Rotational thromboelastometry results are associated with care level in COVID-19

Abstract High prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The primary aim of this study was to test whether rotational thromboelastometry (ROTEM) at admission indicates hypercoagulopathy and predicts the disease severity, assessed as care level, in COVID-19 patients. The study was designed as a prospective, observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: (1) regular wards or (2) wards with specialized ventilation support. Conventional coagulation tests, blood type and ROTEM were taken at admission. 60 patients were included; age 61 (median), 67% men, many with comorbidities (e.g. hypertension, diabetes). The ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with in healthy controls (p < 0.001) and higher in severely ill patients compared with in patients at regular wards (p < 0.05). Our results suggest that hypercoagulopathy is present early in patients with mild to moderate disease, and more pronounced in severe COVID-19 pneumonia. Non-O blood types were not overrepresented in COVID-19 positive patients. ROTEM variables showed hypercoagulopathy at admission and this pattern was more pronounced in patients with increased disease severity. If this feature is to be used to predict the risk of thromboembolic complications further studies are warranted.

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Rotational Thromboelastometry predicts care level in COVID-19

10.1101/2020.06.11.20128710 ◽

2020 ◽

Cited By ~ 2

Author(s):

Lou M. Almskog ◽

Agneta Wikman ◽

Jonas Svensson ◽

Michael Wanecek ◽

Matteo Bottai ◽

...

Keyword(s):

Prospective Observational Study ◽

Severe Disease ◽

Healthy Controls ◽

Care Level ◽

Rotational Thromboelastometry ◽

High Prevalence ◽

Ventilation Support ◽

Level 1 ◽

Clot Formation Time ◽

Maximum Clot Firmness

AbstractBackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment.ObjectivesTo test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients.MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia.ConclusionROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

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Rotational Thromboelastometry Predicts Care Level in COVID-19: A Prospective, Observational Study.

10.21203/rs.3.rs-57906/v1 ◽

2020 ◽

Author(s):

Lou M. Almskog ◽

Agneta Wikman ◽

Jonas Svensson ◽

Michael Wanecek ◽

Matteo Bottai ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Severe Disease ◽

Healthy Controls ◽

Care Level ◽

Rotational Thromboelastometry ◽

High Prevalence ◽

Level 1 ◽

Clot Formation Time ◽

Maximum Clot Firmness

Abstract BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. ConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

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Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

PLoS ONE ◽

10.1371/journal.pone.0243604 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243604

Author(s):

Thiago Domingos Corrêa ◽

Ricardo Luiz Cordioli ◽

João Carlos Campos Guerra ◽

Bruno Caldin da Silva ◽

Roseny dos Reis Rodrigues ◽

...

Keyword(s):

Plasma Levels ◽

Protein C ◽

Protein S ◽

Rotational Thromboelastometry ◽

Normal Reference Range ◽

Coagulation Profile ◽

Coagulation Abnormalities ◽

Coagulation Tests ◽

Over Time ◽

Maximum Clot Firmness

Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objective To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. Methods Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. Results Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM–FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability. Conclusion COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

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Comparison of standard coagulation tests and rotational thromboelastometry for hemostatic system monitoring during orthotopic liver transplantation: Results from a pilot study

Medicinski pregled ◽

10.2298/mpns1510301n ◽

2015 ◽

Vol 68 (9-10) ◽

pp. 301-307 ◽

Cited By ~ 3

Author(s):

Sladjana Novakovic-Anucin ◽

Dusica Kosanovic ◽

Sanja Gnip ◽

Visnja Canak ◽

Velibor Cabarkapa ◽

...

Keyword(s):

Liver Transplantation ◽

Platelet Count ◽

Fibrinogen Level ◽

Activated Partial Thromboplastin Time ◽

Coagulation Time ◽

Rotational Thromboelastometry ◽

Hemostatic System ◽

Coagulation Tests ◽

Clot Formation Time ◽

Maximum Clot Firmness

Introduction. During liver transplantation, continuous laboratory monitoring of complex changes of the hemostatic system is necessary. The aim of this study was to compare two methods of monitoring: standard coagulation tests and rotational thromboelastometry. Material and Methods. The study included 17 patients who had undergone orthotopic liver transplantation in the Clinical Centre of Vojvodina, Serbia in the period from June 2008 to October 2012. The coagulation parameters (platelet count, activated partial thromboplastin time, prothrombin time and fibrinogen level) were compared with the thromboelastometric parameters (coagulation time, clot formation time and maximal clot firmness). Results. The results showed a statistically significant correlation between the platelet count and maximum clot firmness of the intrinsically (r=0.51, p<0.001) and extrinsically activated thromboelastometric assays (r=0.64, p<0.001). The fibrinogen level and maximum clot firmness of the fibrinogen thromboelastometric test correlated significantly as well (r=0.44, p=0.002). No significant correlations were found among the activated partial thromboplastin time, prothrombin time, coagulation time and clot formation time. Conclusion. For an adequate perioperative monitoring of the dynamic intraoperative hemostatic changes and the optimal use of blood derivatives during liver transplantation, the combined application of standard coagulation tests and rotational thromboelastometry should be considered whenever possible. Science and Technological Development, Republic of Serbia

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Prevalence of Acute Traumatic Coagulopathy in Acutely Traumatized Dogs and Association with Clinical and Laboratory Parameters at Presentation

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1721707 ◽

2021 ◽

Author(s):

Yaiza Herrero ◽

Rahel Jud Schefer ◽

Benjamin M. Muri ◽

Nadja E. Sigrist

Keyword(s):

Clotting Time ◽

Acute Traumatic Coagulopathy ◽

Rotational Thromboelastometry ◽

Clot Strength ◽

Laboratory Parameters ◽

Coagulation Abnormalities ◽

Trauma Triage ◽

Clot Formation Time ◽

Maximum Clot Firmness ◽

Traumatic Coagulopathy

Abstract Objective The aim of this study was to determine the prevalence of acute traumatic coagulopathy (ATC) and identify associated clinical and laboratory parameters including rotational thromboelastometry. Study Design Dogs presenting within 6 hours after trauma were allocated to the ATC or non-ATC group based on thromboelastometry analysis (ex-tem S, in-tem S, fib-tem S). ATC was defined as ≥2 hypocoagulable parameters in 1 profile and ≥ 1 hypocoagulable parameter in an additional profile. Parameters used were ex-tem and in-tem clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis and fib-tem MCF. Clinical and laboratory parameters at presentation, animal trauma triage (ATT) score, transfusion requirement and outcome were compared. Logistic regression was used to identify independent factors associated with ATC. Results Eleven of 33 dogs presented with ATC and showed ex-tem CT and CFT prolongation and reduced MCF amplitude in all profiles (all p < 0.001). pH (p = 0.043) and potassium concentration (p = 0.022) were significantly lower and bleeding (p = 0.027) and plasma transfusions (p = 0.001) more common in dogs with ATC. Time after trauma (p = 0.040) and Animal Trauma Triage score (p = 0.038, including haematocrit as confounding factor) were associated with the presence of ATC. Conclusion Acute traumatic coagulopathy is more common in traumatized dogs than previously reported. Acute traumatic coagulopathy was associated with acidosis, Animal trauma triage score, time after trauma and higher transfusion needs. Coagulation abnormalities include ex-tem CT and CFT prolongations and decreased clot strength.

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MANAGEMENT OF APHID BORNE POTATO VIRUS Y (PVY) THROUGH CHEMICAL AND BIO-CHEMICAL METHODS

World Journal of Biology and Biotechnology ◽

10.33865/wjb.002.02.0108 ◽

2017 ◽

Vol 2 (2) ◽

pp. 159

Author(s):

Altaf Hussain ◽

Muhammad Arif ◽

Aqleem Abbas

Keyword(s):

Disease Severity ◽

Potato Virus Y ◽

Disease Incidence ◽

Field Conditions ◽

Individual State ◽

Chemical Methods ◽

Neem Extract ◽

Severity Level ◽

Level 1 ◽

Disease Severity Level

The aim of this study was the management of potato virus Y (PVY) in potato cv. Desiree through chemical and non-chemical methods. The experiment was carried out at the New Developmental Farm (NDF), The University of Agriculture, Peshawar during spring season, 2014 under field conditions. One of the major objectives of the experiment was to assess the effectiveness of the treatments application in their individual state as well as in combinations under field conditions. The treatments were mineral oil, insecticide, biocide and their combinations. Among various treatments, Diver was effective with disease severity level (1) and % disease incidence (40) in individual state and in combination (Diver + Confidor) and (Diver + Confidor + Neem extract) gave good results with % disease incidence (33.33) and with disease severity level (1). Neem extract was found to be less effective when used individually with % disease incidence (56.66) and with disease severity level (3), whereas Confidor when applied individually was more effective than Neem extract with % disease incidence (50) and with disease severity level (2). Moreover Diver in combination with Neem extract was found to be less effective in management of PVY as compared to Diver in combination with Confidor with % disease incidence (40) and disease severity level (1). Three aphid species were found in the field i.e Myzus persicae (Sulzer), Aphid gossypii (Glover) and Macrosiphum euphorbiae (Thomas). In case of aphid’s population, Confidor was more effective in reducing aphid’s population as compared to Diver and Neem extract. Finally, it can be concluded that Diver alone was more effective in the management of PVY. However in combination, Diver with Confidor significantly managed PVY under field conditions

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Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study

Diagnostics ◽

10.3390/diagnostics11111995 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1995

Author(s):

Georgios N. Katsaras ◽

Rozeta Sokou ◽

Andreas G. Tsantes ◽

Aikaterini Konstantinidi ◽

Dimitra Gialamprinou ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Extrinsic Pathway ◽

Term Neonates ◽

Rotational Thromboelastometry ◽

Significant Prolongation ◽

Clot Formation Time ◽

Maximum Clot Firmness

Background: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). Methods: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia “Aghios Panteleimon”. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Results: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates.

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Epidemiology of Blood Stream Infections at a Level-1 Trauma Care Center of India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.129086 ◽

2014 ◽

Vol 6 (01) ◽

pp. 022-027 ◽

Cited By ~ 6

Author(s):

Purva Mathur ◽

Prince Varghese ◽

Vibhor Tak ◽

Jacinta Gunjiyal ◽

Sanjeev Lalwani ◽

...

Keyword(s):

Pathogenic Bacteria ◽

Care Center ◽

Subsequent Development ◽

Bloodstream Infections ◽

Blood Stream ◽

Common Source ◽

Trauma Patients ◽

Major Life ◽

High Prevalence ◽

Level 1

ABSTRACT Purpose: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices. Materials and Methods: A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome. Results: A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens. Conclusions: Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.

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Immunothrombotic Dysregulation in COVID-19 Pneumonia Is Associated With Respiratory Failure and Coagulopathy

Circulation ◽

10.1161/circulationaha.120.048488 ◽

2020 ◽

Vol 142 (12) ◽

pp. 1176-1189 ◽

Cited By ~ 40

Author(s):

Leo Nicolai ◽

Alexander Leunig ◽

Sophia Brambs ◽

Rainer Kaiser ◽

Tobias Weinberger ◽

...

Keyword(s):

Respiratory Failure ◽

Severe Acute Respiratory Syndrome ◽

Disease Severity ◽

Severe Pneumonia ◽

Corona Virus ◽

Coagulation Tests ◽

Myocardial Involvement ◽

Platelet Aggregates ◽

Polymerase Chain

Background: Severe acute respiratory syndrome corona virus 2 infection causes severe pneumonia (coronavirus disease 2019 [COVID-19]), but the mechanisms of subsequent respiratory failure and complicating renal and myocardial involvement are poorly understood. In addition, a systemic prothrombotic phenotype has been reported in patients with COVID-19. Methods: A total of 62 subjects were included in our study (n=38 patients with reverse transcriptase polymerase chain reaction–confirmed COVID-19 and n=24 non–COVID-19 controls). We performed histopathologic assessment of autopsy cases, surface marker–based phenotyping of neutrophils and platelets, and functional assays for platelet, neutrophil functions, and coagulation tests, as well. Results: We provide evidence that organ involvement and prothrombotic features in COVID-19 are linked by immunothrombosis. We show that, in COVID-19, inflammatory microvascular thrombi are present in the lung, kidney, and heart, containing neutrophil extracellular traps associated with platelets and fibrin. Patients with COVID-19 also present with neutrophil-platelet aggregates and a distinct neutrophil and platelet activation pattern in blood, which changes with disease severity. Whereas cases of intermediate severity show an exhausted platelet and hyporeactive neutrophil phenotype, patients severely affected with COVID-19 are characterized by excessive platelet and neutrophil activation in comparison with healthy controls and non–COVID-19 pneumonia. Dysregulated immunothrombosis in severe acute respiratory syndrome corona virus 2 pneumonia is linked to both acute respiratory distress syndrome and systemic hypercoagulability. Conclusions: Taken together, our data point to immunothrombotic dysregulation as a key marker of disease severity in COVID-19. Further work is necessary to determine the role of immunothrombosis in COVID-19.

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Trichuris suis secrete products that reduce disease severity in a multiple sclerosis model

Acta Parasitologica ◽

10.1515/ap-2017-0002 ◽

2017 ◽

Vol 62 (1) ◽

Cited By ~ 10

Author(s):

Christine Søholm Hansen ◽

Henrik Hasseldam ◽

Idahella Hyldgaard Bacher ◽

Stig Milan Thamsborg ◽

Flemming Fryd Johansen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Central Nervous System ◽

Nervous System ◽

Disease Severity ◽

Western World ◽

Cns Disease ◽

High Prevalence ◽

High Level ◽

Reduce Disease Severity ◽

Multiple Sclerosis Model

AbstractMultiple sclerosis is a chronic inflammatory central nervous system (CNS) disease, which affects about 1 in 1000 individuals in the western world. It has been suggested that this relatively high prevalence is linked to a high level of hygiene,

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