Hemocoagulation Disorders Research Articles

Hemocoagulation Disorders and Intoxication in Severe Acute Post-Manipulation Pancreatitis in the Experiment

Introduction. Acute post-manipulation pancreatitis (APMP) is a frequent complication aſter interventions on the major duodenal papilla. The APMP incidence reaches 15 %, of which 5–10 % are severe. The goal of the research is to determine the possibility of correcting hemocoagulation disorders and reducing endogenous toxemia syndrome severity in APMP.Materials and methods. A comparative study was performed in 40 animals (nonlinear albino rats) with severe acute pancreatitis on APMP experimental model. L-17 compound from a new group of organic compounds substituted thiadiazines at a daily dose of 40 mg/kg was used.Results. The development of hemocoagulation disorders and severe toxemia in animals with an experimental model of APMP has been shown. The indicators of the severity of hemocoagulation disorders and toxemia were studied in experimental APMP against the background of the introduction of the compound L-17 from the group of substituted thiadiazines.Discussion. The course of APMP in the experiment is accompanied by the development of severe hemocoagulation disorders and severe toxemia. Effective indicators reflecting the severity of APLP are D-dimers (hemocoagulation) and albumin binding capacity (toxemia).Conclusion. The course of experimental severe APMP is accompanied by pronounced hemocoagulation disorders development involved in the pathogenesis and progression of multiple organ dysfunction, that is characterized by a high level of endogenous toxemia. The course of experimental APMP against the background of the introduction of the compound L-17 is marked by a decrease in the severity of hemocoagulation disorders and the level of endogenous toxemia.

Basic principles of infusion therapy

Infusion therapy (IT) is an essential tool for influencing homeostasis and an integral part of the complex treatment of urgent conditions and chronic diseases accompanied by fluid and electrolyte balance disorders. To this day the features of infusion therapy remain one of the most controversial and poorly studied topics, despite the centuries-old use of this method of treatment. Rational use of IT requires a clear understanding of the pathophysiological changes occurring in the patient’s body during acute and chronic pathology. Its main tasks are the elimination of volemic disorders, replenishment of circulating blood volume, restoration of microcirculation, as well as detoxification and elimination of hemocoagulation disorders. IT acquires particular importance as parenteral nutrition, with limited or excluded possibility of the enteral route of absorption of water, nutrients, and drugs. In the work, the authors focused on clinical and laboratory diagnostics and possible options for correcting acid-base, energy, fluid, and electrolyte disorders. The sequence of actions when prescribing IT is presented in detail; the criteria for calculating the volume of therapy and the initial selection of colloids or crystalloids for a specific clinical situation are considered.

Modern aspects of hemostasis state for fevers of rickettsiosis etiology

To analyze the data obtained from scientific papers on Internet resources and to track the characteristic changes in hemostasis with various types of rickettsiosis fevers, allowing a better understanding of the pathogenesis of rickettsiosis and, as a result, a more competent approach to the treatment of this pathology. In the course of the work, numerous scientific papers of foreign and domestic scientists from various Internet resources (PubMed, CyberLeninka, Elibrari, etc.) were used, which made it possible to analyze changes in hemostasis and summarize them while working.
 At the end of the twentieth century, a rapid economic development of endemic zones caused changes in their nosology, significantly affecting an increase in the incidence of natural focal rickettsiosis from the group of tick-borne spotted fevers in many regions of the world. Geographical conditions of the Volga-Caspian floodplain have created optimal conditions for the formation of natural foci of some rickettsioses on the territory of the Astrakhan region. During the period of controlled epidemiological surveillance from 1983 to 2019, the incidence rate of Astrakhan rickettsia fever has increased several dozen times, the settlements located near the gas complex are hyperendemic. The results of numerous studies regarding infectious diseases of rickettsiosis etiology indicate the leading role of cellular structures in the imbalance of hemostasis suggesting a more detailed study of their functional activity and the determination of factors affecting their activity. Rickettsioses require a more thorough study of the clinical and epidemiological picture, pathogenetic aspects to identify criteria for early diagnosis of hemocoagulation disorders in the hemostasis system that formed the basis of this study.
 Thus, summing up all of the above, rickettsioses require a more thorough study of the clinical and epidemiological picture, pathogenetic aspects to identify criteria for early diagnosis and appointment of adequate therapy. The features of hemocoagulation dynamics in rickettsia fevers deserve special attention, because this process is both a trigger mechanism of the infectious process and an important factor affecting other structures of this biological system.

Polymorphism of Genes of Platelets` Integrins and Fibrinogen as a Risk Factor for Homeostatic Disorders in Preeclampsia

The development of perinatal obstetrics is associated with the need for a detailed study of the pathophysiological mechanisms of preeclampsia (PE). Materials and methods. A prospective cohort study included 173 patients aged 18-45 years with a singleton pregnancy at a gestational age of 22-41 weeks at the Mordovian Republican Central Clinical Hospital. There were 3 groups: group I (n=63) - pregnant women with moderate PE, group II (n=58) - patients with severe PE, group III (control) (n=52) - pregnant women with physiological pregnancy. The assessment of the prevalence of polymorphic variants of genes was by PCR diagnostics. A laboratory study of hemostasis, microcirculation and thromboelastography (TEG) parameters was performed. Results. In patients with severe preeclampsia, there is a high prevalence of homozygous C/C variants (46.5%) of the ITGB3 gene and heterozygous C/T variants (55.5%) of the ITGA2 gene, hetero-(G/A) and homozygous (A/A ) variants of the fibrinogen gene (FGB) - 48.3 and 36.2%, respectively. It is associated with such hemocoagulation disorders as an increase in the prothrombogenic potential of the blood based on a decrease in the number of platelets, prothrombin time and antithrombin III against the background of an increase in fibrinogen and an increase in the strength and volume of the blood clot according to TEG. Conclusions. The severity of thrombophilia is associated with the severity of preeclampsia; pathological alleles of the studied genes are most often recorded in patients with severe PE and severe hemostasis disorders.

ГЕМОРЕОЛОГИЯ И ГЕЛИОГЕОФИЗИЧЕСКАЯ ВОЗМУЩЕННОСТЬ: СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА (ОБЗОР)

There are quite a lot of scientific works that reveal some aspects of the heliogeophysical factors’s influence on the state of the rheological properties of human blood. Nevertheless, the study of the mechanisms of such influence remains open, which is associated with the difficulty of reproducing laboratory experiments, the heterogeneity and short duration of the analyzed time series of medical and biological data, as well as the interdisciplinarity of this area. The aim of this review is to analyze current research results and new original approaches to studying this issue. The results of studies published in the PubMed, Cyberleninka and eLibrary databases for the period from 1990-2021 were devoted to the study of the influence of heliogeophysical disturbances on the state of human hemorheology, and also this data was analyzed. The analysis of the literature showed a connection between heliogeophysical disturbance and the development of hemocoagulation disorders of humans, a tendency to an increase in the degree of platelet aggregation and an acceleration of the onset of thrombosis, a deterioration in the state of the microvasculature, which is most pronounced among people with diseases of the cardiovascular system. In patients with coronary artery disease, the same type of reactions was revealed, expressed by an increase in coagulation, there were heart rhythm disorders and the appearance of episodes of myocardial ischemia.

Нейтрофільні позаклітинні пастки як терапевтична мішень при системних ускладненнях гострого панкреатиту

The review focuses on the role of neutrophilic extracellular traps (NETs) in systemic complications of acute pancreatitis. NETs can activate trypsin, cause inflammation and pancreatic tissue damage, and clog the excretory ducts. The main fatal complications of acute pancreatitis, such as acute lung injury, kidney, myocardial and CNS damage, intestinal dysfunction, hemocoagulation disorders are associated with NETs. Focusing on the formation and degradation of NETs may be a way to develop strategies for treating organ damage in severe acute pancreatitis. Current data on the use of NET-targeted therapy in experimental severe acute pancreatitis, which is aimed at blocking the NETs formation and disassembly of the DNA scaffold, inhibition of proteins toxicity in NETs, are considered.

Anticoagulation Management during Extracorporeal Membrane Oxygenation-A Mini-Review.

Extracorporeal membrane oxygenation (ECMO) has been established as a life-saving technique for patients with the most severe forms of respiratory or cardiac failure. It can, however, be associated with severe complications. Anticoagulation therapy is required to prevent ECMO circuit thrombosis. It is, however, associated with an increased risk of hemocoagulation disorders. Thus, safe anticoagulation is a cornerstone of ECMO therapy. The most frequently used anticoagulant is unfractionated heparin, which can, however, cause significant adverse effects. Novel drugs (e.g., argatroban and bivalirudin) may be superior to heparin in the better predictability of their effects, functioning independently of antithrombin, inhibiting thrombin bound to fibrin, and eliminating heparin-induced thrombocytopenia. It is also necessary to keep in mind that hemocoagulation tests are not specific, and their results, used for setting up the dosage, can be biased by many factors. The knowledge of the advantages and disadvantages of particular drugs, limitations of particular tests, and individualization are cornerstones of prevention against critical events, such as life-threatening bleeding or acute oxygenator failure followed by life-threatening hypoxemia and hemodynamic deterioration. This paper describes the effects of anticoagulant drugs used in ECMO and their monitoring, highlighting specific conditions and factors that might influence coagulation and anticoagulation measurements.

The significance of neutrophilic extracleptal traps in the pathogenesis of hemocoagulation disorders in patients with colorectal cancer

The article contains the main available data on the structures called neutrophil extracellular traps (NECs), the mechanisms of their formation and participation in pathophysiological processes are considered. Currently, scientific literature sources contain data on the structure of NVL and their role in the processes of antibacterial protection, thrombosis, as well as various neoplastic processes. However, there is no definite data regarding the exact role of NVL in the oncological process, and the duality of their influence in relation to tumor cells remains a matter of debate. In addition, data on the diagnostic significance of traps in clinical practice are also lacking.

ОСОБЕННОСТИ ГЕМОСТАЗА У ПАЦИЕНТОВ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ, ВЫЗВАННОЙ SARS-COV-2

Information about the health status of newborns from mothers infected with the SARS-COV-2 coronavirus is few and contradictory, and there is practically no information on hemocoagulation disorders in such children in the available literature. Meanwhile, hemostasis disorders are one of the most urgent problems in neonatology. The importance of the stated topic is due to the potential risk of developing life-threatening conditions due to possible violations of the functions of vital organs, severe hypoxia resulting from massive blood loss. The aim of our study was to study the features of hemocoagulation disorders in newborns from mothers with coronavirus infection caused by SARS-CoV-2 (COVID-19). Confirmation of COVID-19 infection was a positive PCR test - detection of SARS-CoV-2 coronavirus RNA detected in women during pregnancy (in the second trimester or immediately before childbirth). Clinical, laboratory, and biochemical research methods were used in the examination of children. It was revealed that a transmitted coronavirus infection in the second half of pregnancy and before childbirth, indirectly affecting the fetus through the uteroplacental blood flow, exacerbates microcirculatory disorders, which leads to more pronounced hemorrhagic disorders in the newborn. Conflict of interests. The authors declare that there is not conflict of interests

Pathomorphological manifestations of vascular remodeling in the perifocal areas of ischemic cerebral infarction

Abstract. Acute disorders of cerebral circulation remain one of the leading causes of death of patients throughout the world. Tissue recovery after a stroke is directly related to active revascularization, which is intensified in the peri-infarction area. Newly formed vessels contribute to the restoration of cellular metabolism in surviving neurons. The processes of vascular remodeling after stroke have been at the center of many clinical and morphological studies in recent years. The aim of the study. To study the processes of vascular remodeling and neoplasm of vessels in the perifocal areas of ischemic cerebral infarctions. Material and methods. The study researched the brain of 29 deceased patients with hemispheric infarctions with different periods of the disease: up to 3 days (n = 5), 6 days (n = 5), 9-12 (n = 10), 30 (n = 5), 45 days (n = 4). The object of the study was perifocal areas of cerebral infarction, as well as areas outside ischemic lesions. The studies were carried out using histological, morphometric and statistical techniques. Results. Studies have shown that in the perifocal areas of cerebral infarction within 3 days from the onset of the disease, the morpho-functional state of the microvasculature was characterized by circulatory and hemocoagulation disorders. Along with destructive changes in blood vessels, processes are directed to improve blood circulation in ischemic areas of the brain. Collateral blood flow increases, dilation of pial vessels is noted with a decrease in the Kernogan index. On the 6th day, the processes of angiogenesis and vasculogenesis are activated, which intensify in the subsequent stages of the disease. In the long term, the efficiency of collateral blood flow in the pial vessels decreases, reduction in the capillary network, and the lumen of large arteries is recalibrated. Conclusions. In the early stages of cerebral stroke (up to 3 days), increased blood circulation in the ischemic areas of the brain occurs due to increased collateral blood flow. From the 6th day, the processes of angiogenesis in the form of capillary budding and the processes of vasculogenesis intensify. In large arterioles, recalibration processes take place. After 30-45 days in the perifocal areas of cerebral infarction, a significant reduction of the capillary network is recorded, which is regarded as a reaction to a decrease in blood supply to the areas of organized infarction.

Blood platelets in the development of sepsis, septic shock and multiple organ failure syndrome

Participation of blood platelets in the development of sepsis is clearly illustrated by hemocoagulation disorders and frequently observed thrombocytopenia. In the patients with sepsis, thrombocytopenia develops rapidly, with minimal platelet counts registered on the fourth day of observation, after which the platelet counts usually rise. Continuous thrombocytopenia and absence of a relative increase in platelets are considered predictors of patient death. The mechanisms of thrombocytopenia developing in sepsis are quite diverse, but the processes in periphery are prevailing, e.g., the so-called “platelet consumption” which is determined by their activation, chemotaxis and isolation in the microvasculature. Recently, a mechanism has been identified for the accelerated removal of platelets with desialized surface glycoproteins from the circulation. Sialidases, also known as neuraminidases, are widely present in viruses and bacteria, and pharmacological inhibition of sialidases is able to withstand thrombocytopenia in the infectious process. The key role of platelets in the development of septic shock was revealed. Sequestration of platelets in the microvessels of the lungs and brain (manifesting as thrombocytopenia) is accompanied by rapid serotonin release, thus underlying the main clinical manifestations, e.g., decreased blood pressure, heart rate and increased capillary permeability. To counteract sharp release of this mediator, pharmacological attempts are made to inhibit the SERT transporter by means of selective serotonin reuptake inhibitors. Blood platelets are key participants in the pathogenesis of multiple organ failure syndromes, such as acute renal damage, acute respiratory distress syndrome, myocardial dysfunction, and sepsis-associated encephalopathy. To restore impaired vascular permeability in these conditions, in particular, sepsis-associated encephalopathy, a pharmacological S1P receptor mimetic is under study. The review specifies possible pathogenetically significant targets that can be used to perform pharmacological correction of conditions associated with sepsis and concomitant thrombocytopenia.

Interrelation between markers of system of hemostasis and hemocoagulation disorders in patients with tuberculosis of respiratory organs and comorbid diabetes mellitus after surgical intervention on respiratory organs

The relevance of the work is determined by the necessity to study markers of coagulation system of blood and hemocoagulation disorders in patients with pulmonary tuberculosis and comorbid diabetes mellitus in different stages of postoperative period.
 Aim. To determine the interrelation between markers of system of hemostasis and signs of development of intravascular blood coagulation in patients with pulmonary tuberculosis and comorbid diabetes mellitus (TB-DM) depending on the volume of surgical intervention on the respiratory organs.
 Materials and Methods. The extent of changes of markers of the system of hemostasis was determined in 89 patients with TB-DM before and after surgical treatment. Parameters of coagulation system of blood: concentration of fibrinogen, the level of soluble fibrin-monomer complexes, compensatory potentials by the level of fibrinolysis, activity of fibrinolytic system and of anticoagulation system (antithrombin III) were determined; parameters of prothrombin activity were studied. Besides, operation material of lungs was prepared for morphological examination.
 Results. A general tendency to increase in the parameters of hypercoagulation syndrome was identified in all the study groups starting from the 3rd-5th day and reaching maximum on the 7th-10th and 14th-17th days of the postoperative period, with compensatory activation of fibrin-stabilizing factor and of fibrinolytic system. Changes in the markers of hemostasis were most prominent in the group of patients after lobectomy. Microthrombotic lesions of the vessels of pulmonary microcirculation with partial or complete obturation of the lumen were morphologically visualized.
 Conclusion. On the basis of the data obtained a conclusion can be made about the existence of pronounced hypercoagulation syndrome with phenomena of intravascular coagulation of blood in this category of patients, which evidently requires timely prevention and treatment of thromboembolic complications. The results obtained may be used for development of measures aimed at prevention of hemocoagulation complications in patients with TB-DM after the conducted surgical treatment.

SOME FEATURES OF THE PATHOGENESIS OF ALCOHOLIC HEPATITIS AND ALCOHOLIC CIRRHOSIS OF THE LIVER IN COMBINATION WITH ARTERIAL HYPERTENSION

Purpose - to study the features of the combined course of chronic alcoholic hepatitis (CAH) and alcoholic liver cirrhosis (ALC) with arterial hypertension (AH) by determining the main clinical and laboratory parameters. Material and methods. 13 patients with CAH (group I), 22 patients with CAH in combination with arterial hypertension (group II), 22 patients with ADC (group III) and 40 patients with ADC in combination with arterial hypertension (group IV) were examined. Serum content of C-reactive protein, tumor necrosis factor-α (TNFα), transforming growth factor-β1 (TGFβ1 ), interleukin-10 (IL-10), 8-isoprostane, D-dimer, stable metabolites of nitric oxide (nitrites / nitrates), endothelin-1 (ET-1), intercellular adhesion molecules-1 (ICAM-1); plasma recalcification time (PRT), prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), plasma fibrinogen levels, antithrombin III (ATIII) activity, factor XIII activity, platelet aggregation. Liver function and blood lipid spectrum were also examined. Results. It was found that the manifestations of cytolysis and cholestasis syndromes were mostly more pronounced in patients with alcoholic liver disease (ALD) due to its combination with hypertension. At the same time, there was an increase in the levels of CRP, TNFα, TGFβ1 , IL-10, ceruloplasmin and 8-isoprostane. In the presence of concomitant hypertension, the content of IL-10 (in patients with CAH), CRP (in patients with ALC), as well as the content of 8-isoprostane and ceruloplasmin (in patients with CAH and AlC) probably (p <0.05) exceeded that in patients without hypertension. At the same time, in both CAH and ALC, the presence of endothelial dysfunction was established. Disorders of the endothelial functional state were accompanied by changes in the hemocoagulation of homeostasis and the blood lipid spectrum. When evaluating the quality of the LAL test, it was found that the positive test was in 97.5% of patients with ALC with hypertension compared with CAH with hypertension, where this test was positive in 68.2% of cases. When comparing groups of patients with ALC and CAH, it was found that in 77.2% of cases it was positive in group III and in 38.5% - in group I. In patients with ALC with and without hypertension, this test had the following distribution: 39 patients out of 40 had a positive test in group IV and 17 out of 22 - in group III. Conclusion. The occurrence of cytolytic, cholestatic, mesenchymal-inflammatory syndromes and hepatocellular insufficiency in patients with ALD with hypertension is associated with the direct action of ethanol on the liver, the development of systemic inflammation, oxidative stress, dyslipoproteinemia, endothelial dysfunction with hemocoagulation disorders and endotoxemia..

Оптимизация фармакотерапии острого панкреатита тяжелой степени

Проведено изучение эффективности ремаксола у больных острым панкреатитом тяжелой степени. Выявлено, что острый панкреатит в ранней фазе сопровождается активацией процессов перекисного окисления липидов и фосфолипазы A2, гиперкаогуляцией и гипофибринолизом, выраженность данных изменений сопряжена с тяжестью патологического процесса. Включение в комплексную терапию ремаксола способствовало более быстрой коррекции гомеостатических показателей у больных острым панкреатитом тяжелой степени. У этих пациентов выявлено снижение показателей окислительного стресса на 13,4 – 17,1 % (p < 0,05), активности фосфолипазы A2 — на 18,2 – 20,6 % (p < 0,05), гемокоагуляционных расстройств — на 9,2 – 14,7 % (p < 0,05) относительно контроля.

Hemorrhagic Syndrome in Babies

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Influence of epidural anesthesia on the hemocoagulation disorders and quantity of septic complications in patients with acute necrotizing pancreatitis

According to many authors, acute necrotizing pancreatitis (ANP) still remains one of the difficult problems of abdominal surgery. The complexity of the pathogenesis of the disease, features of the pancreas pathomorphology, abdominal hypertension, and high mortality (30 to 70%) necessitate a search for new ways to treat this disease.

The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (≥5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options

Coagulopathy after traumatic brain injury (TBI) is frequent and represents a powerful predictor related to outcome and prognosis. The complex pathophysiological mechanisms of the coagulopathy of TBI are multifactorial and remain still undefined. The nature of the coagulation abnormalities differs between severe TBI and non-TBI with somatic injuries. The current hypothesis for the development of coagulopathy after TBI includes combinations of both hypo- and hypercoagulable states promoted by the magnitude and the extent of the injury resulting in a variable degree of secondary injury via subsequent ischemic and hemorrhagic lesioning. The proposed underlying mechanisms may comprise the release of tissue factor (TF), hyperfibrinolysis, shock, and hypoperfusion thus triggering the protein C pathway, disseminated intravascular coagulation, and platelet dysfunction. Hemocoagulative disorders after TBI may be amenable to treatment, and adequate and timely management may protect from secondary injury and poor outcomes. Functional assays such as viscoelastic tests may be supportive in early detection, diagnosis, and guidance of treatment. This review summarizes the current understanding with regard to frequency, pathogenesis, diagnosis, and treatment of the coagulopathy after TBI.

Glasgow Coma Scale as a predictor for hemocoagulative disorders after blunt pediatric traumatic brain injury*

Coagulopathy is a complication of traumatic brain injury and its presence after injury has been identified as a risk factor for prognosis. It was our aim to determine whether neurologic findings reflected by Glasgow Coma Scale at initial resuscitation can predict hemocoagulative disorders resulting from traumatic brain injury that may aggravate clinical sequelae and outcome in children. A retrospective analysis of 200 datasets from children with blunt, isolated traumatic brain injury documented in the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie was conducted. Inclusion criteria were primary admission, age <14 yrs, and sustained isolated blunt traumatic brain injury. Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie-affiliated trauma centers in Germany. : Two hundred datasets of children (age <14 yrs) with blunt isolated traumatic brain injury were analyzed: children were subdivided into two groups according to Glasgow Coma Scale at the scene (Glasgow Coma Scale ≤ 8 vs. Glasgow Coma Scale >8) and reviewed for coagulation abnormalities upon emergency room admission and outcome. Fifty-one percent (n = 102 of 200) of children had Glasgow Coma Scale >8 and 49% (n = 98 of 200) had Glasgow Coma Scale ≤ 8 at the scene. The incidence of coagulopathy at admission was higher in children with Glasgow Coma Scale ≤ 8 compared to children with Glasgow Coma Scale >8: 44% (n = 31 of 71) vs. 14% (n = 11 of 79) (p < .001). Multivariate logistic regression revealed that Glasgow Coma Scale ≤ 8 at scene was associated with coagulopathy at admission (odds ratio 3.378, p = .009) and stepwise regression identified Glasgow Coma Scale ≤ 8 as an independent risk factor for coagulopathy. Mortality in children with Glasgow Coma Scale ≤ 8 at scene was substantially higher with the presence of coagulation abnormalities at admission compared to children in which coagulopathy was absent (51.6%, n = 16 of 31 vs. 5% n = 2 of 40). Glasgow Coma Scale ≤ 8 at scene in children with isolated traumatic brain injury is associated with increased risk for coagulopathy and mortality. These results may guide laboratory testing, management, and blood bank resources in acute pediatric trauma care.

Influence of epidural anesthesia on the hemocoagulation disorders and quantity of the septic complications at patients with acute necrotizing pancreatitis

Tarabrin, O.; Suslov, V.; Shcherbakov, S.; Gavrychenko, D.; Ivanova, V. Author Information