Discontinuation of the Bleeding Time Test without Detectable Adverse Clinical Impact

Abstract Background: The bleeding time (BT) test predicts a higher bleeding complication rate in populations at risk for inherited or acquired platelet dysfunction, but it is of limited assistance in evaluating individual patients. There are no reports of clinical outcomes after discontinuation of the BT test. Methods: Interviews with a subset of the physicians who had ordered the BT test before discontinuation of the test were conducted. The total number of platelet-aggregation tests, the mean number of monthly, unmodified platelet units transfused, the incidence of kidney biopsy complications, and the number of doses of 1-deamino-8-d-arginine vasopressin (DDAVP) administered 5 months before and after discontinuation of the BT test were compared. We recorded the rates of bleeding complications in the Major Surgery Risk Pool during the 12 months before and the 5 months after the discontinuation of the BT test. Results: Clinicians reported they did not significantly change their preprocedural work-ups, postpone an invasive procedure, experience an increase in bleeding complications, or increase their use of blood products after discontinuation of the BT test. Platelet-aggregation tests (n = 9, before and after), platelet transfusions (P = 0.958), and DDAVP administration (before = 24; after = 10) did not increase after discontinuation of the BT test. The rate of postprocedural bleeding complications did not increase significantly in either Major Surgery Risk Pool cases (<3ς deviation from the mean rate) or in patients undergoing renal biopsies (P = 0.225 for decrease in hematocrit; P = 1.000 for the percentage of patients transfused) after discontinuation of the BT test. Conclusions: Our study failed to identify a clinically significant, negative impact of discontinuing the BT test.

Download Full-text

Comparative Arterial Antithrombotic Activity of Clopidogrel and Acetyl Salicylic Acid in the Pig

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646307 ◽

1992 ◽

Vol 68 (05) ◽

pp. 500-505 ◽

Cited By ~ 32

Author(s):

Ch M Samama ◽

Ph Bonnin ◽

M Bonneau ◽

G Pignaud ◽

E Mazoyer ◽

...

Keyword(s):

Platelet Aggregation ◽

Femoral Artery ◽

Bleeding Time ◽

Ex Vivo ◽

Flow Reduction ◽

Cyclic Flow ◽

Left Femoral Artery ◽

Before And After ◽

The Right ◽

Induced Aggregation

SummaryWe investigated the comparative antithrombotic properties of clopidogrel, an analogue of ticlopidine, and aspirin, using the Folts' model on femoral arteries in 22 pigs. On each animal, clopidogrel or aspirin were used to treat the thrombotic process on the left femoral artery and to prevent this process on the right femoral artery. Sequentially: an injury and stenosis were carried out on the left femoral artery; the thrombotic process was monitored with a Doppler during a 30-min observation period for cyclic flow reductions or permanent cessation of flow; after the first cyclic flow reduction occurred, clopidogrel (5 mg kg-1) or aspirin (2.5, 5, 100 mg kg-1) were injected intravenously; if cyclic flow reductions were abolished, epinephrine (0.4 µg kg-1 min-1) was injected to try to restore cyclic flow reductions and/or permanent cessation of flow; then injury and stenosis were applied on the right femoral artery. Before and after injection of clopidogrel or aspirin, ear immersion bleeding times and ex-vivo platelet aggregation were performed. Clopidogrel (n = 7) abolished cyclic flow reductions in all animals and epinephrine did not restore any cyclic flow reduction. On the right femoral artery, cyclic flow reductions were efficiently prevented, even for two injuries. Basal bleeding time (5 min 28) was lengthened (>15 min, 30 min after clopidogrel and remained prolonged even after 24 h). ADP-induced platelet aggregation was inhibited (more than 78%). Comparatively, aspirin had a moderate and no dose-dependent effect. Aspirin 2.5 mg kg-1 (n = 6) abolished cyclic flow reductions in 2 animals, CFR reoccurred spontaneously in one animal and epinephrine restored it in a second animal. Aspirin 5 mg kg-1 (n = 6) abolished cyclic flow reductions in only 3 animals and epinephrine always restored it. Aspirin 100 mg kg-1 (n = 3) was unable to abolish cyclic flow reductions. On the right femoral artery, aspirin did not significantly prevent cyclic flow reductions which occurred in all animals after one (n = 14) or two injuries (n = 1), except for one animal. Basal bleeding time was lengthened but it shortened rapidly, reaching its basal value after 24 h. ADP-induced aggregation was not significantly inhibited, whereas arachidonic acid induced aggregation was always inhibited. Clopidogrel appears as a more potent antithrombotic drug than aspirin in this model, in treating and preventing spontaneous or epinephrine-induced cyclic flow reductions and lengthening bleeding time.

Download Full-text

Fatigue Assessment of Mooring Chain Considering the Effects Of Mean Load and Corrosion

10.1115/omae2021-62775 ◽

2021 ◽

Author(s):

Erling N. Lone ◽

Thomas Sauder ◽

Kjell Larsen ◽

Bernt J. Leira

Keyword(s):

Negative Impact ◽

Fatigue Tests ◽

Design Practice ◽

Extended Formulation ◽

Considerable Influence ◽

Corrosion Condition ◽

Capacity Model ◽

Significant Negative Impact ◽

The Mean ◽

Mooring Chain

Abstract Results from full scale fatigue tests of offshore mooring chains performed in recent years have revealed considerable influence of both mean load and corrosion condition on the fatigue capacity. It has been shown that a reduction of the mean load gives an increase in fatigue life, whereas the corrosion experienced by used chains have a significant negative impact. Neither of these effects are properly addressed by current S-N design curves or design practice. This paper suggests an extended S-N curve formulation, that includes the effects of mean load and corrosion condition. The parameters of the extended formulation are estimated empirically from mooring chain test data that includes new and used chains, with various mean loads and with different degrees of corrosion. The fitted capacity model is then used for fatigue calculation for the mooring system of a semi-submersible, showing the importance of using realistic mean loads and mooring chain corrosion in fatigue assessments.

Download Full-text

RADIOGRAPHIC IMPLICATIONS OF THE SURGICAL WAITING LIST FOR THE TREATMENT OF SPINAL DEFORMITY

Coluna/Columna ◽

10.1590/s1808-185120181701179018 ◽

2018 ◽

Vol 17 (1) ◽

pp. 19-22

Author(s):

LEONARDO YUKIO JORGE ASANO ◽

MARINA ROSA FILÉZIO ◽

MATEUS PIPPA DEFINO ◽

VINÍCIUS ALVES DE ANDRADE ◽

ANDRÉ EVARISTO MARCONDES CESAR ◽

...

Keyword(s):

Surgical Planning ◽

Negative Impact ◽

Waiting Times ◽

Waiting List ◽

Surgical Morbidity ◽

Level Of Evidence ◽

Mean Waiting Time ◽

Significant Negative Impact ◽

Double Approach ◽

The Mean

ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

Download Full-text

MEASURING WHOLE BLOOD PLATELET AGGREGATION AND ATP-RELEASE WITH A CHRONO-LOG WHOLE BLOOD LUMI-AGGREGOMETER: EFFECT OF STORAGE TIME OF BLOOD SAMPLES

10.1055/s-0038-1644555 ◽

1987 ◽

Author(s):

F C Sieders ◽

A C v Houwelingen ◽

G Hornstra

Keyword(s):

Platelet Aggregation ◽

Whole Blood ◽

Storage Time ◽

Bleeding Time ◽

Atp Release ◽

Blood Platelet ◽

Blood Samples ◽

Before And After ◽

Positive Correlations ◽

Blood Platelet Aggregation

The influence of storing blood for either one or two hours after blood sampling, on whole blood platelet aggregation and ATP-release was measured with a Chrono-log whole blood lumi-aggregometer, in 21 healthy male volunteers. Storage of blood samples, gently revolving at 37 °C in an incubator for one hour, caused a significant increase in aggregation and release as compared with results obtained immediately after sampling. After two hours' storage, the values had returned to their initial levels.Significant positive correlations were seen between values obtained before and after storage of blood, and between various aggregation and release parameters. In this study, bleeding time nor hematocrit values were significantly correlated with the aggregation and release parameters. The considerable influence of storage time on whole blood platelet aggregation and ATP-release underlines the importance of performing these determinations immediately after sampling, or possibly after a standardized storage time. Otherwise, comparison of results -obtained either in clinical situations or in trials - will increase variability as a result of which false conclusions may be obtained. This will be illustrated in a small trial using paracetamol.

Download Full-text

Effect Of Prednisone On Platelet Function In Patients With Bleeding Disorders

10.1055/s-0038-1653330 ◽

1981 ◽

Author(s):

R McKenna ◽

F Bachmann ◽

O Pichairut ◽

B Whittaker

Keyword(s):

Platelet Count ◽

Platelet Function ◽

Bleeding Time ◽

Platelet Factor ◽

Von Willebrand's Disease ◽

Von Willebrand’S Disease ◽

Before And After ◽

History Of ◽

The Mean ◽

One Year

There is considerable controversy regarding the effect of Prednisone on the hemostatic mechanism of normal people versus patients with bleeding diatheses. We administered Prednisone 15 mg TID to patients with a positive history of a bleeding disorder, and evaluated the bleeding time and other in-vitrc tests of platelet function prior to and between the 5th and 7th day after Prednisone.Eleven patients were admitted into this study over a one year period. All patients had a history of excessive bruising, epistaxis, bleeding after dental extractions, and gastrointestinal or other bleeding in various combinations. Two out of the eleven had template bleeding times of greater than 15 minutes both before and after the Prednisone. These two patients were subsequently proven to have von Willebrand’s disease by the washed platelet ristocetin assay. In the remaining 9 patients, the pre-Prednisone bleeding time was 9.3 ±3.7 minutes (x ± 1 S.D.) whereas the post-Prednisone bleeding time was 5.8 ±3.6 minutes (x ±1 S.D.). These results were significant(td=3.83;df:7;p=0.007).Platelet aggregation in response to exogenous ADP (1 μM, 3 μM) Sigma bovine tendon collagen (1.8 mg/ml F) and epinephrine (5.5 × 104M), platelet retention in a glass bead column or platelet factor 3 availability did not improve or worsen after Prednisone therapy. The mean platelet count of 328,000±94,000 (x ±1 S.D.) was significantly (p=0.05) higher than the mean pre-Prednisone platelet count of 268,000±77,000 (x ±1 S.D.).In conclusion, we have shown that large doses of Prednisone appear to shorten the bleeding time in patients with significant defects in the primary hemostatic mechanism. However the bleeding time improvement is not evident in patients with von Willebrand’s disease.

Download Full-text

Identification ofITGA2BandITGB3Single-Nucleotide Polymorphisms and Their Influences on the Platelet Function

BioMed Research International ◽

10.1155/2016/5675084 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Qian Xiang ◽

Shun-Dong Ji ◽

Zhuo Zhang ◽

Xia Zhao ◽

Yi-Min Cui

Keyword(s):

Platelet Aggregation ◽

Platelet Function ◽

Bleeding Time ◽

Clinical Importance ◽

Adenosine Diphosphate ◽

Thrombin Time ◽

Nucleotide Polymorphisms ◽

Coding Region ◽

Minor Alleles ◽

The Mean

The aim of the study was to investigateITGA2BandITGB3genetic polymorphisms and to evaluate the variability in the platelet function in healthy Chinese subjects. The genetic sequence of the entire coding region of theITGA2BandITGB3genes was investigated. Adenosine diphosphate-induced platelet aggregation, glycoprotein IIb/IIIa content, bleeding time, and coagulation indexes were detected. Thirteen variants in theITGA2Blocus and 29 variants in theITGB3locus were identified in the Chinese population. The rs1009312 and rs2015049 were associated with the mean platelet volume. The rs70940817 was significantly correlated with the prothrombin time. The rs70940817 and rs112188890 were related with the activated partial thromboplastin time, andITGB3rs4642 was correlated with the thrombin time and fibrinogen. The minor alleles of rs56197296 and rs5919 were associated with decreased ADP-induced platelet aggregation, and rs55827077 was related with decreased GPIIb/IIIa per platelet. The rs1009312, rs2015049, rs3760364, rs567581451, rs7208170, and rs117052258 were related with bleeding time. Further studies are needed to explore the clinical importance ofITGA2BandITGB3SNPs in the platelet function.

Download Full-text

The Effects of Ketamin-Midazolam and Ketamin-Propofol on Bispectral Index Score as Sedatives During Bone Marrow Puncture Procedure Among Pediatrics

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v2i1.143 ◽

2021 ◽

Vol 2 (1) ◽

pp. 115-134

Author(s):

Aldiar ◽

Fredi Heru Irwanto ◽

Andi Miarta ◽

Irfannuddin

Keyword(s):

Bone Marrow ◽

Controlled Trial ◽

Invasive Procedure ◽

Combination Group ◽

Exclusion Criteria ◽

Pediatric Leukemia ◽

Significant Difference ◽

Optimal Value ◽

Before And After ◽

The Mean

Background: Bone Marrow Puncture (BMP) is an invasive procedure associated with pain and anxiety. The ketamine-midazolam and the ketamine-propofol is an effectivecombination with minimal side effects. This study of the study aims to compare the effect of the combination of ketamine-midazolam and ketamine- propofol on sedation depth based on BIS in pediatric leukemia patients undergoing BMP. Methods: This study was a randomized controlled trial that was done single-blinded. The population was all pediatric patients diagnosed with leukemia who underwent BMP at RSMH and performed sedation. The research sample is the population that fulfill the inclusion and exclusion criteria. The sample size for each group was 25, with 50 Subjects in total. Sampling was done by block randomization. Results: This study found no differences in sex, age, and body weight between the two groups ([p=1.000], [p=0.845], and [p=0.147], respectively). In this study, there was no difference in mean MAP (p=0.592), oxygen saturation (p=0.164), heart rate (p=0.098), and respiratory rate (p=0.252) before intervention between the two groups. BIS value of the two groups had significant difference before and after the intervention where the two groups could reduce BIS to reach the optimal value of sedation <60 (p <0.05) There was no difference in BIS before intervention in the two groups (p=0.385). In this study, it was found that hypersalivation occurred more frequently in the ketamine-midazolam combination group. Conclusion: The combination of ketamine-midazolam and ketamine-propofol was equally good for sedation as indicated by a decrease in the mean BIS in patients undergoing BMP.

Download Full-text

Abstract WP431: Comparing EMS and Emergency Department Last Known Well Times in Ohio

Stroke ◽

10.1161/str.51.suppl_1.wp431 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mussa Zatreh ◽

Melissa Richardson

Keyword(s):

Emergency Department ◽

Negative Impact ◽

Improve Patient Care ◽

Accurate Information ◽

Hospital Size ◽

Patient Demographics ◽

Significant Negative Impact ◽

The Mean ◽

The Difference ◽

Revascularization Therapy

Introduction: During the hyperacute phase of acute stroke management, time the patient was last known well (LKW) is a critical data element. Hospital Emergency Department (ED) personnel rely on accurate information reported by Emergency Medical Services (EMS) prior to arrival, which triggers the intensity of resources organized to determine patient eligibility for revascularization therapy. Over-triage can cause “alarm fatigue”, provider burnout, and/or overutilization of valuable resources. Conversely, under triage may cause a delay in, or lack of, revascularization therapy, which can have significant negative impact on the patient’s outcome. A review of the literature revealed contradictory data about the accuracy of LKW as reported by EMS. Purpose: The purpose of this project is to determine frequency and magnitude of discrepancies between LKW as reported by EMS and ED. The data was analyzed for trends that may influence discrepancies, such as hospital size, location, and patient demographics. Methods: Data on 2,092 patients from 49 hospitals was analyzed from Get With The Guidelines®-Stroke. The difference in the LKW (ΔLKW) was calculated based on source of documentation from EMS or ED. Three datasets were created based on the magnitude of the ΔLKW. For each dataset, the mean, median and patient demographics such as mean age, race, and stroke type were calculated. Results: Of 2,092 patients, 951 (45%) showed an exact match between LKW as reported by EMS and ED (ΔLKW=0), whereas 1,141 patients (55%) showed a discrepancy in the LKW (ΔLKW>0). Discrepancies were not influenced by hospital location or size. Of the overall population, 54% were male, 18% were black, and 73% were diagnosed with an ischemic stroke. The mean age was 72 years. Further collaboration is needed between EMS and ED personnel to improve the accuracy of LKW, and thereby improve patient care and provider efficiency.

Download Full-text

Effect on Blood Lipids and Haemostasis of a Supplement of Cod-Liver Oil, Rich in Eicosapentaenoic and Docosahexaenoic Acids, in Healthy Young Men

Clinical Science ◽

10.1042/cs0610317 ◽

1981 ◽

Vol 61 (3) ◽

pp. 317-324 ◽

Cited By ~ 270

Author(s):

T. A. B. Sanders ◽

Marguerite Vickers ◽

A. P. Haines

Keyword(s):

Platelet Aggregation ◽

Blood Lipids ◽

Bleeding Time ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Plasma Vitamin ◽

Cod Liver Oil ◽

The Mean ◽

Male Subjects ◽

Docosahexaenoic Acids

1. Twelve healthy male subjects took a daily supplement of 20 ml of cod-liver oil for 6 weeks. This provided 1.8 g of eicosapentaenoic acid (20:5ω3) and 2.2 g of docosahexaenoic acid (22:6ω3). The effects of the supplement on blood lipids, haemostatic variables, bleeding time and plasma vitamin A and carotene were studied. In seven subjects platelet aggregation induced by adenosine 5′-pyrophosphate (ADP) was also studied. 2. The proportions of 20:5ω3 and 22: 6ω3 in platelet and erythrocyte phosphoglycerides were substantially increased by the supplement mainly at the expense of ω6 polyunsaturated fatty acids. 3. Mean plasma triglyceride concentrations were reduced and those of high-density-lipoprotein (HDL) cholesterol were increased by the supplement. 4. The mean bleeding time was significantly prolonged after 3 weeks of taking the supplement, but had returned to the presupplementation value 5 weeks after withdrawal of the supplement. 5. The maximum estimated response to platelet aggregation induced by ADP was increased by the supplement. 6. The mean levels of antithrombin III (immunological) and blood pressure were lower at the end of the period of supplementation and remained so 5 weeks after withdrawal of the supplement. No significant changes in other variables were noted.

Download Full-text

Strategies to minimize readmission rates following major urologic surgery

Therapeutic Advances in Urology ◽

10.1177/1756287217701699 ◽

2017 ◽

Vol 9 (5) ◽

pp. 111-119 ◽

Cited By ~ 3

Author(s):

Janet Baack Kukreja ◽

Ashish M. Kamat

Keyword(s):

Negative Impact ◽

Early Discharge ◽

The United States ◽

Time Frame ◽

Major Surgery ◽

Readmission Rates ◽

Urologic Oncology ◽

Improve Symptom ◽

Significant Negative Impact ◽

Recovery Pathways

Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families. Here, we explore the reasons patients are readmitted, using radical cystectomy as a case study, and means to decrease the incidence of readmissions. Since time to readmission for most major urologic oncology surgeries is within the first 2 weeks after discharge, this time frame is critical for efforts to improve symptom identification and reduce the total number and severity of readmissions. Readmission reduction to zero is unlikely for any major surgery, but with effective coordinated strategies, we must strive to reduce the rates as much as possible, as a means to improve the care continuum for our patients.

Download Full-text