Nearly one-third of stroke patients receive blood coagulation testing when the result is unlikely to influence treatment

Patent foramen ovale (PFO) is an important underlying source of cryptogenic stroke (CS) associated with hematologic procoagulability. However, the association of genetically identified hyperocagulability and paradoxical embolism has been difficult to establish due to retrospective analysis and the limited numbers of of known genetically identified hypercoagulable conditions. In this study, we explored the utility of conventional coagulation status in PFO related stroke, as the patients may harbor genetically unidentified hyperocoagulable conditions. Method: Eligible pts were prospectively recruited in accordance with IRB, and underwent conventional coagulation testing (PT/PTT) testing within 12 hours of stroke. All patients underwent full cryptogenic workup such as MRI/MRA, mobile cardiac outpatient telemetry (>30 days), cardiac echo, and hypercoagulable testing. Results: We screened 4,831 pts admitted with acute neurologic diseases, and recruited 358 eligible acute ischemic stroke pts. 54 (15.1%) pts had CS and 32 pts had PFO related stroke. While there is no difference between PFO-related CS and PFO-unrelated CS on full hypercaogulable screen (protein S, protein C, FVL, PTGM, ATIII, APLAb, LA, hcy), aPTT was statistically significantly shortened in PFO-related stroke patients (PFO CS vs. non-PFO CS: aPTT 27.2±4.1s vs. 29.9±2.3s). ROC curve indicates early shortened aPTT can predict PFO related stroke (sensitivity 70%, specificity 81.5%, p=0.017) (see Figure). Conclusion: We found real time aPTT to be significantly shortened in patients eventually diagnosed with paradoxical embolism related to PFO. While studies in larger pt cohorts accounting for other potential confounders are underway, this proof-of-concept study demonstrates the importance and utility of early conventional coagulation testing in identifying paradoxical embolism. Pts with shortened aPTT may need additional workup for other underlying hypercoagulable conditions.

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Advancing blood coagulation testing to the point of care in response to molecular biology-driven development of pharmaceuticals

Clinical Chemistry ◽

10.1093/clinchem/39.9.1982 ◽

1993 ◽

Vol 39 (9) ◽

pp. 1982-1984 ◽

Cited By ~ 3

Author(s):

B J Oberhardt

Keyword(s):

Molecular Biology ◽

Blood Coagulation ◽

Point Of Care ◽

Coagulation Testing

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Coagulation Differences Detectable in Deep and Lobar Primary Intracerebral Hemorrhage Using Thromboelastography

Neurosurgery ◽

10.1093/neuros/nyaa056 ◽

2020 ◽

Vol 87 (5) ◽

pp. 918-924

Author(s):

David Roh ◽

Glenda L Torres ◽

Chunyan Cai ◽

Christopher Zammit ◽

Alexandra S Reynolds ◽

...

Keyword(s):

Linear Regression ◽

Intracerebral Hemorrhage ◽

Blood Coagulation ◽

Whole Blood ◽

Medical Center ◽

Linear Regression Analysis ◽

Laboratory Data ◽

Clot Formation ◽

Stroke Severity ◽

Coagulation Testing

Abstract BACKGROUND There are radiographic and clinical outcome differences between patients with deep and lobar intracerebral hemorrhage (ICH) locations. Pilot studies suggest that there may be functional coagulation differences between these locations detectable using whole blood coagulation testing. OBJECTIVE To confirm the presence of interlocation functional coagulation differences using a larger cohort of deep and lobar ICH patients receiving whole blood coagulation testing: thromboelastography (TEG; Haemonetics). METHODS Clinical and laboratory data were prospectively collected between 2009 and 2018 for primary ICH patients admitted to a tertiary referral medical center. Deep and lobar ICH patients receiving admission TEG were analyzed. Patients with preceding anticoagulant use and/or admission coagulopathy (using prothrombin time/partial thromboplastin time/platelet count) were excluded. Linear regression models assessed the association of ICH location (independent variable) with TEG and traditional plasma coagulation test results (dependent variable) after adjusting for baseline hematoma size, age, sex, and stroke severity. RESULTS We identified 154 deep and 53 lobar ICH patients who received TEG. Deep ICH patients were younger and had smaller admission hematoma volumes (median: 16 vs 29 mL). Adjusted multivariable linear regression analysis revealed longer TEG R times (0.57 min; 95% CI: 0.02-1.11; P = .04), indicating longer clot formation times, in deep compared to lobar ICH. No other TEG parameter or plasma-based coagulation differences were seen. CONCLUSION We identified longer clot formation times, suggesting relative coagulopathy in deep compared to lobar ICH confirming results from prior work. Further work is required to elucidate mechanisms for these differences and whether ICH location should be considered in future coagulopathy treatment paradigms for ICH.

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The effects of fructose diphosphate on routine coagulation tests in vitro

Scientific Reports ◽

10.1038/s41598-021-04263-y ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Tongqing Chen ◽

Duan Chen ◽

Lu Chen ◽

Zhengxu Chen ◽

Baolong Wang ◽

...

Keyword(s):

Platelet Aggregation ◽

Blood Coagulation ◽

Detection System ◽

Coagulation System ◽

Thrombin Time ◽

Aggregation Rate ◽

Coagulation Testing ◽

Coagulation Tests ◽

Routine Coagulation

AbstractTo evaluate the effects of fructose diphosphate (FDP) on routine coagulation tests in vitro, we added FDP into the mixed normal plasma to obtain the final concentration of 0, 1, 2, 3, 4, 5, 6, 10, 15, 20, 25, 30 and 35 mg/mL of drug. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FBG) and thrombin time (TT) of samples were analyzed with blood coagulation analyzers from four different manufacturers(Sysmex, Stago, SEKISUI and Werfen) and their corresponding reagents, respectively. Before the experiment, we also observed whether there were significant differences in coagulation test results of different lots of reagents produced by each manufacturer. At the same time as the four routine clotting tests, the Sysmex blood coagulation analyzer and its proprietary analysis software were used to detect the change of maximum platelet aggregation rate in platelet-rich plasma after adding FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL). The results of PT, aPTT and TT showed a FDP (0–35 mg/mL) concentration-dependent increase and a FBG concentration-dependent decrease. The degree of change (increase or decrease) varied depending on the assay system, with PT and aPTT being more affected by the Sysmex blood coagulation testing instrument reagent system and less affected by CEKISUI, TT less affected by CEKISUI and more affected by Stago, and FBG less affected by Stago and more affected by Sysmex. The results of PT, aPTT and TT were statistically positively correlated with their FDP concentrations, while FBG was negatively correlated. The correlation coefficients between FDP and the coagulation testing systems of Sysmex, Stago, Werfen and SEKISUI were 0.975, 0.988, 0.967, 0.986 for PT, and 0.993, 0.989, 0.990 and 0.962 for aPTT, 0.994, 0.960, 0.977 and 0.982 for TT, − 0.990, − 0.983, − 0.989 and − 0.954 for FBG, respectively. Different concentrations of FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL) had different effects on the maximum aggregation rate of platelet induced by the agonists of adenosine diphosphate (ADP, 5 µmol/L), arachidonic acid (Ara, 1 mmol/L), collagen (Col, 2.5 µg/mL) and epinephrine (Epi,10 µmol/L), but the overall downward trend was consistent, that is, with the increase of FDP concentration, the platelet aggregation rate decreased significantly. Our experimental study demonstrated a possible effect of FDP on the assays of coagulation and Platelet aggregation, which may arise because the drug interferes with the coagulation and platelet aggregation detection system, or it may affect our in vivo coagulation system and Platelet aggregation function, the real mechanism of which remains to be further verified and studied.

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The blood coagulation tests from ischemic stroke patients with or without type 2 diabetes mellitus

Biomedical Research ◽

10.4066/biomedicalresearch.29-18-332 ◽

2018 ◽

Vol 29 (14) ◽

Author(s):

Olha Kravchenko ◽

Volodymyr Melnyk ◽

Tetiana Tsarenko ◽

Oleksandra Kostiuk ◽

Tetyana Halenova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Ischemic Stroke ◽

Blood Coagulation ◽

Blood Coagulation Tests ◽

Stroke Patients ◽

Coagulation Tests

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Blood Coagulation Testing Smartphone Platform Using Quartz Crystal Microbalance Dissipation Method

Sensors ◽

10.3390/s18093073 ◽

2018 ◽

Vol 18 (9) ◽

pp. 3073 ◽

Cited By ~ 3

Author(s):

Jia Yao ◽

Bin Feng ◽

Zhiqi Zhang ◽

Chuanyu Li ◽

Wei Zhang ◽

...

Keyword(s):

Blood Coagulation ◽

Quartz Crystal Microbalance ◽

Quartz Crystal ◽

Clinical Laboratory ◽

Point Of Care ◽

Dissipation Factor ◽

Parylene C ◽

Adhesive Surface ◽

Self Testing ◽

Coagulation Testing

Blood coagulation function monitoring is important for people who are receiving anticoagulation treatment and a portable device is needed by these patients for blood coagulation self-testing. In this paper, a novel smartphone based blood coagulation test platform was proposed. It was developed based on parylene-C coated quartz crystal microbalance (QCM) dissipation measuring and analysis. The parylene-C coating constructed a robust and adhesive surface for fibrin capturing. The dissipation factor was obtained by measuring the frequency response of the sensor. All measured data were sent to a smartphone via Bluetooth for dissipation calculation and blood coagulation results computation. Two major coagulation indexes, activated partial thromboplastin time (APTT) and prothrombin time (PT) were measured on this platform compared with results by a commercial hemostasis system in a clinical laboratory. The measurement results showed that the adjusted R-square (R2) value for APTT and PT measurements were 0.985 and 0.961 respectively. The QCM dissipation method for blood coagulation measurement was reliable and effective and the platform together with the QCM dissipation method was a promising solution for point of care blood coagulation testing.

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