Hemostatic Parameters Research Articles

Hemostatic parameters in pulmonary tuberculosis patients after intensive phase treatment.

Background:Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis (Mtb). This infection causes the release of proinflammatory cytokines that affect hemostasis. Pulmonary TB infection causes an increased activation of procoagulant factors, decreased anticoagulant factors and suppresses fibrinolysis which causes hypercoagulable. Our study is conducted to assess the association between pulmonary TB infection (PTB) with hemostatic parameters before and after intensive phase treatment.Methods:This was an analytic observational prospective cohort design. The study was conducted at the Community Center for Lung Health in South Sulawesi. Studied subjects were recruited by consecutive sampling, in which the patients who met the inclusion criteria received intensive phase of ATD treatment. PT, aPTT, fibrinogen, and D-dimer were measured before treatment and after the intensive phase of ATD. These data were analyzed using the SPSS Version 22.Results:In this study, 30 subjects are new cases of PTB. Prothrombin time, aPTT and D-dimer levels were higher in far advanced lesions and smear-positive sputum group (p<0.001). There was a significant level decrease in PT, aPTT, fibrinogen, D-dimer after intensive phase treatment (p<0.001).Conclusion:Pulmonary tuberculosis infection is associated with hypercoagulability which is characterized by an increase in hemostatic parameters and has significant improvement after intensive phase of ATD treatment.

LEVELS OF IMMUNOGLOBULIN G AND MARKERS OF VASCULAR INFLAMMATORY RESPONSE AS PREDICTORS OF POSSIBLE VASCULAR COMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER SARS-COV-2

Objective: To investigate the level and relationship of specific immunoglobulin G (IgG) antibodies to SARS-CoV-2 with laboratory parameters of vascular inflammatory response (VIR) during follow-up of patients with arterial hypertension (AH) in 3 months after disease onset. Design and method: Retrospective, single-center observational study included 76 confirmed cases of COVID-19 associated with pneumonia (April-May 2020). Gr.1 consisted of 32 patients without AH; Gr.2 involved 44 AH patients, including 18 patients with metabolic disorders (abdominal obesity and impaired carbohydrate metabolism). Complete blood count, biochemical and hemostatic parameters were determined on the day of admission. Comprehensive analysis of clinical instrumental and laboratory parameters, including blood pressure, heart rate, IgG (positivity rate), cytokines, NT-pro BNP, endothelial dysfunction markers, cystatin C, glucose and others was performed in 3 months after discharge. Results: In Gr.1, IgG was negatively associated with hemoglobin, red blood cell volume, neutrophils, creatine phosphokinase, homocysteine, those were supplemented by NT-pro BNP, interleukin-6, lactate dehydrogenase, creatinine (p &lt; 0.0001–0.034) in Gr.2 and additionally, D-dimer level, transforming growth factor and P-selectin (p &lt; 0.001–0.036) in metabolic disorders subgroup. Therewith, in patients aged over 40 years, positive association of IgG with levels of SBP and DBP (p &lt; 0.011 and 0.034), MDRD (p &lt; 0.01) was registered. Correlation and regression analysis revealed greater association of IgG level &lt; 12.9 with vascular inflammatory markers, and IgG level &gt; 12.9 with thrombogenic parameters. Conclusions: IgG might be a sensitive indicator of VIR and can play a role in predicting possible unwanted vascular complications in AH patients after suffering from SARS-CoV-2.

Evaluating the Correlation of Hemostatic and Endocrine Parameters with Child-Turcotte-Pugh Scoring in Patients with Non-Alcoholic Liver Cirrhosis

Background: Liver cirrhosis is one of the most significant causes of death in many regions worldwide. This study aimed to assess the correlation of hemostatic and endocrine parameters with Child-Turcotte-Pugh (CTP) scoring in patients with non-alcoholic liver cirrhosis. Materials and Methods: This study included 59 patients monitored for non-alcoholic liver cirrhosis in a gastroenterology clinic from January 2018 to February 2019. The subjects were grouped according to the CTP scores, and their adrenocorticotropic hormone (ACTH), cortisol, dehydroepiandrosterone sulfate (DHEA-SO4), progesterone, growth hormone (GH), insulin-like growth factor-1 (IGF-1), GH/ IGF-1 ratio, fibrinogen, D-dimer, and D-dimer/fibrinogen ratio were measured. Results: According to CTP scoring, 20.3% of patients were CTP-A (n=12), 35.6% were CTP-B (n=21), and 44.1% were CTP-C (n=26). There were statistically significant differences for IGF-1, DHEA-SO4, and GH/IGF-1 ratios between CTP-A and CTP-B groups (P=0.002, P=0.043, P=0.038, respectively). Additionally, there were statistically significant differences between the CTP-B and CTP-C groups for D-dimer and GH values (P=0.024, P=0.006, respectively). There were statistically significant differences for D-dimer, GH, IGF-1, and D-dimer/fibrinogen ratio between the CTP-A and CTP-C groups (P&lt;0.001, P=0.016, P=0.002, P=0.031, respectively). Conclusion: Severe hemostatic and endocrine complications develop in patients with liver cirrhosis due to non-alcoholic causes. Additionally, it seems that using D-dimer and D-dimer/fibrinogen ratio, along with fibrinogen level, can be beneficial in showing liver damage in these patients.

Improvement in the cardiovascular profile of patients with morbid obesity following bariatric surgery: Effect on hypercoagulability.

Obesity is an inflammatory state related to vascular endothelium dysfunction. It generates a biological situation of hypercoagulability increasing the risk of thrombosis. This prothrombotic condition could be improved by bariatric surgery.The main objective was to analyze the impact of bariatric surgery on cardiovascular risk factors (CVRF) associated with changes in thrombin generation and procoagulant activity of microparticles (MP).We present a prospective longitudinal study including consecutive patients candidate for bariatric surgery. We performed 3 sequential clinical visits: at inclusion, before surgery after completing the modified fasting phase, and 6 months after surgery. We analyzed CVRF, thrombin generation, and MP activity. The data analysis was performed using a logistic regression model to determine changes over time of hemostatic parameters and body mass index (BMI). McNemar test for binary variables was used to analyze the CVRF.We included 94 patients (66 women), with an average age of 45.7 ± 10.1 years. The mean BMI reduction at the end of the follow-up was 15.5 ± 4.2 kg/m2. We detected a statistically significant improvement in CVRF: hypertension, diabetes mellitus, dyslipidemia, and obstructive sleep apnea, as well as a significant reduction in thrombin generation capacity and procoagulant MP activity.Massive weight loss induced by bariatric surgery improves the cardiovascular profile, associated with a reduction in the hypercoagulable status.

Modulation of Hemostasis in COVID-19; Blood Platelets May Be Important Pieces in the COVID-19 Puzzle.

Although the precise pathogenesis of coronavirus disease 2019 (COVID-19) currently remains unknown, its complex nature is gradually being revealed. COVID-19 is a disease caused by the SARS-CoV-2 virus and leads to respiratory dysfunction. Studies on hemostatic parameters have showed that COVID-19 significantly affects the disruption of the coagulation system and may contribute to coagulation and thrombotic events. A relevant cause of hemostasis disorders is inflammation and cytokine storms, which cause, for example, endothelial dysfunction in blood vessels. In order to prevent and treat states of hypercoagulability and thrombosis, the administration of anticoagulants, e.g., heparin, is recommended. The present mini-review describes the relationship between hemostasis and COVID-19, and discusses whether this relationship may cast light on the nature of COVID-19. The present short manuscript also examines the relationship between blood platelets and COVID-19. In addition, the paper explores the potential use of antiplatelet drugs in COVID-19 cases. The studies were identified by searching electronic databases, including PubMed and SCOPUS.

Inside the Thrombus: Association of Hemostatic Parameters With Outcomes in Large Vessel Stroke Patients.

Background: Actual clinical management of ischemic stroke (IS) is based on restoring cerebral blood flow using tissue plasminogen activator (tPA) and/or endovascular treatment (EVT). Mechanical thrombectomy has permitted the analysis of thrombus structural and cellular classic components. Nevertheless, histological assessment of hemostatic parameters such as thrombin-activatable fibrinolysis inhibitor (TAFI) and matrix metalloproteinase 10 (MMP-10) remains unknown, although their presence could determine thrombus stability and its response to thrombolytic treatment, improving patient's outcome.Methods: We collected thrombi (n = 45) from large vessel occlusion (LVO) stroke patients (n = 53) and performed a histological analysis of different hemostatic parameters [TAFI, MMP-10, von Willebrand factor (VWF), and fibrin] and cellular components (erythrocytes, leukocytes, macrophages, lymphocytes, and platelets). Additionally, we evaluated the association of these parameters with plasma levels of MMP-10, TAFI and VWF activity and recorded clinical variables.Results: In this study, we report for the first time the presence of MMP-10 and TAFI in all thrombi collected from LVO patients. Both proteins were localized in regions of inflammatory cells, surrounded by erythrocyte and platelet-rich areas, and their content was significantly associated (r = 0.41, p < 0.01). Thrombus TAFI was lower in patients who died during the first 3 months after stroke onset [odds ratio (OR) (95%CI); 0.59 (0.36–0.98), p = 0.043]. Likewise, we observed that thrombus MMP-10 was inversely correlated with the amount of VWF (r = −0.30, p < 0.05). Besides, VWF was associated with the presence of leukocytes (r = 0.37, p < 0.05), platelets (r = 0.32, p < 0.05), and 3 months mortality [OR (95%CI); 4.5 (1.2–17.1), p = 0.029]. Finally, plasma levels of TAFI correlated with circulating and thrombus platelets, while plasma MMP-10 was associated with cardiovascular risk factors and functional dependence at 3 months.Conclusions: The present study suggests that the composition and distribution of thrombus hemostatic components might have clinical impact by influencing the response to pharmacological and mechanical therapies as well as guiding the development of new therapeutic strategies.

Effect of First Long-Term Training on Whole Blood Count and Blood Clotting Parameters in Thoroughbreds.

Training has a strong effect on the physiology of hematological parameters and blood coagulation, both in humans and in horses. Several blood changes have been reported after exercise in horses but available data differ. We aimed to investigate modifications in complete blood count and some hemostatic parameters induced by the first training period in young untrained Thoroughbred racehorses to detect a possible labile blood coagulability in racehorses. Twenty-nine untrained 2-year-old Thoroughbreds were followed during their incremental 4-month sprint exercise schedule. Blood collection was performed once a month, five times (T-30, T0, T30, T60 and T90), before and during the training period for measurement of complete blood count (CBC) and blood clotting parameters (prothrombin time-PT, activated partial prothrombin time-APTT, thrombin clotting time-TCT, fibrinogen-Fb, thrombin-antithrombin complex-TAT). Differences among the time points for each parameter were analyzed (ANOVA, Kruskal-Wallis one-way analysis of variance, p < 0.05). In Thoroughbreds, the first long-term exercise workout period was found to induce a statistical increase in red blood cell indexes and lymphocytes, eosinophils and platelet counts, as well as a hypercoagulability state evident at 30 days of training, which returned to basal levels after 90 days. Regular physical exercise seems to blunt the negative effects of acute efforts on hematological and clotting parameters, an effect that may be attributed to the training condition.

A notable key for estimating the severity of COVID-19: 25-hydroxyvitamin D status

Abstract Background Vitamin D is recognized to be an immune regulator. Also, it is known to have antiviral effects by several mechanisms, including reducing inflammatory cytokines. Objectives To examine the 25-hydroxyvitamin D (25(OH)D) status for assessing the severity of COVID-19. Methods This study consisted of 596 patients confirmed as SARS-CoV-2 infection and 59 healthy individuals. The cases separated into non-severe group, severe survival, and severe non-survival group. 25(OH)D and other laboratory parameters were evaluated retrospectively. Results In all COVID-19 groups 25(OH)D levels were low compared to controls (p&lt;0.05). 25(OH)D concentrations were lowest in patients in severe non-survival groups than those in other SARS-CoV-2 infection groups (p&lt;0.05). Multivariate regression analysis exhibited that decreasing 25(OH)D was associated with an increased likelihood of non-severe, severe survival and severe non-survival disease. There were significant associations between 25(OH)D and certain inflammatory and hemostatic parameters (p&lt;0.05, for all). Conclusions 25(OH)D deficiency was observed among patients with COVID-19. Declined steadily 25(OH)D levels make a huge contribution to the scale of the progression of the disease. Correlations support that 25(OH)D may be a substantial tool for utilizing the severity of the disease and estimating the survival. Also, supplementation of 25(OH)D might slow down the course of the COVID-19.

Correction of hemostasis and hemorheology with intravenous laser blood irradiation and cytokinotherapy in indirect revascularization at the perioperative period in patients with critical ischemia of their lower extremities

Purpose . To study potentials for correcting hemostasis and hemorheology with intravenous laser blood irradiation (ILBI) and cytokine therapy (CT) in indirect revascularization at the perioperative period in patients with critical ischemia of lower extremities. Material and methods . A prospective controlled clinical trial included 162 patients with critical lower limb ischemia (CLLI) having distal arterial steno-occlusion who had indirect revascularization surgery. CLLI etiological factors were: obliterating atherosclerosis in 108 (66.7%) patients and obliterating thromboangiitis in 54 (33.3%) patients. 56 patients had chronic ischemia of degree III; 106 patients – chronic ischemia of degree IV. All patients were divided into 5 groups who had various curative modalities at their perioperative period: Group I (n = 34) –standard treatment; Group II (n = 32) – standard treatment + ILBI; Group III (n = 32) – standard treatment + CT with Roncoleukin; Group IV (n = 33) – standard treatment + ILBI + CT; patients from Group V (n = 31) in revascularizing osteotrepanation had intraosseous marrow laser irradiation (IOLI) – standard treatment + ILBI + CT. The researchers also studied dynamics of hemostatic parameters (fibrinogen – F, fibrinolytic activity – FA, fibrin degradation products – PDF, activity of antithrombin-III, plasminogen – P) and hemorheology (erythrocyte deformability – DE, von Willebrand factor – WF, ADP induced platelet aggregation). The obtained hemostasis and hemorheology findings were compared with identical parameters of 48 practically healthy subjects («reference group»). Results . On admission, patients with CLLI in distal steno-occlusion had a sharp change in their hemostasis formula shifting towards hypercoagulation and deterioration of hemorheology. ILBI and CT techniques applied either separately or in combination with other therapeutic measures in the perioperative period of indirect revascularization normalized parameters of blood coagulation system (for all parameters – p < 0.05; r = 0.4) and of hemorheology (for DE – p < 0.05; r = 0.4; for WF and ADP-induced platelet aggregation – p < 0.05; r = 0.3). The best results were obtained under the combination of ILBI and CT at the perioperative period of indirect revascularization, especially in revascularizing osteotrepanation with IOLI. Conclusion . ILBI and CT applied in combination with standard treatment at the perioperative period in indirect revascularization reliably correct hemostasis and hemorheology in patients with CLLI and distal arterial steno-occlusion.

Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study

BackgroundIncidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. ObjectivesWe aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. MethodsSingle-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. ResultsAmong 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4–142, p < .05). ConclusionsDespite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.

Sex differences in haemostatic and other haematological parameters of tuberculosis patients at pre-treatment, post-intensive and post-continuation phase anti-tuberculosis therapy

Aims &amp;Objective: Gender variations are common features of many physiological parameters. Thus sex differences in haemostatic and haematological parameters are expected, but how anti-tuberculosis therapy modulates these differences is unclear. We hypothesized that anti-tuberculosis therapy will induce further changes in the level of these parameters when compared between male and female tuberculosis (TB) subjects. Aims and Objectives: This comparative follow-up study was designed to compare the levels of haemostatic and other haematological parameters between male and female TB subjects at pre-treatment, and followed up with a repeat comparison at post-intensive phase treatment and post-continuation phase treatment, to ascertain the differences at each phase of treatment. Methods: A total of sixty TB subjects of both genders (35 males and 25 females) were enlisted in this study. They were recruited before initiation of therapy and followed up post-intensive phase and post-continuation phase treatment and samples collected and analysed. Results: At pre-treatment, P-selectin (ng/ml), PCV (l/l), neutrophil-lymphocyte ratio (NLR) and platelet count (x109 /l) were significantly higher in male compared to female TB subject (P=0.044, 0.022, 0.040 and 0.039). At post-intensive phase treatment, P-selectin (ng/ml), TPO (pg/ml), total white blood cell count (x109 /l), neutrophil count (x109 /l), lymphocyte count (x109 /l), monocyte count (x109 /l), eosinophil count (x109 /l) and monocyte lymphocyte ratio (MLR) was significantly higher in male compared to female TB subjects (P=0.046, 0.030, 0.022, 0.044, 0.029, 0.036, 0.042 and 0.036). Conversely, the mean platelet count (x109 /l) was significantly higher in females than males (P=0.022). At post-continuation phase treatment, the median P-selectin (ng/ml) was significantly higher in male compared with female TB subjects (P=0.028). Conclusion: Sex differences in haemostatic and haematological parameters vary with different phases of anti-tuberculosis treatment. But P-selectin displays a consistent higher level in male TB subjects at all phases of treatment.

Longitudinal Dynamics of Coagulation and Angiogenesis Markers in Cancer Patients During and After Chemotherapy.

Hemostatic parameters have been investigated as molecular determinants of tumor progression. To analyze the dynamics of microparticle-associated tissue factor activity (MPTF), tissue factor antigen (TF-Ag), and angiopоietin-2 (ANG-2) in cancer patients before, during, and after active treatment and to explore their potential as biomarkers for metastatic occurrence and death. Blood for the analysis of MPTF, TF-Ag, ANG-2, and conventional hemostatic tests was sampled in 111 patients with various cancers at 4 consecutive visits: before first chemotherapy cycle, after 3 courses, at the sixth course, and 3 months after chemotherapy cessation. Patients were followed up until metastatic progression/death or the end of the study. MPTF did not change during chemotherapy, but increased significantly after treatment cessation. Total TF-Ag and ANG-2 decreased throughout active treatment. Significant drop of their levels was observed 3 months post therapy cessation. Progressive disease was significantly associated with higher pre-chemotherapy TF-Ag and fibrinogen. Elevated baseline levels of fibrinogen were associated with increased risk of shortened progression free survival. Cessation of chemotherapy is associated with significant change of hemostatic parameters. Pre-chemotherapy levels of TF-Ag and fibrinogen may be informative of disease state and prognosis.

Hemostasis assessment with standard coagulation tests and rotational thromboelastometry (ROTEM) during therapeutic plasma exchange treatment.

In therapeutic plasma exchange (TPE), large amounts of plasma with all components, including antibodies, albumin, coagulation factors and inhibitors, are removed and usually replaced with replacement fluid without coagulation factors. Hemostatic parameters should be closely monitored in patients at risk of bleeding or with large volume exchanges with a short recovery interval. In this prospective study, we compared standard coagulation parameters and the rotational thromboelastometry (ROTEM) point-of-care test to identify hemostatically severely compromised patients treated with TPE. 22 patients without recent or planned invasive procedures received 63 TPE treatments with regional citrate anticoagulation. One plasma volume was exchanged with replacement fluid containing albumin and electrolytes. Standard coagulation tests, fibrinogen concentration, and rotational thromboelastometry (ROTEM, including EXTEM test, INTEM test, and FIBTEM test) were performed before and after each TPE treatment. Fibrinogen concentration decreased significantly and international normalized ratio increased slightly after TPE. Activated partial thromboplastin time, EXTEM, INTEM, and FIBTEM clotting times as well as clot formation times were prolonged, and maximum clot firmness decreased after TPE procedures. No serious adverse events occurred during TPE treatment. Our study showed that ROTEM parameters changed significantly after TPE performed with replacement fluid without coagulation factors. Among all parameters, FIBTEM clotting time showed the highest percentual change after TPE. According to this data, the ROTEM point-of-care test may have a potential to guide TPE therapy, particularly in patients at high risk for bleeding.

Global hemostatic status in patients with acute‐on‐chronic liver failure and septics without underlying liver disease

Unlabelled Box AbstractBackgroundEven the sickest patients with chronic liver disease (CLD), such as those with acute‐on‐chronic liver failure (ACLF) remain in hemostatic balance due to a concomitant decline in pro‐ and antihemostatic factors. ObjectivesWe aimed to study whether the hemostatic status in ACLF is merely an exaggeration from the status in patients with compensated and acutely decompensated cirrhosis, or whether sepsis‐associated hemostatic changes contribute. MethodsWe performed extensive hemostatic profiling in 31 adult patients with ACLF, 20 patients with sepsis without underlying CLD, and 40 healthy controls. ResultsWe found similarly elevated plasma levels of the platelet adhesive protein von Willebrand factor (VWF) and decreased levels of the VWF‐regulating protease ADAMTS13 in both groups compared to healthy controls. In vivo markers of activation of coagulation (thrombin‐antithrombin III, D‐dimer) were similarly elevated in both groups compared to controls, but ex vivo thrombin‐generating capacity was similar between patients and controls, despite a much more profound international normalized ratio elevation in ACLF. Plasma fibrinogen levels were much higher in septics, which was accompanied by a decreased ex vivo clot permeability and an increase in ex vivo resistance to clot lysis. All hemostatic parameters were remarkably stable over the first 10 days after admission. ConclusionsWe have found hemostatic changes in ACLF to partially overlap with that of patients with sepsis, and evidence of preserved hemostatic capacity in both patient groups. The notable difference was a profound hyperfibrinogenemia, associated with a thrombogenic clot structure and a marked ex vivo resistance to fibrinolysis in patients with sepsis.

Состояние гемостаза у женщин с ожирением и метаболическим синдромом

To date, obesity is a global epidemic that resulted in increased morbidity and mortality, including those associated with thrombotic conditions. Metabolic syndrome (MS) is characterized by abdominal obesity, glucose metabolism disorders, hypertension, and dyslipidemia. Patients with MS have higher risks of thrombosis and cardiovascular events. Hemostatic disorders in women with obesity and MS are an important clinical issue. Hemostatic abnormalities in these patients (hypercoagulation, hypofibrinolysis, platelet dysfunctions) increase the risk of cardiovascular morbidity and mortality and venous thromboembolism (VTE). Combined oral contraceptives (COCs) increase VTE risk in women with obesity. During pregnancy and postnatal period, obesity is one of the most common causes of VTE. In postmenopause, obesity and MS, and COCs prescribed as menopausal hormone therapy require close attention in controlling hemostatic parameters. This paper reviews significant hemostatic abnormalities in obesity and MS and discusses the role of these conditions in developing hemostatic disorders and VTE in women of reproductive age and postmenopause. KEYWORDS: obesity, metabolic syndrome, hemostasis, combined oral contraceptives, pregnancy, postmenopause, venous thromboembolism. FOR CITATION: Kuzina I.A., Goncharova E.V., Martirosyan N.S. et al. Hemostasis in women with obesity and metabolic syndrome. Russian Medical Inquiry. 2021;5(9):598–604 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-598-604.

Specific parameters of the thromboelastographic profile of patients with COVID-19 in the intensive care unit

The objective : to study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosi s/p ulmonary embolism without COVI D -1 9. Subjects and methods. A singl e-c enter prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April - May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 201 2-2 014, and a group of healthy volunteers. Results . Evaluation of the hemostasis system in patients with thrombosis and patients with COVI D -1 9 demonstrates the same type of changes: MA , Angle, G indices increase according to thromboelastography results, as well as D-d imer and fibrinogen levels increase, while antithrombin III activity decreases. Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis.

Тромботические события при редких формах генетических тромбофилий

Цель исследования: изучить лабораторный фенотип редких мутаций Лейдена [FVL А(1961)A] и гена протромбина [FII А(20210)A] при их клинической реализации в виде тромбозов. Материалы и методы. Проведено многоцентровое проспективное наблюдательное исследование, включающее 80 носителей редких генетических форм тромбофилий: FVL А(1961)A (n = 31), FII А(20210)A (n = 10) и компаунд FII G(20210)A + FVL G(1691)A (n = 39). У всех пациентов исследована резистентность фактора Va к активированному протеину С (APC-R) по нормализованному отношению (НО) и уровень активности протромбина в плазме крови в состоянии физического здоровья и в случае эпизода тромботического события. Результаты. Определена ассоциативная связь развития тромботических событий со снижением НО при оценке APC-R как у гомозиготных носителей мутации Лейден (Ме = 0,35; 95% ДИ = 0,31–0,37 по НО), так и гетерозиготных компаундов (Ме = 0,43; 95% ДИ = 0,42–0,45 по НО). Заключение. Лабораторный мониторинг пациентов с редкими формами генетических тромбофилий позволяет выделить группу высокого тромбогенного риска, нуждающуюся в пролонгированной тромбопрофилактике. Objectives: to study the laboratory phenotype of rare Leiden mutation [FVL A(1961)A] and the prothrombin gene mutation [FII А(20210)A] implementating clinically as thrombosis. Patients / Methods. A multicenter prospective observational study included 80 carriers of rare genetic kinds of thrombophilia: FVL A(1961)A (n = 31), prothrombin FII А(20210)A (n = 10) and the compound FII G(20210)A + FVL G(1691)A (n = 39). All patients were tested for the factor Va resistance to activated protein C (APC-R), normalized ratio (NR), and the plasma prothrombin activity (%) in healthy conditions and in the case of thrombotic event. Results. An associative relation between the development of thrombotic events and a decrease in NR was determined when assessing APC-R, both in homozygous carriers of the Leiden mutation (Me = 0.35; 95% CI = 0.31–0.37 in NR) and heterozygous compounds (Me = 0.43; 95% СI = 0.42–0.45 in NR). Conclusions. Laboratory follow up for patients with rare kinds of genetic thrombophilias allows to identify a group at high thrombogenic risk requiring prolonged thromboprophylaxis.

Investigation of the Possible Effects of Injectable and Skin Patch Contraceptives on Selected Haemostatic and Haematologic Parameters in Women Attending Primary Healthcare Centre in Eleme, Rivers State

The was a case control and comparative study aimed at investigating the possible effects of injectable and skin patch contraceptives on selected haematologic and haemostatic parameters in women attending primary healthcare centre at Eleme, Rivers State The study population consists of seventy-five (75) apparently healthy, non-pregnant, non- smoking women, aged between 25 and 45years; (31 women on DEPO-PROVERA contraceptive, 14 women on Implanon, and 30 apparently healthy non-contraceptive users as control group). Fibrinogen, antithrombin, tissue plasminogen activator was analysed with reagents prepared by Elabscience, Wuhan, China, using an ELISA machine (STAT FAX-2100). Prothrombin time and activated partial thromboplastin time was done manually with reagents prepared by Quimica Clinica Aplicada S.A, Spain. Haematologic parameters were analysed using SYSMEX KX-21-N auto analyser. Graph-pad Prism 5.0 was used in analysing all data, p &lt; 0.05 was considered statistically significant. For haemostatic parameters, results showed that there was statistically significant increase in mean values of antithrombin (38.48 ± 17.48/ml versus 21.02 ± 15.54ng/ml, p=0.0011) and tissue plasminogen activator (1.34 ± 1.35ng/ml versus 0.28 ± 0.46ng/ml, p=0.0047) in women using the two types of contraceptive, while activated partial thromboplastin time (28.11± 2.37s versus 29.87 ± 2.77s, p=0.0205) was statistically decreased in women on the investigated contraceptives, other haemostatic parameters were not statistically significant. For haematological parameters, the results showed that there was statistically significant increase in mean values of packed cell volume 38.13 ± 2.28% versus 36.21 ± 3.07% (p=0.0126), haemoglobin 12.35 ± 0.79g/dL versus 11.56 ± 0.99g/dL (p=0.0028), white blood cells 6.17 ± 1.22 x109/L versus 5.26 ± 1.18 x109/L (p=0.0143) in women using injectable (DEPO-PROVERA) and skin patch (IMPLANON) contraceptive, other parameters showed no statistically significance. Based on duration of use of contraceptive, there was no statistically significant difference (p&gt;0.05) in women using skin patch; while for injectable, platelet count was high in those who had used it for more than a year. Comparing values obtained from using injectable and skin patch, there was no statistical significant difference in all the parameters. Using analysis of variance to compare values based on parity, there was no statistical significant difference. Conclusively, increase in antithrombin and tissue plasminogen activator, and a decrease in activated partial thromboplastin time in women using IMPLANON (skin patch) and DEPO-PROVERA (injectable) are the haemostatic changes that occurs while using contraceptives and these changes may likely predispose them to bleeding, therefore adequate monitoring of the blood haemostatic processes while taking these contraceptives is critical in order not to expose users to haemorrhage.

The haemostatic profile in critically ill COVID-19 patients receiving therapeutic anticoagulant therapy: An observational study.

Hypercoagulability and thrombosis remain a challenge in severe coronavirus disease 2019 (COVID-19) infections. Our aim is to investigate the hemostatic profile of critically ill COVID-19 patients on therapeutic anticoagulant treatment.Forty one patients were enrolled into the study. We recruited 11 consecutive, COVID-19, patients who received therapeutic anticoagulant treatment on intensive care unit (ICU) admission. Disease severity indexes, biochemical, hematological and haemostatic parameters, endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1) activity and extrinsically activated rotational thromboelastometry assay (EXTEM) were recorded on days 1, 3, 7. We also enrolled 9 ICU non-COVID-19, 21 non-ICU COVID-19 patients and 20 healthy blood donors as control populations.Critically ill COVID-19 patients demonstrated a more hypercoagulable and hypofibrinolytic profile related to those with COVID-19 mild illness, based on EXTEM amplitude at 10 min (A10), maximum clot firmness (MCF) and lysis index at 60 min (LI60) variables (p = 0.020, 0.046 and 0.001, respectively). Similarly, a more hypercoagulable state was detected in COVID-19 ICU patients related to non-COVID-19 ICU patients based on A10 and MCF parameters (p = 0.03 and 0.04, respectively). On the contrary, ETP and EXTEM (clotting time) CT values were similar between patients with severe and mild form of the COVID-19 infection, probably due to anticoagulant treatment given.Critically ill COVID-19 patients showed a hypercoagulable profile despite the therapeutic anticoagulant doses given. Due to the small sample size and the study design, the prognostic role of the hypercoagulability in this clinical setting remains unknown and further research is required in order to be assessed.

Гемостатические сдвиги у крыс при комбинированном гипер- и гипотермическом воздействии и их коррекция витаминами А, Е, В6, В

This study aimed to assess the state of haemostasis at supplementation of the diet with vitamins and the possibility of correcting changes in coagulation under combined thermal effects on the body of laboratory animals (white rats). The animals were kept on a nutritious diet with sufficient intake of proteins, fats, carbohydrates and trace elements. As part of daily servings in addition to the diet, the experimental group received vitamins A, E, B6, B9, B12 and P in therapeutic doses adequate to those recommended for humans; the control group did not receive vitamins. After 14 days, part of the animals from both groups were subjected to combined thermal stress. At all painful manipulations the animals were anesthetized with ethoxyethane. Blood samples were taken in a syringe from the jugular vein exposed by an ovalshaped incision immediately after stress exposure. For coagulation testing, blood was stabilized with a 3.8 % sodium citrate solution in a ratio of 1 to 9. Subsequent blood treatment met the requirements accepted for coagulation testing. The following haemostatic parameters were studied: platelet count, activated partial thromboplastin time, prothrombin time, thrombin time, antithrombin III activity, as well as content of fibrinogen and soluble fibrin monomer complexes. The obtained results showed that the combined thermal effect causes a significant acceleration of continuous blood coagulation (consumption thrombocytopenia, hypofibrinogenaemia and mismatch of clotting test parameters) in rats. Additional vitaminization restrains the severity of these changes, which is manifested in the absence of platelet consumption, a decrease in the consumption of plasma coagulation factors and the preservation of a high antithrombin potential.