A chromogenic assay of prothrombin compared with coagulation tests during anticoagulant therapy and liver disease

1981 ◽  
Vol 11 (3) ◽  
Author(s):  
Armando Tripodi ◽  
Camilla Di Santo ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Liver Disease ◽  
Anticoagulant Therapy ◽  
Chromogenic Assay ◽  
Coagulation Tests

FIBRINOLYSIS AND HAEMOSTASIS DURING ASCITES RECIRCULATION

1987 ◽  
Author(s):  
P C Cooper ◽  
D R Triger ◽  
H Kennedy ◽  
R G Malia ◽  
F E Preston
Keyword(s):  
Liver Disease ◽  
Ascitic Fluid ◽  
Geometric Mean ◽  
Dilution Effect ◽  
Screening Tests ◽  
Small Reduction ◽  
Chromogenic Assay ◽  
Fibrin Plate ◽  
Coagulation Tests ◽  
Mean Diameter

The use of ascites recirculation in liver disease removes litres of incapacitating fluid and the patient is reinfused with the concentrated ascites, a rich source of albumin. Ascites is thought to contain plasminogen activator (PA) which may further affect deranged haemostasis in these patients. We have examined the effect that ascites recirculation has on levels of tPA, fibrinogen, FDP and platelet count on samples taken pre and approximately 4 hours into ascites recirculation. Using plasminogen rich fibrin plates we were able to demonstrate PA in unfractioned ascitic fluid (N=10, mean diameter lysis=10.2mm); this activity was quenched by addition of antibody to tPA (mean diameter lysis=0.2mm). Despite demonstrating tPA in unfractioned ascitic fluid, we were unable to demonstrate an increase in plasma tPA, mid recirculation, using a sensitive chromogenic assay (pre, geometric mean tPA = 0.061Iu/ml; mid, geometric mean tPA = 0.024Iu/ml). In addition we have also measured the effect that an intra-abdominal injection of the glucocorticoid, dexamethosone (dex), 24 hours prior to recirculation, has on PA content of the ascites, as well as the effect on coagulation screening tests. Fibrin plate lysis showed only a small, though significant reduction in mean lysis diameter in 9 of 10 patients receiving dex, (mean 11.6 to 10.2mm). Results of the coagulation tests showed marked changes during recirculation which were similar in both groups.In conclusion, we have demonstrated free tPA in unfractionated ascites fluid of patients with liver disease, and shown a small reduction in tPA level 24 hours post injection of dex in ascites. Dexamethosone did not influence the changes in coagulation profile post recirculation. We suggest that the changes in coagulation are not due to primary fibrinolysis, but may be due to either dilution effect or DIG.

scholarly journals Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests?

2020 ◽  
Vol 40 (03) ◽  
pp. 364-378
Author(s):  
Sara Reda ◽  
Laure Morimont ◽  
Jonathan Douxfils ◽  
Heiko Rühl
Keyword(s):  
Anticoagulant Therapy ◽  
Thrombin Generation ◽  
Waveform Analysis ◽  
Laboratory Diagnostics ◽  
Coagulation Assays ◽  
Coagulation Process ◽  
Complex Process ◽  
Coagulation Tests ◽  
The Individual

AbstractHemostasis is a complex process in which abnormalities can cause shifts toward prothrombotic or prohemorrhagic states resulting in thrombosis or bleeding, respectively. Several coagulation tests may be required to characterize these defects but may yet not always reflect a patient's true hemostatic capacity. Thus, global coagulation tests aiming to simulate the coagulation process in vitro instead of measuring single components thereof are certainly of interest to assess prothrombotic or prohemorrhagic tendencies. This review describes the development and application of global coagulation tests, concentrating on the more widely used methods of viscoelastometry and thrombin generation. A focus is placed on conditions characterized by simultaneous changes of various components of hemostasis, such as anticoagulant therapy or hormone-induced coagulopathy, in which global coagulation tests are especially promising. If the key challenges of standardization and automation of these tests are solved, as is the case with automated thrombogram or clot waveform analysis, global coagulation assays will play an important role in the future of laboratory diagnostics of hemostasis and thrombosis.

scholarly journals Comparison of Thromboelastography and Conventional Coagulation Tests in Patients With Severe Liver Disease

2020 ◽  
Vol 26 ◽  
pp. 107602962092591
Author(s):  
Patryck Lloyd-Donald ◽  
Abhinav Vasudevan ◽  
Peter Angus ◽  
Paul Gow ◽  
Johan Mårtensson ◽  
...  
Keyword(s):  
Liver Disease ◽  
Prospective Observational Study ◽  
International Normalized Ratio ◽  
Clot Formation ◽  
Clot Strength ◽  
Coagulation Tests ◽  
Severe Liver Disease ◽  
Standard Reaction ◽  
Α Angle ◽  
The Relationship

Objective: Thromboelastography (TEG) may provide rapid and clinically important coagulation information in acutely ill patients with chronic liver disease (CLD). Our objective was to describe the relationship between TEG and conventional coagulation tests (CCTs), which has not been previously explored in this population. Methods: In acutely ill patients with severe CLD (Child-Pugh score > 9, category C), we conducted a prospective observational study investigating coagulation assessment as measured by both CCTs and TEG. We used quantile regression to explore 30 associations between TEG parameters and corresponding CCTs. We compared TEG and CCT measures of coagulation initiation, clot formation, clot strength, and fibrinolysis. Results: We studied 34 patients on a total of 109 occasions. We observed inconsistent associations between TEG and CCT measures of coagulation initiation: TEG (citrated kaolin [CK] assay) standard reaction time and international normalized ratio: R 2 = 0.117 ( P = .044). Conversely, there were strong and consistent associations between tests of clot formation: TEG (CK) kinetics time and fibrinogen: R 2 = 0.202 ( P < .0001) and TEG (CK) α angle and fibrinogen 0.263 ( P < .0001). We also observed strong associations between tests of clot strength, specifically TEG MA and conventional fibrinogen levels, across all TEG assays: MA (CK) and fibrinogen: R 2 = 0.485 ( P < .0001). There were no associations between TEG and D-dimer levels. Conclusions: In acutely ill patients with CLD, there are strong and consistent associations between TEG measures of clot formation and clot strength and conventional fibrinogen levels. There are weak and/or inconsistent associations between TEG and all other conventional measures of coagulation.

THROMBOEMBOLISM IN PROSTHETIC VALVE ENDOCARDITIS AND ANTICOAGULANT THERAPY

1987 ◽  
Author(s):  
T Fukui ◽  
M Aosaki ◽  
Y Uetsuka ◽  
K Iwade ◽  
T Nirei ◽  
...  
Keyword(s):  
Blood Culture ◽  
Valve Replacement ◽  
Anticoagulant Therapy ◽  
Prosthetic Valve ◽  
White Blood Cells ◽  
Prosthetic Valve Endocarditis ◽  
Clinical Results ◽  
The Other ◽  
Coagulation Tests ◽  
Diagnostic Criterion

The clinical results of thromboembolism (TE) in Patients with prosthetic valVe endocarditis (PVE) and anticoagulant therapy were studied. 22 PVE patients (ll males and females each from 4 to 59 years old, average 32.7) were selected from 1939 patients who had undergone valve replacement at this hospital from 1964 and 1985. The complication frequency of TE and its clinical results, anticoagulant therapy and coagulation tests were investigated. Diagnostic criterion was determined in either of the following two: l) those patients who experienced valve replacement, with at least gradual pyrogenic symptons and inflammation factors such as a large increase in white blood cells, the progress of ESR and positive CRP, also with the same bacterium found more than twice in blood culture, also with the same bacterium found more than twice in blood culture, or 2) those patients who experienced valve replacement, with bacterial verruca found at re-valve replacement or at pathological anatomy. PVE onset took 2 days to 6.5 years (average 407 days) to appear after valve replacement. 8 out of the 22 PVE patients (36.3%) showed complications at TE onset, and 5 out of the 8 patients repeated. Embolism was found in 6 cases of brain, 4 cases of kidney, 2 cases of lung, 2 cases of limbs and 1 case of spleen, and 8 patients all died. On the other hand, 5 complications (22.7%) at bleeding were found in 3 cases of brain, 1 case of duodenum and 1 case of site of replaced aortic valve, and 4 patients died. Anticoagulant therapy was given to 21 out of the 22 PVE patients, and thrombotest (TT) values at TE onset were all less than 30%. Warfarin was administered as anticoagulant. 2 patients were administered with aspirin, but one was given with 250mg aspirin per day together with warfarin, and the other with 330mg aspirin per day alone. TT values at the onset of bleeding were from 10 to 56%. Anticoagulant therapy had been performed to the PVE patients since PVE onset did not yet appear, but complications coagulability by TT values, and all the patients died. In addition to this, complications at bleeding were found many and most of patients died even when the TT values were not so low. Therefore, we believe that the anticoagulant therapy that had been performed after PVE onset still needs further studies.

Point-of-Care Testing in Liver Disease and Liver Surgery

2017 ◽  
Vol 43 (04) ◽  
pp. 407-415 ◽  
Author(s):  
Lasitha Abeysundara ◽  
Susan Mallett ◽  
Ben Clevenger
Keyword(s):  
Liver Disease ◽  
Blood Product ◽  
Point Of Care ◽  
Massive Bleeding ◽  
Point Of Care Testing ◽  
Hemostatic System ◽  
Coagulation Tests ◽  
Postoperative Thrombosis ◽  
Coagulation Status ◽  
Point Of Care Tests

AbstractThe alterations in coagulation and hemostasis that accompany liver disease are complex, and while patients with this disease have traditionally been perceived as having a bleeding diathesis, it is now understood that in stable patients hemostasis is “re-balanced.” Hepatic surgery, and particularly liver transplantation, can be associated with large fluid shifts, massive bleeding, and coagulopathy, as well as postoperative thrombosis. Point-of-care tests (POCTs) of coagulation facilitate goal-directed treatments and hemostatic monitoring in dynamic environments where the coagulation status can alter rapidly and often unpredictably. POCTs reflect more accurately the re-balanced hemostatic system than do conventional coagulation tests (CCTs). Viscoelastic POCT-guided transfusion algorithms permit a reduction in blood product administration and are a key component of patient blood management programs. Moreover, viscoelastic POCTs are better able to identify patients with hypercoagulability than CCTs. With thrombosis increasingly recognized to be a problem in patients with liver disease, POCTs hold promise for both individualized bleeding and thrombosis management.

scholarly journals Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Gut ◽  
2020 ◽  
Vol 69 (8) ◽  
pp. 1382-1403 ◽  
Author(s):  
James Neuberger ◽  
Jai Patel ◽  
Helen Caldwell ◽  
Susan Davies ◽  
Vanessa Hebditch ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Royal College ◽  
Clinical Information ◽  
British Society ◽  
Clinical State ◽  
Evidence Based ◽  
Or Management ◽  
Antiplatelet Medication ◽  
Coagulation Tests

Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.

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