of IE, 5,754 (10.7%) had a concurrent diagnosis of stroke (75% IS, 6.9% ICH, 4.5% SAH, 14% multiple stroke types). The mean age at IE diagnosis was 59 years; 42.3% were female; 71.8% Caucasian, 14.2% Black, 7.8% Hispanic, 2.7% Asian, and 0.8% Native American; 9.2% of patients died during hospitalization (7.5% without stroke, 23% with stroke, p&lt;0.001). Factors independently associated with stroke are shown in the Table; the C-statistic was 0.63. Opioid use and cardiac valve replacement were not associated with stroke. Conclusion: In this large, nationally representative sample of hospitalized IE patients, comorbidities independently associated with higher odds of stroke included mitral valve disease, metastatic cancer, coagulopathy, weight loss, and electrolyte disorders. Detailed clinical data, not available from this administrative data set, may allow better prediction of stroke, but our findings may suggest areas for additional research.

Acute Atraumatic Compartment Syndrome of the Thigh Due to Acquired Coagulopathy Disorder: A Case Report in Known Healthy Patient

Introduction:We present a case of spontaneous compartment syndrome due to a very rare cause which is acquired hemophilia.Case Presentation:A 34-year-old patient presented with the right thigh swelling and features of acute compartment syndrome without history of trauma. He had no history of bleeding disorder. There were no features of infection. As his initial blood tests were within normal 16 g/dl, and his compartment syndrome worsened, he had decompression of the thigh. During the post-operative period, the patient developed persistent bleeding from the decompressed wounds and a fall in hemoglobin which led to further investigation when the blood profile showed a deficiency of factor VIII and antibodies to factor VIII, diagnosis of acquired hemophilia was made and appropriate treatment given.Conclusion:If atraumatic compartment syndrome diagnosed, possibility of acquired factor VIII deficiency should be raised by isolated prolonged activated partial thromboplastin time and diagnosis confirmed by measuring factor VIII activity level and detecting any factor’s VIII antibodies in blood, such as in this case, the factor VIII level was 5.5 (very low) and against factor VIII antibodies level was 60.8 (high). Here, hematologist should be involved in management.

Congenital Factor VII Deficiency Presenting With Isolated Recurrent Hematuria: A Case Report

Factor VII deficiency is a rare congenital coagulopathy disorder. In most cases, this disorder is diagnosed in childhood. Common symptoms of congenital factor VII deficiency are different and consist of cutaneous, mucosal hemorrhage, gastrointestinal bleeding, and joint bleeding. CNS hemorrhage is a fatal and severe complication of congenital factor VII deficiency. The incidence of gross hematuria is a rare symptom of factor VII deficiency. Isolated presentation of hematuria is rarer and usually is accompanied by bleeding in other sites. The patient reported here is a 6-month-old girl who was diagnosed with congenital Factor VII deficiency following episodes of isolated gross hematuria. We decided to report this case to demonstrate if there is no other organic cause in the investigation of a child with recurrent hematuria, we should also consider a coagulation factors deficiency. Since isolated hematuria is a rare symptom in the coagulation factors deficiency, the coagulation tests may be of less interest.

The Doctors in ICU Need to Know the Basics of Coagulopathy

Coagulopathy is common in critically ill patients. Under pathogenic factors, the homeostasis of coagulation, anticoagulation, and fibrinolytic system is disrupted, causing a series of cascade reactions that ultimately lead to coagulopathy. The pathophysiology of coagulopathy markedly varies according to the etiology. For sepsis-induced coagulopathy, inflammation interacts with coagulation. This process involves various cells, including endothelial cells, neutrophils, and platelets. Thrombocytopenia, as a common coagulopathy disorder among intensive care unit (ICU) patients, is indicative of poor outcome, and its differential diagnosis is crucial. However, the standardized diagnostic criteria for disseminated intravascular coagulation are yet to be established, and the existing ones have limitations. Therefore, we used PubMed to search literature related to &#8220thrombocytopenia,” “sepsis,” “coagulopathy,” “disseminated intravascular coagulation,” and “coagulation biomarkers” and expected ICU doctors to fully understand knowledgeable of the pathophysiology of Coagulopathy. The traditional coagulation indicators can be combined with novel coagulation-related biomarkers for the accurate diagnosis and treatment of coagulopathy.

Abstract 15390: Outcomes in Patients Hospitalized With Influenza-related Myocarditis in the United States: A Nationwide Study

Introduction: Acute myocarditis is a serious complication of influenza. While current reports suggest that subclinical cardiac involvement may be transient, myocarditis has been implicated in up to a third of sudden deaths in patients with influenza. Methods: Patients hospitalized with influenza in the US between 2003 and 2017 were identified using the Nationwide Inpatients Sample. They were subsequently classified to specify those with and without a diagnosis of myocarditis and specific outcomes of interest were compared between these subgroups. Results: : Between 2003 and 2017, 1,187,615 patients were hospitalized with influenza in the US. Of these, 2,430 patients (0.2%) were diagnosed with myocarditis while 1,185,185 patients (99.8%) did not have myocarditis. Patient characteristics and outcomes are shown in the table below. Independent predictors of myocarditis were: age (adjusted odds ratio [aOR]:0.98; 95% CI:0.98-0.99), male sex (aOR:1.21 ; 95% CI:1.01-1.46), Elixhauser score ≥3 (aOR:1.34; 95% CI:1.07-1.7), coagulopathy (aOR:1.67; 95% CI:1.29-2.17), valvular disease (aOR:1.5; 95% CI:1.07-2.1), abnormal weight loss (aOR:1.7; 95% CI:1.23-2.35), and a diagnosis of the 2009 H1N1 influenza virus (aOR:4.79; 95% CI:1.51-15.24). Independent predictors of death in patients hospitalized with influenza myocarditis were: age (aOR:1.04; 95% CI:1.01-1.06), stroke (aOR:11.16; 95% CI:1.57-79.49), shock (aOR:61.1; 95% CI:11.88-314.3), renal failure (aOR:3.56; 95% CI:1.2 -10.55), coagulopathy (aOR:2.62; 95% CI:1.04-6.6), and electrolyte disorders (aOR:3.19; 95% CI:1.07-9.47). Conclusions: Patients with influenza who develop myocarditis are younger than those without myocarditis and have more interventions, longer LOS and worse outcomes including a four-fold higher risk of cardiac arrest and a two-fold higher mortality rate. The strongest independent predictor of developing myocarditis was having the 2009 H1N1 influenza virus infection.

Etiology and Comorbidity Diagnoses Effect on Outcomes for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is now the first-line approach to treating choledocholithiasis. As a minimally invasive procedure, it is considered relatively safe but still entails a higher risk than other routine endoscopic procedures. This study aims to look at possible patient etiologies and comorbidities that may affect patient outcomes. MethodsThis study used the Nationwide Inpatient Sample (NIS) from the years 2012 - 2015 to collect anonymous patient data through the use of International Classification of Diseases, Ninth Revision (ICD-9) codes. Specific codes were used to determine the top five etiologies (or presenting diagnosis) for patients who had this surgery and to separate outpatients with specific comorbidity diagnoses. The IBM Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) was then used to compare patients with these diagnoses or etiologies to those without to measure differences in patient outcomes, such as mortality, length of stay, and total charges.ResultsPatients who had an etiological diagnosis of acute kidney failure had worse outcomes than patients who were admitted for ERCP without that etiological diagnosis. There were also specific comorbidity diagnoses that were noted to have worse patient outcomes, including congestive heart failure, diabetes mellitus with complications, a coagulopathy disorder, anemia, or chronic liver disease. Additionally, patients who had both acute kidney disease and chronic liver disease had the worst outcomes.ConclusionsThis study highlights the need to understand all patient risk factors before having them undergo ERCP, especially in the setting of scheduled surgery. Working to control these factors before surgery can increase the possibility of avoiding negative outcomes like mortality, increased patient costs, and increased length of stay.

Musculoskeletal manifestation of hemarthrosis as presentation of coagulopathy disorder in a child

Nontraumatic hemarthrosis is caused by variety of bleeding disorders which could be hereditary or acquired. Hereditary includes hemophilias and other coagulation factor deficiency disorder. Most of the coagulopathy patients present with uncontrolled spontaneous bleeding without any trauma. Here, we are presenting a case of 12-year-old boy who presented with stiffness and swelling of the right knee without any history of trauma.

48. Identification of risk factors for readmission risk in patients undergoing ACDF: a predictive risk scale

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the most common surgical treatment for a variety of cervical disk pathologies. With the Center for Medicare and Medicaid Services (CMS) selecting readmissions as a key measure of health care quality, increasing focus has been generated on the topic of reducing readmissions. PURPOSE The objective of this study was to analyze readmission rates in patients across several large state databases, analyze which factors were associated with risk of readmission, and develop a numeric scale for clinicians to utilize for prediction of readmission risk. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 91,550 ACDF surgeries were recorded in the State Inpatient Database (SID) of NY and CA between 2006 and 2014, which made up the derivation cohort to identify risk factors. There were 87,655 ACDF surgeries recorded in the SID from FL and WA over the same time period, making up the validation cohort. OUTCOME MEASURES Readmission status within 30 days and goodness-of-fit of regression curve after application of scale to the validation cohort. METHODS Risk factors for readmission were identified using univariate and multivariate regression analysis of the derivation cohort. After identification of risk factors, odds ratios were then used to generate a predictive scale that was tested utilizing the validation cohort. An exponential regression model was applied to determine the goodness-of-fit of the scale to the readmission risk in the validation cohort. RESULTS Overall readmission rates within 30 days of discharge were 5.68% and 5.29% in the derivation and validation cohorts, respectively. In both cohorts, patients with renal failure and congestive heart failure were readmitted most often. On multivariate analysis of the derivation cohort, age greater than 80 years (OR, 1.74) male gender (OR, 1.16), Medicaid Insurance (OR, 1.99), Medicare Insurance (OR, 1.72), self-pay insurance (OR, 1.42), anemia (OR, 1.45), chronic lung disease (OR, 1.23), coagulopathy (OR, 1.42), depression (OR, 1.15), diabetes (OR, 1.24), fluid and electrolyte disorder (OR, 1.63), hypertension (OR, 1.09), liver disease (OR, 1.34), and renal failure (OR, 1.79) were found to be statistically significant predictors for readmission. These factors were incorporated into a numeric risk scale that, when tested on the validation cohort, could explain 95.5% of the variability in readmission rate. CONCLUSIONS Overall 30-day readmission following ACDF surgery was 5-6%. Factors including advanced age, male gender, Medicaid insurance, Medicare insurance, anemia, lung disease, congestive heart failure, coagulopathy, depression, diabetes, electrolyte disorder, hypertension, liver disease, and renal failure were found to be significant risk factors for 30-day readmission following ACDF surgery. A novel risk scale based on these factors may be helpful in identifying patients who require additional optimization to reduce perioperative morbidity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Gender difference in plasminogen activator inhibitor-1 activity in patients with type 2 diabetes with and without albuminuria, a matched case-control study

Background: Women with type 2 diabetes are more susceptible to coagulopathy disorders and endothelial dysfunction. One possible explanation is the effects of different sex hormones in inflammatory conditions. Increased plasminogen activator inhibitor-1 (PAI-1) activity has been observed as a possible predisposing factor for coagulopathy disorders and endothelial dysfunction. However, the effect of gender on PAI-1 in patients with type 2 diabetes (T2D) and albuminuria has not been studied sufficiently.Objectives: In this study, we examined whether changes of PAI-1 activity according to the albuminuria state in patients with type 2 diabetes are different in males and females.Materials and Methods: A matched case-control study was performed among participants with T2D, as 38 microalbuminuric patients were matched with 38 normoalbuminuric patients who were similar in age and body mass index (BMI). PAI-1 activity was compared between the two groups with and without gender stratification.Results: PAI-1 activity in microalbuminuric women was higher in comparison to that of the normoalbuminuric controls (P-value &lt; 0.05). There was no significant difference in PAI-1 activity between macroalbuminuric and normoalbuminuric men. In women with type 2 diabetes and albuminuria, PAI-1 activity was independently and significantly associated with urinary albumin excretion.Conclusions: Gender differences in PAI-1 activity, seen in the early stages of diabetic nephropathy, are a possible explanation for the higher incidence of vasculopathy in women with type 2 diabetesKeywords: plasminogen activator inhibitor-1; coagulopathy; microalbuminuria; type 2 diabetes; gender

Screening for undiagnosed bleeding disorders in post-tonsillectomy bleed patients: Retrospective review and systematic review of the literature

ObjectivesThere is currently no standard for screening children with post-tonsillectomy bleeds (PTB) for coagulopathy disorders. This study aims to identify children with occult coagulopathy diagnosed at PTB and to identify factors associated with diagnosis. A systematic review of the literature further identified trends in this topic. MethodsA retrospective chart review of patients returning to the operating room for PTB at a tertiary children's hospital was undertaken from 2012 to 2016. A systematic review using Medline OVID was subsequently performed. ResultsOf 12,503 tonsillectomies, 311 children (52% male, mean age 8 years) required surgery for PTB (2.5% rate). Twenty-one patients (7%) had multiple episodes. Only two patients (0.6%) (both with known coagulopathy) underwent pre-tonsillectomy labs and 260 (84%) had labs at PTB. Six patients (2%) were diagnosed with a new coagulopathy, most commonly von Willebrand's Disease (vWD) in five (2%). Three patients (1%) were diagnosed at first PTB and three (1%) at second PTB. Of the three diagnosed at second PTB, two had normal partial thromboplastin time (PTT). In systematic review, 1243 manuscripts were reviewed and 8 papers discussing this topic are presented. ConclusionOccult coagulopathy was rarely diagnosed at PTB, but this may be limited by inconsistent screening. PT and PTT are not sensitive tests for vWD, and normal coagulation labs may lead to delayed diagnosis. The literature reveals occult coagulopathy is rare but often diagnosed after severe or recurrent hemorrhage. In order to provide efficient care and medical management, a standardized algorithm and sensitive labs for screening PTB patients are needed.

Incidence and Etiology of Stroke among Hospitalized Children: A Case-Series Study.

Stroke is a sudden blockage or rupture of brain vessels resulting neural defect or impairment. We aimed to investigate the incidence and causes of stroke in hospitalized children (Tehran-Iran, 2008-2013). This case series study was carried out in pediatric ward of tertiary care Vali-Asr Hospital, Imam Khomeini Hospitals Complex (Tehran- Iran) from 2008 to 2013. One month to 15 yr old admitted children due to stroke were enrolled into this case series study. Diagnosis was confirmed with brain imaging. Participants' demographic data, potential risk factors and neuroimaging findings were obtained from Hospital Reporting System. Recorded data were studied and considered regarding the incidence of stroke and its causes. Indeed we investigated cardiological causes as well as different items related to hematological disorders. Of 20000 admitted subjects in Imam Hospital during 5 yr, stroke was diagnosed in 15 cases. The incidence among the population study was 0.75 per 100000 children. Stroke was more frequent in males than females ( ). The most common age of stroke was 4-6 yr and the mean age of stroke was 58.8 months equal to 4.9 year. The most frequent stroke was hemorrhagic stroke (26%), followed by vascular (20%) and coagulopathy disorders (20%). The incidence of stroke in children was 0.75 per 100000. Hemorrhagic stroke due to major trauma, coagulopathy and vasculopathy were observed as most frequent causes that necessitate implementing some strategies for prevention, earlier diagnosis, and treatment.

Gastrointestinal Bleeding in Patients With Acute Respiratory Distress Syndrome: A National Database Analysis.

BackgroundThe goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB.MethodsARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions.ResultsWe identified 149,190 ARDS patients. The incidence of GIB was the highest among patients > 60 years (P < 0.001). GIB was associated with longer hospitalization days (7.3 days versus 11.9 days, P < 0.001), higher mortality (11% versus 27%, P < 0.001) and greater economic burden ($82,812 versus $45,951, P < 0.001). GIB was common in cirrhosis (OR: 8.3), peptic ulcer disease (OR: 3.7), coagulopathy disorders (OR: 3.003), thrombocytopenia (OR: 2.6), anemia (OR: 2.5) and atrial fibrillation (OR: 1.5). ARDS secondary to aspiration pneumonia (OR: 2.0), pancreatitis (OR: 2.0), sepsis (OR: 1.6) and community acquired pneumonia (OR: 0.8) was more likely to have GIB.ConclusionOur study demonstrates that GIB in ARDS patients is associated with significant increased mortality, hospitalization and health care cost.