Prothrombin Time Values Research Articles

Can routine biochemical tests be a short-term prognostic biomarker in patients operated for chronic subdural hematoma?

Objectives: The effect of routine blood biochemistry parameters on the short-term prognosis of patients with chronic subdural hematoma (CSDH) has not been evaluated in literature before. In this study, it was aimed to establish markers for determination of short-term prognosis using data of patients who were operated for CSDH. Methods: During admission to hospital, data of patients including age, sex, antiaggregan and/or anticoagulant drugs usage, comorbidity, Glasgow Coma Scale (GCS) and Glasgow Outcome Scale scores were evaluated. Location and thickness of CSDH were recorded using brain CT or MR images. Blood leukocyte, neutrophil, lymphocyte, eosinophil, basophil, platelet count results, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio results, activated prothrombin time and INR values, serum glucose, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, sodium, potassium, blood urea nitrogen and creatinine level values were also recorded. Patients were divided into two groups according to CSDH located “unilaterally (n=19)” and “bilaterally (n=12)”. In addition, patients with unilateral CSDH were divided into two groups as CSDH located at the "right hemisphere (n=6)” and "left hemisphere (n=13)". Results: It was concluded that short-term prognosis of patients with unilateral or bilateral CSDH was similar. Correlation analysis showed no correlation between short-term prognosis and demographic, clinical and laboratory findings. However, Likelihood Ratio test revealed that GCS score could be a biomarker in order to predict short-term prognosis of these patients, albeit weak (X2=6.138, p=0.046). Conclusion: It was thought that GCS scores could be effective in predicting short-term prognosis in patients with CSDH but routine biochemistry laboratory parameters could not predict short-term prognosis of these patients.

Issues to be considered to address the future liver remnant prior to major hepatectomy

An accurate preoperative evaluation of the hepatic function and application of portal vein embolization in selected patients have helped improve the safety of major hepatectomy. In planning major hepatectomy, however, several issues remain to be addressed. The first is which cut-off values for serum total bilirubin level and prothrombin time should be used to define post-hepatectomy liver failure. Other issues include what minimum future liver remnant (FLR) volume is required; whether the total liver volume measured using computed tomography or the standard liver volume calculated based on the body surface area should be used to assess the adequacy of the FLR volume; whether there is a discrepancy between the FLR volume and function during the recovery period after portal vein embolization or hepatectomy; and how best the function of a specific FLR can be assessed. Various studies concerning these issues have been reported with controversial results. We should also be aware that different strategies and management are required for different types of liver damage, such as cirrhosis in hepatocellular carcinoma, cholangitis in biliary tract cancer, and chemotherapy-induced hepatic injury.

Different Coagulation Indicators in Predicting Clinical Outcomes for Patients With Direct Oral Anticoagulants: A Systematic Review and Meta-analysis

PurposeThere are many anticoagulant test indexes available for direct oral anticoagulants (DOACs), but how to select the appropriate index and the index cutoff values are still controversial. This is the first study, to our knowledge, to assess the association of different coagulation indicators with clinical outcomes among DOACs using a meta-analysis of observational studies. MethodsA medical literature search was conducted using PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Library from inception to February 2020. Studies that reported relationships between coagulation indexes and clinical outcomes or the diagnostic value of coagulation assays were included in the analysis. FindingsA total of 17 articles (7 meta-analyses and 10 systematic reviews) from 8904 citations were included in the analysis. In the analysis of bleeding events with coagulation indexes for DOACs, for peak prothrombin time level (cutoff value of 19–25 s), the pooled results found a sensitivity of 0.61 (95% CI, 0.44–0.75) and a specificity of 0.71 (95% CI, 0.49–0.86). For rivaroxaban, the trough anti–factor Xa concentration (AXA-C) (cutoff value of 400–500 ng/mL) had a sensitivity of 0.53 (95% CI, 0.16–0.87) and a specificity of 0.87 (95% CI, 0.71–0.94), with a diagnostic odds ratio of 7 (95% CI, 2–32). For apixaban, trough AXA-C had a sensitivity of 0.85 (95% CI, 0.60–0.96) and a specificity of 0.83 (95% CI, 0.52–0.95). The AUC of the AXA-C peak was higher than that of the trough AXA-C for apixaban, with a higher sensitivity and specificity. Compared with trough concentration of anti–factor IIa for dabigatran, the peak concentration had a higher specificity (98%) at the cutoff value of 484 ng/mL. In the analysis of thromboembolic events with coagulation indexes for DOACs, peak and trough prothrombin time values were not typically correlated with subsequent symptomatic venous thromboembolism, without a sensitivity or specificity higher than 90%. Trough AXA-C had a sensitivity of 100% and but a low specificity (<50%) for rivaroxaban-apixaban. Trough AXA-C had a sensitivity of 100% and a specificity of 32% with a cutoff value of 108 ng/mL for dabigatran. ImplicationPeak prothrombin time (19–25 s) and AXA-C had a better predictive value on bleeding outcomes for rivaroxaban and apixaban, whereas peak concentration of anti–factor IIa activity can be an indicator for dabigatran. Coagulation indexes might not be a good indicator of thromboembolic events of DOACs. Because the limited studies focused on association of coagulation indicators and clinical outcomes, more studies are needed to verify this in the future.

Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions.

Background: Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters. Methods: Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated. Results: Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: −0.74; 95%CI: −1.01, −0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: −0.60, 95%CI: −0.82, −0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen. Conclusions: Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.

T2 Values for Diagnosing Acute-on-Chronic Liver Failure in Hepatitis B Patients.

The aim of this study was to investigate the value of hepatic T2 imaging for the evaluation of chronic hepatitis-B-related acute-on-chronic liver failure (HBV-ACLF). Three groups of patients underwent liver MRI utilising m-GRASE sequence (multi-echo gradient and spin echo): HBV-ACLF patients (n = 28), chronic hepatitis B patients (n = 11), and healthy control patients (n = 14). A T2 image was produced using post-processing software, and the mean T2 (relaxation time) value was calculated. Blood biochemical indices for the HBV-ACLF and Chronic Hepatitis B were obtained within 2 days pre- or post-MR scanning. The patients' T2 values, and the correlation between their biochemical indices and T2 values were analysed. A receiver operating characteristic curve was employed to evaluate the efficiency of utilising T2 values in the diagnosis of HBV-ACLF. There were significant variations in the T2 values (χ2 = 19.074, P < 0.001) among the 3 groups. The AUC of T2 values for diagnosing HBV-ACLF was 0.86 (P < 0.001), with a cut-off value of 57.73 ms. A moderately positive correlation was observed between the T2 value and the international normalised ratio, prothrombin time, and hyaluronic acid values (rs = 0.65, P < 0.001; rs = 0.67, P < 0.001; rs = 0.39, P = 0.025). A moderately negative correlation was observed between the T2 value and the prothrombin activity, albumin, and prealbumin values (rs = -0.67, P < 0.001; rs = -0.48, P = 0.004; rs = -0.37, P = 0.030). T2 values could accurately reflect liver function state, as they correlated well with certain biochemical indices, illustrating good diagnostic efficiency for diagnosing HBV-ACLF.

Valores de referência de tempo de protrombina e tempo de tromboplastina parcial ativada para felinos domésticos (Felis catus) com kit reagente humano

Os exames de avaliação da coagulação sanguínea são utilizados para verificar a hemostasia em todas as suas fases e investigar a presença de doenças hemostáticas em pequenos animais. Diante da escassez e do alto valor aquisitivo de reagentes específicos para a avaliação da hemostasia em felinos, os reagentes humanos são utilizados em grande parte dos laboratórios clínicos veterinários, o que compromete a sensibilidade dos resultados. O presente trabalho teve como objetivo determinar valores de referência para o tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa) para felinos domésticos (Felis catus), utilizando reagentes da marca Wiener Lab, padronizados para humanos. Amostras de sangue de 50 felinos adultos clinicamente sadios foram utilizadas. Os resultados obtidos foram de 3,9 ± 1,52 segundos para o TP, com valores mínimo e máximo de 3,52 e 4,34; e de 27,94 ± 1,77 segundos para TTPa, com valores mínimo e máximo de 27,50 e 28,48, respectivamente. Concluiu-se, que os valores obtidos neste experimento podem ser utilizados como referência para felinos, em testes manuais com kit humano da marca Wiener Lab.

Mortality rate and prognostic factors for dogs with severe anaphylaxis: 67 cases (2016–2018)

To determine mortality rates for dogs with severe anaphylaxis and identify potential prognostic factors. 67 dogs with suspected anaphylaxis graded as severe. Dogs were classified on the basis of outcome as survivors and nonsurvivors. Medical records were reviewed, and data were extracted including signalment, examination findings, time to hospital admission from onset of clinical signs, CBC results, serum biochemical analysis results, coagulation testing results, and findings on abdominal ultrasonography. Initial treatment within the first 6 hours after hospital admission was recorded for analysis, specifically including the use of epinephrine, diphenhydramine, corticosteroids, antimicrobials, fresh-frozen plasma, and supplemental dextrose. The overall mortality rate was 14.9% (10/67) for dogs with anaphylaxis graded as severe. Serum phosphorus concentration and prothrombin time (PT) were significantly higher in nonsurvivors, compared with survivors. Nonsurvivors had lower presenting body temperatures than survivors. Serum phosphorus concentration ≥ 12.0 mmol/L, hypoglycemia within 6 hours after hospital admission, high PT value, concurrently high PT and partial thromboplastin time (PTT) values > 50% above the reference range limit, and the need for supplemental dextrose were associated with death. The incidences of coagulopathy and peritoneal effusion were unexpectedly high (85.2% and 65.5% of dogs, respectively) but were not indicative of survival. Despite the poor presenting clinical condition seen in dogs with severe anaphylaxis, the rate of survival with treatment was fairly high. Coagulopathy and the presence of peritoneal effusion were common findings in dogs with severe anaphylaxis. Serum phosphorus concentration ≥ 12.0 mmol/L, high PT value, concurrent increases of PT and PTT values > 50% above reference range limits, hypoglycemia within 6 hours after hospital admission, and the need for supplemental dextrose were associated with death.

Risk factors of acute kidney injury induced by multiple wasp stings

In Asia, acute kidney injury (AKI) induced by wasp stings is common; however, the pathophysiological mechanisms involved remain unclear. To evaluate the mechanisms associated with AKI induced by wasp stings, we conducted a retrospective cohort study that assessed blood and urinary samples from 112 patients with hospital admissions resulting from wasp stings. These samples were divided into those with AKI and without AKI as described in the Kidney Disease Improving Global Outcomes (KDIGO) database. Of the patients, 48.2% presented with an elevated number of leukocytes (median 19.9 vs. 15.8 × 109/L), serum creatinine (median 122.0 vs. 66.0 μmol/L), alanine aminotransferase (ALT) (median 176 vs. 32 U/L), aspartate aminotransferase (AST) (median 402 vs. 37 U/L), lactate dehydrogenase (LDH) (median 3076.0 vs. 300.0 U/L), creatine kinase (CK) (median 9990.0 vs. 261.0 U/L), creatine kinase myocardial band (CK-mb) (median 200.0 vs. 29.5 U/L), activated partial thromboplastin time (APTT) (median 70.0 vs. 42.5s), prothrombin time (PT) (median 15.0 vs. 12.5s), myoglobin (median 2200.0 vs. 78.0 ng/mL), proteinuria (51.9% vs. 17.2% ≥ 1+), and urinary monocyte chemotactic protein-1 (MCP-1) (median 432.0 vs. 177.0 pg/mL), and subsequently developed AKI. As determined by multivariate logistic regression analysis, elevated leukocytes (>10 × 109/L) [OR 1.12 (95% CI 1.02–1.23)], high myoglobin (>1200 ng/mL) [OR 18.51 (95% CI 1.51–132.27)], and high urinary MCP-1 (>200 pg/mL) [OR 5.42 (95% CI 1.27–30.39)] on admission were independent risk factors for AKI. At admission, baseline values for ALT, aspartate aminotransferase (AST), LDH, CK-mb, APTT, PT, and proteinuria were higher for those who later died as well as for those who developed end-stage renal disease (ESRD). No patients without AKI died or developed ESRD. The present study explored the pathophysiology of AKI induced by wasp stings based on the findings of risk factors as well as factors related to outcomes. An understanding of AKI induced by wasp stings allows better treatment options and clinical management for wasp stings patients.

Valores de referência de tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e fibrinogênio em cães hígidos da raça beagle

Background: Hemostasis is a process of blood coagulation with the function of preventing hemorrhagic processes in the organism. The Coagulation Time (CT), Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen, Thrombin Time (TT), Increased Fibrin Degradation Products (IFDP) and D-Dimers are laboratory tests that can be used to evaluate the coagulation cascade. Objectives: The present study aimed to determine the reference values of PT, APTT and Fibrinogen by semi-automatic methodology with laboratorial kits. Methods: Blood samples were collected from 22 healthy beagle dogs and immediately centrifuged and citrated plasma stored at -20oC for posterior analysis. PT, APTT and fibrinogen were measured using commercial kits in a semi-automatic coagulometer by the viscosity detection system. Results: Mean values obtained were 6.0 ± 7.3 seconds for PT, 8.4 ± 16.9 seconds for APTT, and 10.2 ± 26.4 seconds for Fibrinogen. Conclusion: It is concluded that the values obtained in this work can be used as reference for healthy Beagles.

Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study.

Cervical spine blunt trauma patients with the presence of a cerebrovascular injury may be given initiation of heparin anticoagulation treatment prior to necessary surgical stabilization. Literature regarding the safety and efficacy of these procedures while a patient is on active anticoagulation is limited, requiring further investigation. The primary research question for this study is: Can cervical spine decompression and fusion in the context of a blunt cerebrovascular injury and anticoagulation therapy be completed safely? To accomplish this a comparison of outcomes and perioperative complications was made to a control group. A total of 63 trauma patients requiring cervical spine decompression and fusion from 2013 to 2015 were identified at our North American level 1 trauma center. Evaluation of patient injury data, bleeding events, postoperative infections, and neurologic outcomes was collected from chart review. The American Spinal Injury Association (ASIA) grading system was used to measure change in postoperative neurologic outcomes. Of 63 patients, 14 had a concomitant cerebrovascular injury that required perioperative anticoagulation treatment. In the 14 patients receiving anticoagulation, 11 had anterior and 3 had posterior stabilization. A total of 2 patients experienced a complication (pneumonia and hardware failure), but neither was related to anticoagulation. An elevated prothrombin time value was noted postoperatively in 1 patient, but with no adverse outcome. No bleeding or thrombotic events, surgical site infection, or neurologic deterioration occurred. The difference in postoperative ASIA grades between groups was not significantly different (P = .57). The operative cohort receiving anticoagulation therapy did not demonstrate an increase affinity for perioperative complications or a decline in ASIA scores postoperatively when compared to a control cohort. Patients with a cerebrovascular injury receiving anticoagulation treatment can undergo safe and successful cervical spine stabilization procedures. Therapeutic level III.

Alteration of hemostatic and hemorheological parameters in Nigerian patients with type 2 diabetes mellitus: Does age play a role?

Background: Diabetes mellitus has been associated with coagulation abnormalities characterized by decreased levels of antithrombin, protein C, increased concentrations of fibrinogen and von Willebrand factor, and alteration of hemorheological indices, which have been linked to the increased hyperviscosity state. The aim of this study was to determine the effect of age on hemostatic and hemorheological parameters in patients with type 2 diabetes mellitus. Materials and Methods: Eighty-four patients of 168 participants, aged 30–69 years, were recruited from the Metabolic Clinic of the University of Maiduguri Teaching Hospital, Borno State between January and December 2018, whereas the remaining 84, age- and sex-matched nondiabetic subjects resident in Maiduguri served as controls. Samples for platelet indices, fibrinogen concentration, hematocrit, relative plasma viscosity (RPV), whole blood viscosity (WBV), protein C, antithrombin, and d-dimer were analyzed using standard techniques. Results: The values of platelet indices, prothrombin time (PT), activated partial thromboplastin time (aPTT), protein C, antithrombin, d-dimer, fibrinogen, hematocrit, and RPV in diabetic patients with respect to different age groups showed no significance (P > 0.05). However, significantly lower levels of protein C, antithrombin and hematocrit, and significantly higher values of d-dimer, fibrinogen, and WBV were observed in patients with diabetes irrespective of the age compared to that of nondiabetic subjects (P < 0.05). Conclusion: Age had no influence on the values of platelet count, platelet indices, PT, aPTT, protein C, antithrombin III, d-dimer, fibrinogen, hematocrit, RPV, and WBV in patients with diabetes. However, patients with type 2 diabetes mellitus could be prone to thrombosis and increased fibrinolytic activity irrespective of their age.

Green tea consumption effects on coagulation profile

OBJECTIVES: The objective was to study the prothrombin time (PT) and activated partial thromboplastin time (APTT) values among Sudanese regularly drinking green tea.METHODS: This comparative study was conducted from May to November 2018 at the cities of Kosti, Rabak, and Sinnar, Sudan. Two hundred volunteers recruited in this study included individuals who drank more than three cups of green tea per day for at least 1 year or more (n = 100), and another group represented individuals who did not drink green tea (n = 100). Blood samples were collected in ethylenediaminetetraacetic acid and trisodium citrate anticoagulant containers. Coagulometer analyzer machine and standard methods were used for PT and APTT analysis.RESULTS: The study results showed significantly prolonged in both PT and APTT mean values of individuals who drank green tea when compared with those who did not drink green tea. The PT mean values are 19.88 ± 3.7 s vs. 15.43 ± 0.52 s (P < 0.001) and the APTT mean values are 34.94 ± 3.4 s vs. 32.86 ± 3.2 s (P < 0.002). The multiple linear regression analysis confirmed a positive impact relationship between age, drinking green tea, and duration time of drinking green tea with both PT and APTT values.CONCLUSION: The study concludes that daily drinking green tea for a long time could affect an individual's coagulation profile.

Alternative processing technology for the preparation of carbonized Zingiberis Rhizoma by stir-frying with sand

Context Carbonized ginger, a type of charry herb, has been used as a hemostatic medicine since ancient times. However, there are some serious problems such as inhomogeneous heating and emitting smoke during processing with traditional stir-frying method. Objective To investigate the feasibility to obtain carbonized ginger by stir-frying with sand instead of stir-frying method. Materials and methods Dried-ginger (100 g) was processed by stir-frying for 30 min at 270 ± 10 °C, or by stir-frying with sand (1:10, w/w) for 8 min at 240 ± 5 °C. The HPLC fingerprint was established for two samples. The adsorption capacity and major components including tannins, gingerols, shogaols and gingerone were quantitated by UV and HPLC, respectively. The hemostatic effect by prothrombin time (PT) and activated partial thromboplastin time (APTT) was evaluated in vitro. Results The similarity of the two samples for HPLC fingerprints was >0.93. The sand-fried samples showed significantly higher adsorption capacity compared with the stir-fried samples (4.915 vs. 4.593 mg/g; p < 0.05) and higher contents of major components (4.698 vs. 3.930 mg/g, 1.352 vs. 1.144 mg/g, 2.419 vs. 2.095 mg/g, 0.666 vs. 0.568 mg/g and 1.083 vs. 0.911 mg/g for tannins, gingerone, 6-shogaol, 8-shogaol and 10-shogaol, respectively; p < 0.05); while no significant differences were seen for 6-gingerol, 8-gingerol and 10-gingerol (p > 0.05). The PT and APTT values were similar between the stir-fried and sand-fried test groups and significantly lower compared to controls (p < 0.05). Conclusions The carbonizing process by stir-frying with sand is superior to the stir-frying method for carbonized ginger.

The Investigation Preoperative Coagulation Values of Patients Undergoing Oral Surgical Procedure Under Local Anesthesia

Objective: The aim in this study was to investigate preoperative coagulation values of patients undergoing oral surgery under local anesthesia.Material and Method: The study included 1598 patients who presented to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry at Adıyaman University between 2017 and 2018 for various reasons and underwent surgery under local anesthesia based on examination. The patients’ age and gender as well as their coagulation values such as activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) were recorded and analyzed statistically.Results: The age range of the patients included in the study ranged between 11 and 92, and their mean age was 30.51 ± 11.09. Of these patients, 63.06% (n = 1007) were female, and 36.94% (n = 591) were male. The total number of female patients admitted was more than that of the male patients in terms of the distribution by gender. When the number of patients admitted were examined in terms of age groups (0–20, 21–40, 41–60, &amp;gt; 60), statistically significant differences were found especially between the ages 0–20 and 21–40 in both gender (p &amp;lt;0.05). No significant differences were found in groups over the age of 40 (p &amp;gt; 0.05). Values outside the normal range were observed in all of the coagulation values examined. Among these, APTT and PT (%) values that were lower than the normal and INR and PT (s) values that were higher than the normal were found to prevail. An examination of these abnormal values in terms of gender revealed that the values other than PT (%) were found to be statistically significantly higher in women, compared to men. In terms of age groups, these abnormal values belonging to the four coagulation parameters were found to be statistically significantly the highest among the people who were 21–40 years old (p &amp;lt; 0.001).Conclusion: Taking preoperative coagulation tests prior to locally applied surgical procedures is especially important in patients for whom detailed medical history cannot be obtained.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma

Objective To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution. Methods A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness≥5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018. There were 37 males and 23 females, aged 18-80 years [(47.0±16.9)years]. There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group. Coagulation function [prothrombin time (PT) and international normalized ratio (INR)] on admission, hospital stay, Glasgow outcome scale (GOS), and brain CT results were compared between the two groups. Results The PT and INR values in the rapid resolution group were (11.9±2.1)s and 1.1±0.2 respectively, while those in the non-rapid resolution group were (10.8±1.0)s and 1.0±0.1 respectively, with significant differences (P 0.05). The thickness of subdural hematoma of the two groups in the first CT scanning was (8.2±2.3)mm and (7.3±1.8)mm, respectively, with no statistically significant difference (P>0.05). In the second CT scanning, the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs. (6.6±2.1)mm] (P<0.01). The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group (93% vs. 36%) (P<0.01). The incidence of subarachnoid hemorrhage(SAH) increase was significantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan (74% vs. 15%) (P<0.01). The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4% in the rapid resolution group, which was significantly lower than 18% in the non rapid resolution group (P<0.05). Conclusions The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma. The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma, suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients. Key words: Hematoma, subdural, acute; Tomography, spiral computed; Rapid spontaneous resolution

Effect of Self-Management Program on Self-efficacy and Medication Adherence in Patients with Mechanical Heart Valve: a Randomized Clinical Trial.

Introduction: Patients with mechanical heart valve need anticoagulant therapy to prevent thrombotic events. The treatment interacts with some foods and drugs. The aim was to evaluate the effect of self- management program on self-efficacy and medication adherence in patients with mechanical heart valve.Methods: This was a randomized controlled trial. eighty eligible patients, with the ability to read and speak in Farsi, aged between 15 to 60, were included in the study from the cardiac surgery clinic in Imam Khomeini hospital affiliated to Tehran University of Medical Sciences (Tehran, Iran) and randomly allocated to intervention and control groups. The participants had no history of psychiatric disorders, had undergone valve replacement surgery at least one year before the study, and were being treated with Warfarin. The intervention was a combination of 2 one- hour self-management education via small groups with 3 to 5 members, self-management educational booklets, and weekly call follow- ups for 8 weeks about 10- 15 minutes. The control group received no intervention. Self- efficacy was the primary outcome and medication adherence, Prothrombin Time (PT), and International Normalized Ratio (INR) were secondary outcomes. Data were analyzed using spss13.Results: Although the mean of self-efficacy and medication adherence, PT, and INR values were not different between the two groups at baseline, they improved significantly following the program.Conclusion: Self-management program had a positive effect on self-efficacy and medication adherence of patients with mechanical heart valve.

Hemostatic activity of aqueous extract of Myrtus communis L. leaf in topical formulation: In vivo and in vitro evaluations.

Myrtus communis L. (MC) is a well-known medicinal plant in traditional Persian medicine, which contains a large amount of phenolic compounds (mainly hydrolyzable tannins). As mentioned in ancient literature, MC was widely used to control bleeding in every part of the body. Nevertheless, there is no pharmacological study on the anti-hemorrhagic activity of this plant till now. The current in vivo and in vitro study aimed at evaluating the hemostatic activity of M. communis aqueous leaf extract (MCE) in topical formulation. Two parameters of bleeding time and amount in tail bleeding model were measured in vivo in rats treated with MCE (1%, 2.5%, 5%, 7.5%, 10%, 15%, and 20% w/v), 5% M. communis aqueous leaf extract gel (G), tannic acid (TA) (1%, 2.5%, 5%, 7.5%, and 10%), normal saline (NS), and the Monsel's solution (MS), a commercial hemostatic agent. Also, the effect of 5% MCE and 5% TA on PT (prothrombin time) and aPTT (activated partial thromboplastin time) as well as protein precipitation and platelet aggregation were assessed in vitro. In the rat-tail bleeding model, bleeding time and amount significantly (P<0.001) reduced by the application of 5% MCE solution on the cut tail compared with the NS group. The bleeding time and amount in the MS group were not significantly different from those of the 5% MCE group. Platelet microaggregates were detected by fluorescent microscope. PT and aPTT values increased >120s and >180s by 5% MCE, respectively. Also, protein precipitation and significant reduction in serum proteins were observed in the 5% MCE group. The current study provided new insights into the hemostatic effect of MCE, which may be partially mediated by platelet aggregation activity. Hence, it could be evaluated as the resource of new plant origin hemostatic agent.

Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures

Objective To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients. Methods A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Peking University between January 2016 and December 2018. Collected were their baseline parameters including age, gender and American Society of Anesthesiologists (ASA) scores, preoperative blood parameters including coagulation indicators [D-Dimer, fibrinogen degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and thrombin time (TT)] and platelets indicators, and fracture parameters including number of fractured vertebrae and duration of fracture. The 2 patients groups were divided into 5 age groups: 4 age groups for each 10 between 50 and 90 years and one age group for >90 years. The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group. The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed. Results There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05). The mean onset time for the fracture group was 6.7 days. The values of D-Dimer, FDP, PT, INR, TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001). After the D-Dimer threshold adjusted by age, 75.71%(53/70) of the patients in the fracture group were negative while 98.57%(69/70) of those in the degenerative disease group were negative. Meanwhile, the values of D-Dimer and FDP showed a significant correlation (P<0.001) with a Pearson correlation coefficient of 0.932. Compared with the degenerative disease group, the values of D-Dimer and FDP in the fracture group increased significantly in the age groups from 61 to 90 years(P< 0.001). Conclusions Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients. It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease. Key words: Osteoporosis; Aged; Spinal fractures; Blood coagulation; Deep vein thrombosis; D-Dimer

Age-Associated Changes of Coagulation Test and Coagulation Factor Activities in Healthy Chinese Children

Background: The concept of developmental hemostasis has been universally accepted. Plasma concentrations of many coagulation factors in childhood are significantly different from adults for both mean values and ranges of normal. Thus, an understanding of developmental hemostasis and the development of appropriate age-dependent reference ranges are pivotal for prevention, diagnosis, and treatment of hemostatic problems during childhood. However, no data of developmental hemostasis are available in healthy Chinese children. Methods: Coagulation data from children aged 0-18 years old receiving minor elective surgery in Chengdu Women and Children's Central Hospital, from Sep. 2017 to Feb. 2019 was collected, and patient medical records were reviewed. Ethical approval was obtained from the parents of all children and the study was approved by the Ethics Review Committee at Chengdu Women and Children's Central Hospital. To qualify for the study, enrolled subjects had to meet the following criteria: (1) Children aged 0-18 years receiving minor elective surgery.(2) No history of bleeding problems.(3)No family history of bleeding nor thrombosis .(4) No history of heart, lung, liver or kidney diseases, normal physical examination. (5) Normal blood routine test. Normal liver function and kidney function, (6)No history of medication use for at least two weeks prior to specimen collection.(7) The operation gone successfully, and postoperative recovery was well. Blood samples (3 mL) were obtained by venipuncture into plastic tube containing 3.2% (109 mmol/L) buffered sodium citrate (1 part citrate:9 parts blood). The specimens were centrifuged immediately at 2500 g for 15 min at room temperature to prepare platelet-poor plasma (PPP) for the preoperative coagulation screening tests, consisting of activated partial thromboplastin time (APTT), prothrombin time (PT)), international normalized ratio (INR), thrombin time (TT) and fibrinogen. Activity of coagulation factors VIII, IX, XI, XII,Ⅱ,Ⅴ,Ⅶ,Ⅹ were determined using one-stage clotting methods with respective factor-deficient plasma. Results: A total of 82 samples were collected, while only 67 met the enrollment criteria. Specimens with inappropriate ratio of blood to anticoagulant, hemolysis or abnormal values of coagulation tests (APTT, PT, TT, fibrinogen) were excluded from analysis. The total of 67 children (40 Male 27 female), with a median age of 2.0 years (range: 1month -14 years) were divided into three groups according to the age: &lt;1y group 15 cases, 1-5y group 45 cases, and &gt;6y group 7cases. (1) The values of APTT, PT, TT, and fibrinogen were (36.1±5.2) seconds, (11.1±0.85) seconds, (20.3±1.6) seconds, (2.4±0.89) g/L respectively. No significant differences were found between groups. (2) In all children ,the activities of factor VIII、IX、XI、XII、vWF、II、V、VII、X were(123.6±48.3)%、(75.9±16.9)%、(95.9±24.3)%、(43.7±16.3)%、(111.3±50.4)%、(90.2±14.0)%、(104.7±21.1)%、(81.6±19.1)%、(93.0±21.8)% respectively. Factor VIII and vWF activities were significantly higher than other factors, while factor XII activities were significantly lower than others. (3)Mean values of FII:C, FVIII:C, FIX:C, FXI:C were significantly lower in children below &lt;1year old group than those in 1-5y group. No significant difference were seen in FVII:C, FV:C, FX:C, FXII:C, vWF:C among three groups. Conclusions: Coagulation test is just a simple and easy screening test. Coagulation factor activities changed dynamically with age during childhood, especially the FII:C, FVIII:C, FIX:C and FXI:C. Physiological reference ranges for coagulation factor activities in Chinese children of different ages should be established in order to evaluate the children with congenital or acquired bleeding diseases correctively. Table Disclosures No relevant conflicts of interest to declare.

To Study the Coagulation Profile Derangements in Metabolic Syndrome

Introduction: The metabolic syndrome is a complex disorder characterized by the presence of a clustering of metabolic risk factors usually in a single individual associated with the presence of central obesity and a strong association with diabetes and cardiovascular disease morbidity and mortality. It is a fast spreading global pandemic &amp; emerging as a public health problem with poor outcome and Quality of life thus more predilection is towards preventive than curative treatment. According to WHO Clinical Criteria, Metabolic syndrome is defined as insulin resistance, identified by 1 of the following, Type 2 diabetes, fasting blood glucose more than 110 mg/dl plus any 2 of the following: antihypertensive medication and /or high blood pressure &gt; 140 mm systolic or &gt;90 mm diastolic, plasma triglyceride (TG) level more than 150 mg/dl (1.7 mmol/L), high-density lipoprotein (HDL) cholesterol level less than 35 mg/dl (0.9 mmol/L) in men or less than 39 (1.0 mmol/L)in women , BMI &gt;30 kg/m2 and/or waist:hip ratio &gt;0.9 in men, &gt; 0.85 in women, Urinary albumen excretion rate &gt; 20 mcg/min or albumin:creatinine ratio&gt;30mg/g Aims &amp; Objectives: To investigate the coagulation profile derangements in metabolic syndrome. To study the relationship of various components of metabolic syndrome with coagulation parameters. Material &amp; Methods: This was a prospective cross-sectional study carried out in Haematology &amp; Medicine Deptt of SafdarJang Hospital, New Delhi. After taking consent from the Hospital Ethics Committee, a total of 50 cases of metabolic syndrome presenting as outpatient or inpatient were included in the study. 50 age &amp; sex matched controls were selected which did not satisfy the criteria for metabolic syndrome. Observation &amp; Results: In our study we found that the cases with metabolic syndrome have significantly increased levels of Fibrinogen, Factor VIII and Plasminogen Activator Inhibitor1 (PAI1). PT &amp; APTT were shorter in cases with metabolic syndrome. The mean value of fibrinogen in cases was 402.24 ± 66.92 mg/dl while that in control was 261.5 ± 41.95 mg/dl with a P value of &lt;.0001 which was statistically significant. The mean value of Factor VIII in cases was 152.66 ± 7.54 IU/dl while that in control was 131.44 ± 6.24 IU/dl with a P value of &lt;.0001 which was statistically significant. The mean value of Plasminogen Activator Inhibitor1 (PAI1) in cases was 49.99 ± 5.34 ng/ml while that in control was 36.75 ± 3.35 ng/ml with a P value of &lt;.0001 which was statistically significant. Prothrombin Time (PT) values in cases were 9.79 ± 0.74 seconds and in controls were 12.04 ± 0.7 seconds &amp; this difference was statistically significant (p&lt;.0001). Activated partial Thromboplastin Time (APTT) values in cases were 28.96 ± 0.92 seconds and in controls were 32.6 ± 1.34 seconds &amp; this difference was statistically significant (p&lt;.0001). Conclusions: The coagulation parameters studied correlated significantly with the components of metabolic syndrome. The values varied significantly with increased number of features of metabolic syndrome. Thus we can conclude that metabolic syndrome is a hypercoagulable state and further studies are required for further evaluation of the consequences of this hypercoagulable state.. Disclosures No relevant conflicts of interest to declare.