Normal Coagulation Parameters Research Articles

AHP P06 Optimizing Coagulation Screen Practices in CVC Removal Amongst Surgical Patients: A Retrospective Audit Assessing Necessity, Compliance, and Implications

Abstract Background Conflicting findings in recent literature question the significance of traditional coagulation variables in predicting bleeding associated with central venous catheter (CVC) removal. This audit evaluates the necessity and compliance of conducting same-day coagulation screens at Churchill Hospital. The study assesses the practice's relevance, compliance rates, and associated costs, offering implications for clinical decision-making, resource utilization, and potential modifications to current practices. The findings may lead to the adoption of new predictive factors or a targeted approach to coagulation testing, optimizing patient care and resource allocation in CVC removals. Methods This retrospective audit focused on surgical patients in the upper gastrointestinal, hepatobiliary and pancreatic, lower gastrointestinal, and transplant surgery departments at the Churchill Hospital. The study encompassed all instances of central venous catheter (CVC) removal that occurred between January 1st, 2022, and December 31st, 2022. Data retrieval was conducted using electronic patient records, and coagulation test results were interpreted utilizing the reference ranges available in the electronic patient record system (INR 0.9-1.2, PT 9-12, APTT 20-30). Results 78 patients had an average age of 53 years and a mean hospital stay of 35 days. The average duration of CVC in-situ was 8.9 days. Patients underwent an average of 5.07 coagulation tests per stay, equivalent to 0.28 tests per admission day. Among the audited patients (n=67), 41.8% had same-day coagulation screens, 17.9% had the screen one day prior to CVC removal, and 40.3% had the screen more than one day before removal. Analysis showed that 88% had normal INR values, with only eight patients having abnormal values. Furthermore, 74.6% and 58.2% had normal PT and APTT values, respectively. Conclusions This retrospective audit of CVC removals in surgical patients at Churchill Hospital revealed a concerning in-compliance rate of 44% with coagulation screens during CVC removals. Most patients had normal coagulation parameters, questioning the need for same-day screens. Delays and high costs (£64.76 per patient, £12.95 per screen) were incurred. Individualized risk-based approach, considering bleeding history, could be more efficient. Implementing targeted coagulation testing saves costs and optimizes resource utilization. Further evaluation required to improve patient care and resource allocation in CVC removals, reducing reliance on routine same-day screens.

Percutaneous Transcatheter Retrieval of Central Venous Port Fragments in Pediatric Patients; A Single-center Experience From the Pediatric Cardiology Department.

Split/fracture and embolization of central venous/shunt catheters are rare but serious complications in children. Percutaneous retrieval of intravascular foreign bodies is an important minimal invasive treatment. This study is aimed to represent our largest pediatric sample experience till now of 17 years from a single institution. Another aim is to compare the results regarding the removal or leaving in place of embolized or ruptured intravascular or cardiac venous catheter parts in children. A total of 26 cases were included in this study. Any pediatric patient with normal coagulation parameters and a fractured catheter fragment was included in this study. Other intravascular foreign bodies related to interventional devices and/or pacemaker/implantable cardiac defibrillator leads were excluded from this study. Twenty-six patients, of whom 25 had oncologic diseases and 1 had a ventriculoatrial shunt, were included. The median age was 83.5 months (between 20 mo and 18 y) at treatment.Superior vena cava (9 cases), followed by the right atrium (5 cases), were the most two common sites of embolization for cardiovascular foreign bodies. The success rate of percutaneous retrieval was 92.3% in all patients. There were neither complications nor deaths. The retrieval technique revealed a predisposition for extraction through the femoral vein (96.1%) and using snare techniques (100%). Additional catheters like pigtail, National Institutes of Health, or ablation catheters were used for stabilization in selective cases in which the permanent central venous fragments stuck to the vessels. A tractional maneuver and capturing the ruptured material in the middle were other trick points for successful retrieval. Patients were asymptomatic in 76.9% of cases (20/26). Percutaneous retrieval of cardiovascular foreign bodies is a reasonable, safe, and effective way in children when the catheter fragments are free and mobile. It should be considered the preferred treatment option instead of surgery. In patients where catheter fragments are stuck and are adherent to vessels, it could be left, and followed up by anticoagulation. Novel techniques accompanied by an experienced team could be helpful in difficult cases.

Epistaxis associated with Angiostrongylus vasorum infection in a dog

AbstractA 9‐month‐old, female, entire border collie was presented as an emergency for unilateral epistaxis, rapidly evolving to bilateral, and lethargy of sudden onset. A moderate broncho‐interstitial pattern was present on thoracic radiographs, particularly in the caudo‐dorsal lung lobes. Haematology and coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen) were within normal range. Multiple larvae (L1) of Angiostrongylus vasorum were identified both on flotation (Ovassay technique) and sedimentation (McKenna technique). The dog was treated with fenbendazole (50 mg/kg) for 15 days. On re‐examination, 4 days after completion of treatment, faecal analysis was negative and thoracic radiographs were improved. This case reports epistaxis as the main clinical finding in a young dog infested with A. vasorum, in the southwest of France, where this parasite is endemic. If bleeding diatheses are increasingly reported in angiostrongylosis, epistaxis is an unusual presentation, especially as the sole clinical sign of bleeding, in a dog with normal coagulation parameters.

Correlation between asparaginase enzyme activity levels and coagulation parameters during childhood acute lymphoblastic leukemia treatment.

Thromboembolism is a serious toxicity in the treatment of acute lymphoblastic leukemia (ALL), but little is known about the correlation between asparaginase enzyme activity (ASA) levels and coagulation parameters. We included 65 non-high risk ALL patients, aged 1-17years. Coagulation parameters and corresponding ASA levels were measured during asparaginase treatment. We found ASA to be negatively correlated with antithrombin and fibrinogen up to ASA levels of 250IU/L, after which these parameters reached a plateau and did not decrease further with further increase of ASA. Patients with silent inactivation of asparaginase had normal coagulation parameters.

Is COVID-19 Infection also a Silent Killer?

A 59-year-old male had multiple comorbidities such as diabetes, dilated cardiomyopathy, hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. He presented with dyspnea and had ground-glass opacity in the lungs. It was during the pandemic of COVID-19 so repeated Reverse transcription polymerase chain reaction (RT-PCR) was done, but all were negative. He got stabilized within 5 days and we planned discharge. Suddenly, he had right hemiplegia and developed altered sensorium. He had NIH Stroke Scale/Score of 28 and computed tomography-Alberta Stroke Program Early Computed Tomography Score of 10. We used tenecteplase (0.25 mg/kg bodyweight) for thrombolysis within 20 min of onset and planned mechanical thrombectomy for the occlusion of internal carotid artery and beyond. However, in magnetic resonance imaging of the brain, he had an established infarct in the left middle cerebral artery (MCA) territory (within this short time) without significant DWI/FLAIR mismatch. Hence, we continued conservative management. We incidentally detected him to have COVID-19 infection positivity on that day, but all inflammatory and coagulation parameters were normal on that day and later. His monitor did not reveal arrhythmia (during the event and later) and echocardiography failed to reveal evidence of culprit lesion. He had a rapid clinical decline, required hemicraniectomy but expired within 2 days. COVID-19 infection may have negative reports initially, but malignant MCA infarct with normal inflammatory markers makes our case special. The rapidity with which stroke developed underscores the severe nature of the disease process, the absence of arrhythmias (in this in-house stroke), and normal coagulation parameters hints that the exact mechanism of stroke in this type of infection is still an enigma.

Effect of Fresh Frozen Plasma Transfusion Inpatients with Coagulation Abnormalities

Aim: To study the efficacy of Fresh Frozen Plasma (FFP) transfusion practice in patients with coagulation abnormalities varies in clinical practice.
 Study Design: A retrospective study.
 Place and Duration of Study: This study was conducted in Department of Transfusion Medicine, SMCH, Chennai, between the period of 2019-2020.
 Methodology: The medical records of each patient receiving FFP transfusions that occurred in patients with coagulation abnormalities were reviewed and the data were collected based on pre-and post transfusion PT (>12 sec), APTT (>70sec) and INR (>1.5) and then analysed statistically. Patients with normal coagulation parameters were excluded from study.
 Results: A total of 1259 units of fresh frozen plasma were transfused to 315 patients between the year 2019-2020. Of the 1259 units transfused 1133 units where transfused to 283 patients with coagulation abnormalities. Apparently 32 patients were excluded from the study as they had normal coagulation profile. Among 251 patients, 37 patients PT were greater than 12 seconds before FFP transfusion out of which the PT was corrected for 14 patients (37.8%) after FFP transfusion. In 228 patients APTT was greater than 70 seconds before FFP transfusion, out of which APTT was corrected in 18 patients (8%) after transfusion. INR values for all 251 patients were greater than1.5 before FFP transfusion, out of which INR was corrected in 84 patients (29%) after transfusion.
 Conclusion: We conclude that FFP transfusions in patients with coagulation abnormalities maycorrects the defect only in less percentage of patient population, as in our study it corrects only an average of 31% of patient population.

Ascorbic Acid to Prevent Postpolypectomy Bleeding in the Colon: A Randomized Controlled Trial.

It has been reported that vitamin C replacement can quickly reverse nonspecific bleeding in surgical patients with normal coagulation parameters. We evaluated the effect of intravenous ascorbic acid administration for prevention of postpolypectomy bleeding in large polyps of the colon. Patients with large polyps with heads larger than 10 mm, stalk diameter larger than 5 mm, and a length larger than 10 mm were included in this randomized controlled clinical trial. In the study group, the first 500 mg intravenous dose of vitamin C diluted in normal saline was administered 2h before colonoscopic resection of polyps and the second and third similar doses were administered on days 2 and 3 of polypectomy, respectively. The control group received normal saline in a similar fashion. The resection of polyps was performed in snare and cut-blend mode. Early and late postoperative bleeding were compared between the two groups. A total of 153 polyps were resected by endoscopic polypectomy. Early bleeding was observed in 7.2% of the patients, which was significantly lower in the vitamin C group (2.6% vs 11.8%, P =0.03). Late bleeding was observed in 6.5% of the patients with a trend lower in the vitamin C group (2.6% vs 10.5%, P =0.057). The proportion of postprocedural bleeding was significantly higher in the vitamin C group (5% vs 20%, P =0.007). Hazard ratios of early and postprocedural bleeding were 78% and 76% lower in the vitamin C group compared to the control group (P <0.05). Intravenous ascorbic acid infusion could reduce postpolypectomy bleeding.

Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization.

To determine long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring transarterial embolization compared to patients who underwent uncomplicated renal cryoablation without major hemorrhage. Utilizing a matched cohort study design, retrospective review identified 23 patients who underwent percutaneous image-guided renal cryoablation complicated by major hemorrhage requiring ipsilateral transarterial embolization (TAE group) and a control group of 23 patients who underwent uncomplicated renal cryoablation matched 1:1 by age, gender and RENAL Nephrometry score at a single institution from 1/1/2005 to 12/31/2019. Primary outcome parameters included change in creatinine (mg/dl) and estimated glomerular filtration rate (ml/min/1.73 m2; eGFR) from baseline and were compared between TAE and control group using a paired t-test. There was a significantly higher proportion of patients on pre-ablation anticoagulation in the TAE v. control group (30% v. 4%; p = 0.047), but all patients were off anticoagulation and with normal coagulation parameters at the time of cryoablation. Otherwise there were no significant differences in clinical, renal tumor, Charlson co-morbidity index, baseline renal function or cryoablation parameters between the TAE and control group. In the post-ablation period, there was trend toward greater increase in creatinine from baseline to worst post-ablation creatinine in the TAE v. the control group (+ 0.5 ± 0.7mg/dl v. 0.2 ± 0.1mg/dl; p = 0.056). However, at a mean follow-up of 42.7 ± 35.7months, there was no significant difference between the TAE and control group in creatinine (p = 0.68), eGFR (p = 0.60) or change from baseline in creatinine (p = 0.28), eGFR (p = 0.80) or CKD stage (p = 0.74). No patient required initiation of hemodialysis. Selective transarterial embolization for post-renal cryoablation hemorrhage does not significantly affect long-term renal function compared to cryoablation alone. Pre-ablation anticoagulation despite normal coagulation at time of ablation may be a risk factor for post-ablation hemorrhage, and warrants further evaluation when considering pre-ablation embolization.

Successful treatment of thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26.COV2.S vaccination

Successful treatment of thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26.COV2.S vaccination

Effects of the ketogenic diet on platelet counts and global coagulation tests in childhood epilepsy

PurposeSeveral antiseizure drugs (ASD), especially Valproic acid (VPA), influence platelet counts and coagulation parameters. The ketogenic diet (KD), established in drug-resistant epilepsy, is combined with ASDs. Bruising and prolonged bleeding times during KD have been described, but whether hemostatic changes result from the KD or from concomitant ASDs, remains unclear. Aim of the present study was to evaluate bleeding, platelet counts and global coagulation tests prior to and during KD in childhood epilepsy. MethodConsecutive children treated with KD were systematically observed for bleeding. Serial measurements of platelet counts and global coagulation tests (APTT, PT and fibrinogen) were obtained at baseline and during KD (at 1, 3, 6 and 12 months). Children with KD monotherapy, concomitant VPA, or other ASDs were compared. ResultsAmong 162 children receiving KD, we observed neither bleeding in daily life nor perioperative bleeding in those undergoing surgery (n = 25). Most children had normal platelet counts and coagulation parameters. Only a few had transient mild thrombocytopenia and mildly prolonged APTT values, not indicative of a bleeding risk. Even KD combined with VPA did not cause relevant coagulopathy. Unexpectedly, we found mild thrombocytosis in 24 % of patients prior to KD, which was most pronounced in yet untreated epilepsy. Thrombocytosis steadily resolved during KD. ConclusionsDuring KD treatment of childhood epilepsy, we observed neither bleeding symptoms nor laboratory results indicating a bleeding risk. Unexpectedly, mild thrombocytosis was present in 24 % at baseline, normalising during KD. Thrombocytosis may reflect the underlying inflammatory process of untreated epilepsy and requires further study.

Maxillary Sinusitis of Odontogenic Origin in Relation to Ectopic 2.8 Associated with Follicular Dentigerous Cyst – Combined Transnasal and Oral Endoscopic Approach: A Case Report

Purpose: To describe the management of orosinusal pathology by combined transnasal and oral endoscopy. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. In the ENT evaluation by videorhinoscopy with rigid optics, complex deviation of the nasal septum was revealed, without any evident formation or pathological secretion. On inspection of the oral cavity, the mucous membranes appeared unscathed. The previously extracted aleveolus of 1.6 was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that had a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostiomeatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat fat pad and closure by first intention. In the same session, the ENT moment is carried out transnasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and then six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: Based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with mycotic and actinomycotic superinfection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and resolve the pathology without recurrence.

Idarucizumab for dabigatran reversal in daily clinical practice

Real-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited. To evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia. We analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use. Idarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were: emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min, and one patient with persistent bleeding required retreatment with idarucizumab. Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.

Maxillary sinusitis of odontogenic origin in relation to ectopic 2.8 associated with follicular dentigerous cyst: Combined transnasal and oral endoscopic approach, a case report

Purpose of the study: To describe the management of orosinusal pathology by combined transnasal endoscopy and oral combined. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. To the ENT evaluation in videorinoscopy with rigid optics, complex deviation of the nasal septum was relevated with not any evident formations or pathological secretions. While on inspection of the oral cavity the mucous membranes appeared unscathed. Alveolus of 1.6 previosuly extracted was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that has a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostio-meatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat adipose bolla and closure by first intention. In the same session, the ENT moment is carried out trans nasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with therefore mycotic and actinomycotic super infection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and to resolve the pathology without any sign of recurrence.

Retrospective analysis of maternal, fetal, and neonatal outcomesof intrahepatic cholestasis of pregnancy at Gazi University.

Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period. After ethics committee approval, data from 1 January to 31 December 2015 were collected to identify parturients with ICP. Ten out of 37 patients underwent normal spontaneous vaginal delivery (NSVD), and the remaining 27 parturients underwent cesarean section (CS). Five of 27 parturients underwent nonelective cesarean section, while 22 had elective cesarean delivery. As for NSVD deliveries, only one parturient received combined spinal and epidural anesthesia (CSE) for labor. Neuraxial (n = 22 for spinal and n = 1 for CSE) and general anesthesia (n = 4) rates for CSs were 85% and 15%, respectively. Approximately 96% of neuraxial anesthesia choices were spinal anesthesia. Nearly 18.5% of CSs were not elective. Adverse outcomes included 2 preterm births, 2 preterm labors, 2 newborns with hepatitis, and one perinatal fetal death. Parturients with ICP who had normal coagulation parameters despite increased liver enzymes preoperatively underwent cesarean delivery under spinal anesthesia without complication. Although maternal outcomes were generally positive, adverse fetal and neonatal outcomes are more likely to occur, particularly in cases with severe ICP.

Liver function abnormalities in falciparum malaria

Background: Malaria still continues to be a major killer of mankind especially in developing countries. Almost all deaths and severe disease are due to Plasmodium falciparum . It is observed that the patients of falciparum malaria with liver function abnormalities are more vulnerable to the development of complications like cerebral malaria, anemia, renal failure, acute respiratory distress syndrome, etc. Methods: 50 cases of Plasmodium falciparum malaria diagnosed by peripheral smear examination or by immuno-chromatographic test - falci check, pan malaria or by rapid optimal test were included in the study. All these patients were subjected to blood investigations like hemoglobin level, total leukocyte count, differential count, renal function tests, liver function tests and random blood sugar. Results: Serum bilirubin level was raised in 66% of cases with 28% of cases showing levels above 3.0g/dL. Patients with clinical jaundice showed mean 2-3 fold raise in AST levels along with ALT levels. 64% of cases had normal ALK levels. Serum proteins found to be normal in 92% of cases. Conclusions: Deranged liver functions are commonly seen as a complication of severe malarial infection. Presence of raised hepatic enzymes with near normal coagulation parameters, in presence of documented malarial infection should suggest presence of malarial hepatopathy.

Current status and future prospects for platelet function testing in the diagnosis of inherited bleeding disorders.

Platelets play a crucial role in haemostasis by preventing bleeding at the site of vascular injury. Several defects in platelet morphology and function have been identified and described over the years. Although a range of methodologies is available to assess platelet function, a significant proportion of subjects with bleeding symptoms and normal coagulation parameters still appear to have normal results on platelet function testing. This might suggest that the reason for bleeding is multifactorial and is due to a combination of several minor defects in platelet function and/or other parts of the haemostatic system or might indicate that the currently available platelet function tests do not provide optimal diagnostic power. This review will summarize the established platelet function tests used for diagnosing inherited platelet abnormalities in adults and children, and discuss the newly developed methodologies as well as unmet challenges and potential areas for further improvement in this field.

Diclofenac Related Spontaneous Extensive Ecchymosis and Hematoma despite Normal Coagulation Parameters

Diclofenac is a member of nonsteroidal anti- inflammatory drugs. In Turkey, it is often used as a analgesic. Diclofenac may very occasionally lead to spontaneous extensive ecchymosis and hematoma despite a normal coagulation parameters. In this paper, we report one patient who presented with spontaneous extensive ecchymosis and was diagnosed with a hematoma in the anterior chest wall associated with diclofenac use despite normal coagulation parameters. In countries like Turkey where NSAID are used extensively, drug history should be questioned in patients presenting with spontaneous bleeding and have normal coagulation parameters by physicians.

Coagulation parameters in dogs with heat stroke – A short study

The present study was performed to detect the usefulness of coagulation parameters that helps in the diagnosing the severity of changes associated with heat stroke. Twenty five previously healthy dogs with the history of epistaxis, hyperthermia and dyspnea after exposure to high environmental temperature were selected and subjected to detailed clinical examination, physical examination, laboratory tests and coagulation analysis. Bilateral epistaxis, hyperthermia and respiratory distress were the common clinical signs recorded. Prothrombin time and activated partial thromboplastin time were significantly increased in affected dogs than normal. Dogs with normal coagulation parameters responded to the treatment.

Therapeutic Plasma Concentrations of Epsilon Aminocaproic Acid and Tranexamic Acid in Horses

Antifibrinolytic drugs such as epsilon aminocaproic acid (EACA) and tranexamic acid (TEA) are used to treat various bleeding disorders in horses. Although horses are hypofibrinolytic compared to humans, dosing schemes have been derived from pharmacokinetic studies targeting plasma concentrations in humans. We hypothesized therapeutic plasma concentrations of antifibrinolytic drugs in horses would be significantly lower than in humans. Our objective was to use thromboleastography (TEG) and an in vitro model of hyperfibrinolysis to predict therapeutic concentrations of EACA and TEA in horses and humans. Citrated plasma collected from 24 random source clinically healthy research horses. Commercial pooled human citrated plasma with normal coagulation parameters was purchased. Minimum tissue plasminogen activator (tPA) concentration to induce complete fibrinolysis within 10 minutes was determined using serial dilutions of tPA in equine plasma. Results used to create an in vitro hyperfibrinolysis model with equine and human citrated plasma, and the minimum concentrations of EACA and TEA required to completely inhibit fibrinolysis for 30 minutes (estimated therapeutic concentrations) determined using serial dilutions of the drugs. Estimated therapeutic concentrations of EACA and TEA were significantly lower in horses (5.82; 95% CI 3.77-7.86 μg/mL and 0.512; 95% CI 0.277-0.748 μg/mL) than in humans (113.2; 95% CI 95.8-130.6 μg/mL and 11.4; 95% CI 8.62-14.1 μg/mL). Current dosing schemes for EACA and TEA in horses may be as much as 20× higher than necessary, potentially increasing cost of treatment and risk of adverse effects.

The Impact of Eltrombopag Administration on the Clinical Course of Severe Refractory Fatal Acquired Aplastic Anemia

The Impact of Eltrombopag Administration on the Clinical Course of Severe Refractory Fatal Acquired Aplastic Anemia