Risk Factors For Coagulopathy Research Articles

A243 THROMBOELASTOGRAPHY-GUIDED COAGULOPATHY CORRECTION IN CIRRHOTIC PATIENTS DECREASES BLOOD PRODUCT TRANSFUSION: A SYSTEMATIC REVIEW AND ANALYSIS

Abstract Background Patients with cirrhosis are a risk factor for coagulopathy and bleeding complications. Thromboelastography (TEG) guided therapy is available to rapidly assess and guide blood product transfusion in this population. Purpose This study aims to determine if TEG-guided therapy is able to decrease the administration of blood products and reduce adverse events such as bleeding and mortality compared to standard coagulation testing (SCT). Method We performed a systematic review and meta-analysis of literature in PubMed, EMBASE, and The Cochrane Library and pooled six randomized-controlled trials comparing thromboelastography versus standard coagulation testing in patients with cirrhosis. A total of six studies were pooled (n= 386). Primary outcomes were mean platelet transfusion units and fresh frozen plasma (FFP) transfusion units. Secondary outcomes were mortality and bleeding events. Result(s) Compared to SCT, there was a significant standard mean decrease in platelet (P<0.00001) and FFP (P<0.00001) administration compared to TEG perioperatively prior to a liver transplant. However, there was no significant difference in the pooled odds ratio between TEG and SCT in patients receiving both platelets and FFP (OR 1.40 [95% Cl 0.61-3.23, P=0.42]). Recurrent variceal bleeding was significantly reduced in the TEG group compared to SCT for platelet transfusion (OR 0.05 [95% Cl 0.01-0.20, P<0.0001]) or FFP transfusions (OR 0.18 [95% Cl 0.05-0.63, P=0.007]). With regards to the 5-day, 28-day, 42-day, and 90-day mortality, there was no significant difference between the pooled odds ratio between the TEG and SCT groups (OR 0.69 [95% Cl 0.47-1.02, P=0.06]). The 24-hour, 48-hour, 5-day, and 42-day rebleeding rates were significantly lower in TEG versus SCT groups (OR 0.50 [95% Cl 0.29-0.85, P = 0.01)]. Conclusion(s) The use of TEG-guided therapy favors a reduction in platelet and FFP transfusion compared to SCT in patients with cirrhosis. Additionally, TEG-guided therapy is able to improve patient care by reducing the rebleeding rate of patients with cirrhosis compared to SCT. However, this same effect was not seen for mortality. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Hepatic Vein Thrombosis in a COVID-19 Patient with Hereditary Thrombophilia: A Case Report

Background: COVID-19 is an infection secondary to the novel SARS-COV-2 virus with a well-established increased risk for thrombotic events. However, the interaction between COVID-19 and other patient-specific hereditary or acquired thrombophilias remains a poorly explored area. Case Presentation: We herein report a case of a 23-year-old Caucasian female with known risk factors for coagulopathy (smoking, oral contraceptives, anti-phospholipid (aPL) antibodies, heterozygous Factor V Leiden mutation, and homozygous methylenetetrahydrofolate reductase (MTHFR) mutation) who developed a Budd-Chiari syndrome after testing positive for COVID-19. To our knowledge, this is the first report of a case of splanchnic vein thrombosis in a COVID-19 patient with the above risk factors. Conclusion: Such a presentation underscores the additional increased thrombotic risk attributed to COVID-19 infections in the setting of underlying hereditary or acquired thrombophilias.

Risk factors of acute coagulation dysfunction after aneurysmal subarachnoid hemorrhage

BackgroundAlthough coagulopathy have been proved to be a contributor to a poor outcome of aneurysmal subarachnoid hemorrhage (aSAH), the risk factors for triggering coagulation abnormalities have not been studied after aneurysm clipping.MethodsWe investigated risk factors of coagulopathy and analyzed the relationship between acute coagulopathy and outcome after aneurysm clipping. The clinical data of 137 patients with ruptured CA admitted to our institution was collected and retrospectively reviewed. Patient demographic data (age, sex), smoking, alcohol use, hypertension, diabetes, Hunt-Hess grade, Fisher grade, operation time, intraoperative total infusion volume, intraoperative blood loss, intraoperative transfusion, intraoperative hemostatic drug treatment, calcium reduction (preoperative free calcium concentration–postoperative free calcium concentration) were recorded. Coagulation was assessed within 24 h. Postoperative hemorrhage and infarction, deep venous thrombosis (DVT), and mortality were analyzed.ResultsCoagulopathy was detected in a total of 51 cases (group I), while not in 86 cases (group II). Univariable analysis demonstrated that age, smoking, alcohol use, intraoperative total infusion volume, intraoperative blood loss, intraoperative transfusion, and calcium reduction (≥ 1.2 mg/dl) were related to coagulopathy. Non-conditional logistic regression analysis showed that age [OR, 1.037 (95% CI, 1.001–1.074); p = 0.045] and calcium reduction (≥ 1.2 mg/dl) [OR, 5.509 (95% CI, 1.900–15.971); p = 0.002] were considered as the risk factors for coagulopathy. Hunt-Hess grade [OR, 2.641 (95% CI, 1.079–6.331); p = 0.033] and operation time [OR, 0.107 (95% CI, 1.012–0.928); p = 0.043] were considered as the risk factors for hypocoagulopathy. There were 6 cases (11.7%) with cerebral infarction in group I, while 6 cases (6.98%) in group II (χ2 = 0.918, p = 0.338). There were 4 cases (7.84%) with rebleeding in group I, while 5 cases (5.81%) in group II (χ2 = 0.215, p = 0.643). The mortality was 9.80% (5/51) in group I, while 1.16% (1/86) in group II (χ2 = 5.708, p = 0.017). DVT was not detected in all cases.ConclusionsIn conclusion, age (≥ 65 years) and calcium reduction (≥ 1.2 mg/dl) were considered as the risk factors for coagulopathy and have been proved to be associated with higher mortality after aneurysm clipping.

Analysis of risk factors affecting coagulopathy after donor hepatectomy in a newly established liver transplant center.

As might be expected, living donor liver surgery is associated with serious morbidity and mortality risks. Coagulopathy after donor hepatectomy is an important risk factor affecting morbidity. In this study, risk factors affecting the development of coagulopathy after donor hepatectomy was evaluated in a newly-established liver transplant center. A retrospective evaluation of 46 liver donors to whom hepatectomy was applied in Medipol Universty of School of Medicine Department of Organ Transplantation between April 2014 and July 2015 was made. Coagulopathy was defined as prothrombin time ≥15 sec. or platelet count <80000/mm3 on postoperative day 3. Donors were separated into 2 groups as those with (n=24) and without (n=22) coagulopathy. Preoperative, intraoperative and postoperative factors acting on coagulopathy were analyzed. In the intergroup analysis, it was seen that remnant liver volume, remnant liver volume % and remnant liver volume to body weight ratio were factors associated with coagulopathy. The cut-off values for these 3 parameters were calculated as 773.5 cm3, 40.5% and 0.915 cm3/kg, respectively. Only remnant liver volume % was determined as a risk factor for coagulopathy after donor hepatectomy on multiple logistic regression analysis. The results of this study showed that the most important risk factors affecting coagulopathy after donor hepatectomy were the parameters associated with remnant liver volume.

Risk factors for coagulopathy in acute isolated traumatic brain injury

Objective To discuss the risk factors for coagulopathy in acute isolated traumatic brain injury (TBI). Methods A retrospective study was performed on 191 patients with acute isolated TBI hospitalized from July 2012 to June 2015. There were 70 patients with coagulopathy (coagulopathy group) and 121 patients without coagulopathy (control group). Age, gender, injury type, midline shift on CT and injury severity (Glasgow Coma Scale, GCS) were analyzed to identify the independent risk factors for coagulopathy using the logistic regression analysis. Correlation between the independent risk factors and coagulation indices was analyzed. Results Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT were identified as the independent risk factors for coagulopathy(P 1 ). Furthermore, injury severity and acute subdural hematoma were respectively associated with abnormalities of international normalized ratio (INR) and fibrinogen (Fg) (P<0.05 or P<0.01), intraventricular bleeding with abnormalities of prothrombin time (PT) and platelet count (PC) (P<0.01), and midline shift on CT with abnormalities of Fg and PC (P<0.05). Conclusions Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT are independent risk factors for coagulopathy in patients with acute isolated TBI, and correlate with abnormalities of several coagulation indices. Changes in coagulation indices should be monitored accurately after TBI, and timely treatment of coagulopathy can improve the prognosis. Key words: Brain injuries; Blood coagulation disorders; Risk factors of coagulopathy

In vitro Influence of Fibrinogen and Factor XIII on Viscoelastic Characteristics of Clot Formation under Hypothermia and Acidosis

Hypothermia and acidosis are risk factors for coagulopathy during trauma. We investigated influence of fibrinogen and factor XIII on whole blood coagulation under hypothermia and acidosis in an in vitro model.

Social correlates of clotting disorders in adults and the very old: UK Understanding Society cohort, 2009–2010

Dear Editor, In spite of biological risk factors for coagulopathy [1], social correlates could also play a role. However, research in this area is rather scarce, and national population-based studies are limited. Therefore, it was aimed to understand social correlates of clotting disorders for adults and the very old in two compatible country-wide population-based studies in the UK (Scottish Health Survey and Health Survey for England in 2003). Study design and sampling method were described and published in detail elsewhere [2, 3]. Information on demographics, living and work conditions, and selfreported clotting disorders was obtained by household interview (Question: May I just check, do you have a clotting or clotting disorder or are currently on anticoagulant drugs such as Warfarin?). In the current analysis, only participants aged 16 and above were included. Analysis included logistic regression modeling. Adjustments were made to control for covariates mentioned above. Effects were estimated by using odds ratios (OR) and 95 % confidence intervals (CI) with P value <0.05 considered statistically significant. Statistical software STATA version 12.0 (STATA, College Station, TX, USA) was used to perform all the analyses. Since it is a secondary data analysis in the present study, no further ethics approval is required. In the year 2003, there were 316 (1.9 %) people who had ever clotting disorders. In Table 1a, unfortunately, social factor was not observed to be associated with clotting disorders among the very olds. In adults aged 16–79 (see Table 1b), however, it was shown that body mass index (BMI) ≥30 (OR 1.62, 95 % CI 1.09–2.39, P =0.02), being widowed (OR 2.28, 95 % CI 1.19–4.37, P =0.01), and not having regular exercise (OR 2.01, 95 % CI 1.41–2.88, P <0.001) were significantly associated with higher risk of clotting disorders. On the other hand, a protective effect from annual household income was noted. People whose annual household income was in the range of £18,200–52,000 (OR 0.52, 95 % CI 0.36–0.74, P < 0.001) or £52,000–99,999 (OR 0.42, 95 % CI 0.22–0.83, P = 0.01) had a lower risk of clotting disorders compared to those whose annual household income was in the range of £0–18, 200. In the present study, recent evidence on significant associated social factors for clotting disorders among adults and the very olds in Scotland and England was provided. Although it is not new to know that BMI and physical activity are related to risk of clotting disorders, additionally, it was observed that marital status also played a role in risk of clotting disorders in adults for the first time. To be specific, widowed people tended to be older and less physically active. Methodologically, this has revealed that in previous studies, marital status was not carefully examined and blinded by the advancing age and/or physical activity. After regrouping the study participants into adults aged 16–79 and the very old aged 80 and above, we have observed a significant effect of marital status on adults aged 16–79 in our study. From a public health perspective, intervention programs or supportive groups targeting helping relieve pains and grieves I. Shiue (*) School of the Built Environment, Heriot–Watt University, Riccarton, EH14 4AS Edinburgh, Scotland, UK e-mail: i.shiue@hw.ac.uk

Coagulopathy in patients who experience snakebite

Background/AimsCoagulopathy is a common complication of snakebite, but there is little information on the clinical importance of coagulopathy. We analyzed the characteristics of coagulopathy after envenomation.MethodsNinety-eight patients who experienced snakebite were enrolled in this study. We divided all the patients into three groups by the ISTH DIC scoring system: the normal, simple coagulopathy and DIC groups. The coagulopathy group included both the simple coagulopathy and DIC groups. We then conducted a case-control study.ResultsThere was a significant decrease in the Hct, protein, albumin, ALP and cholesterol levels in the coagulopathy group, and only the cholesterol level was deceased in the DIC group (p<0.05). Leukocytosis and rhabdomyolysis were significantly associated with coagulopathy, and hemolysis and rhabdomyolysis were associated with DIC (p<0.05). The presence of rhabdomyolysis was considered a risk factor for coagulopathy (p<0.05). These conditions continued for up to six to seven days after the snakebite.ConclusionsEvaluation of coagulopathy with using these characteristics is helpful to properly manage the patients who experience snakebite.