scholarly journals Meta-analysis of coagulation disbalances in COVID-19: 41 studies and 17601 patients

2021 ◽  
Author(s):  
Polina Len ◽  
Gaukhar Iskakova ◽  
Zarina Sautbayeva ◽  
Aigul Kussanova ◽  
Ainur T. Tauekelova ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Publication Bias ◽  
Partial Thromboplastin Time ◽  
Meta Analysis ◽  
Activated Partial Thromboplastin Time ◽  
Coagulation Parameters ◽  
Reticulated Platelets ◽  
Significant Difference ◽  
Funnel Plots ◽  
Egger Test

Introduction. Coagulation parameters are important determinants for COVID-19 infection. We conducted meta-analysis to assess the early hemostatic parameters in retrospective studies in association with severity of infection. Methods. Ovid, PubMed, Web of Sciences, and Google Scholar were searched for research articles that addressed clinical characteristics of COVID-19 patients and disease severity. Results were filtered using exclusion and inclusion criteria and then pooled into a meta-analysis to estimate the standardized mean difference with 95% CI for each of five coagulation parameters (D-dimers, fibrinogen, prothrombin time, platelets count, activated partial thromboplastin time). Two authors independently extracted data and assessed study quality. To explore the heterogeneity and robustness of our fundings, sensitivity and subgroup analyses were conducted. Publication bias was assessed with contour-enhanced funnel plots and Egger test by linear regression. Results. Overall, 41 original studies (17601 patients) on SARS-CoV2 were included. For the two groups of patients, stratified by severity, we identified that D-dimers, fibrinogen, activated partial thromboplastin time, and prothrombin time were significantly higher in the severe group (SMD 0.6985 with 95%CI [0.5155; 0.8815]); SMD 0.661with 95%CI [0.3387; 0.9833]; SMD 0.2683 with 95%CI [0.1357; 0.4009]; SMD 0.284 with 95%CI [0.1472; 0.4208]). In contrast, PLT was significantly lower in patients with more severe cases of COVID-19 (SMD -0.1684 with 95%CI [-0.2826; -0.0542]). Neither the analysis by the leave-one-out method nor the influence diagnostic have identified studies that solely cause significant change in the effect size estimates. Subgroup analysis showed no significant difference between articles originated from different countries but revealed that severity assessment criteria might have influence over estimated effect sizes for platelets and D-dimers. Contour-enhanced funnel plots and the Egger test for D-dimers and fibrinogen revealed significant asymmetry that might be a sign of publication bias. Conclusions. The standard coagulation laboratory parameters with exception of platelets counts are significantly elevated in patients with severe COVID-19. However, fibrinolysis shutdown requires evaluation outside conventional coagulation tests and analysis of additional specific markers related to clotting formation and PLT characteristics. We hypothesize that a proportion and parameters of immature reticulated platelets may serve as additional biomarkers for prediction of adverse events.

Thromboelastography - Viscoelastic Haemostatic Assay (VHA) Versus Routine Plasma Based Coagulation Parameters in Trauma Patients to Detect Coagulopathy within 24 Hrs After Injury

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5248-5248
Author(s):  
Bhaumik Arvindkumar Shah ◽  
Arulselvi Subramanium ◽  
Subhadra Sharma ◽  
Deepak Agrawal ◽  
Gaurav Chhabra ◽  
...  
Keyword(s):  
Head Injury ◽  
Prothrombin Time ◽  
Whole Blood ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Trauma Patients ◽  
Thrombin Time ◽  
Coagulation Parameters ◽  
Conventional Methods ◽  
D Dimer

Abstract Abstract 5248 In India trauma related deaths occur every 1.9 minutes. Mortality in severe traumatic injury (ISS>16) is six times higher in developing country like India. Coagulopathy is observed in almost 25– 30% of trauma patients which itself is an independent risk factor for haemorrhage. Coagulopathy detected early after injury is indicative of injury severity and itself is a prognostic factor for mortality. Aim To find out the usefulness of thromboelastography (TEG) in detecting coagulopathy in contrast to conventional methods of plasma based standard coagulation parameters (PT, aPTT, TT, fibrinogen, D-dimer) Objective To detect coagulopathy early by TEG in trauma patients within 24 hrs after injury which can be useful to guide haemostatic therapies to reduce mortality. Materials and methods Patients admitted to trauma casualty were studied within 24 hrs after injury. Native whole blood was withdrawn through venepuncture appropriately in syringe using 21G needle and TEG was performed within 2 mins. Blood was also collected in citrated tube to assess standard coagulation parameters (prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, D-dimer) and also by means of thromboelastography. Results Patients (n=87,New ISS-24.78(mean)) admitted to J.P.N Apex trauma centre casualty from 1st April,2011 to 31st July,2011 were studied. The cases included in the study were isolated head injury (n=40, NISS-25.87(mean)), multiple trauma with head injury (n=13,NISS – 30.69 (mean)) and trauma other than head injury (n=34, NISS-21.24 (mean)).Thromboelastography was performed using whole blood (n=69) and citrated blood (n=18). Coagulation tests were performed on all 87 patients using both TEG and conventional coagulation parameters. Total 52 patients showed coagulopathy by TEG and only 14 patients showed coagulopathy by standard coagulation parameters (prothrombin time, activated partial thromboplastin time). Only in 10 cases coagulopathy was detected by both methods. 4 patients showed coagulopathy only by conventional methods while 42 patients showed coagulopathy by only Thromboelastography (TEG). To find out whether there is any stastistical significance in the observed apparently better result by TEG, McNemar Test was carried out and P value was <0.0001. Conclusion Thromboelastography could be a better technique as compared to conventional measurements of PT, aPTT, TT, Fibrinogen, D-dimer in early detection of coagulopathy in trauma patients. Disclosures: No relevant conflicts of interest to declare.

Evaluation of bone marrow with particular consideration of the megakaryocyte lineage and coagulation profile in the pregnant fallow deer (Dama dama)

2016 ◽  
Vol 19 (2) ◽  
pp. 359-364
Author(s):  
A. Snarska ◽  
P. Sobiech
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Fallow Deer ◽  
Activated Partial Thromboplastin Time ◽  
Control Group ◽  
Slight Reduction ◽  
Thrombin Time ◽  
Coagulation Parameters

Abstract The aim of the study was to evaluate the megakaryocyte lineage of bone marrow and coagulation parameters in fallow deer during the last month of pregnancy. The animals were managed in the barn-feeding system. Twenty female fallow deer, aged 2-3 years, divided into 2 groups were used in the study. Group 1 comprised the females in the last month of pregnancy, and the non-pregnant females were used as the control. All the animals were clinically healthy. Coagulation parameters were measured in all the deer: thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and plasma concentrations of fibrinogen, D-dimer, and antithrombin III. A quantitative assessment of bone marrow was carried out for the erythroblastic, myeloid, lymphoid, monocyte-macrophage, and megakaryopoietic cell lines. A detailed analysis of megakaryocyte lineage was performed after whole blood and platelet count. There were no significant differences in the erythroblast, granulocyte, monocyte-macrophage and lymphoid systems between the animal groups. Thrombocyte count in the pregnant deer was lower than that found in the control group. Bone marrow smears revealed a slightly decreased megakaryocyte count, while the megakaryoblast and promegakaryocyte counts were unchanged. The analysis of coagulation parameters showed increased levels of fibrinogen, thrombin time, prothrombin time and activated partial thromboplastin time in the pregnant animals. The study suggested a hyperactivation of the coagulation system with a slight reduction in the megakaryocyte count in bone marrow, and a reduction in platelet count in peripheral blood at the end of pregnancy.

scholarly journals Pediatric Thromboelastograph 6s and Laboratory Coagulation Reference Values

2021 ◽  
Author(s):  
Katie M. Moynihan ◽  
Kerry Johnson ◽  
Mark Rane ◽  
Andrew Norman ◽  
Susan Humphreys ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Venous Blood ◽  
Age Groups ◽  
Activated Partial Thromboplastin Time ◽  
Specific Reference ◽  
Fibrinogen Concentration ◽  
Healthy Children ◽  
Coagulation Parameters ◽  
Model Based

Context.— Specific reference intervals (RIs) facilitate accurate interpretation of results. Coagulation assay results may vary by demographics and also between reagents and analyzers used. Current Thromboelastograph 6s (TEG 6s) Hemostasis Analyzer RIs were generated from adult samples. Objective.— To generate reagent analyzer-specific pediatric RIs for TEG 6s and coagulation parameters. Design.— A prospective, observational, single-center study of healthy children undergoing general anesthesia (January 3, 2017 to January 3, 2019). Venous blood samples were obtained for TEG 6s (Kaolin, Kaolin-Heparinase, Rapid and Functional Fibrinogen assays) and coagulation parameters (activated partial thromboplastin time, prothrombin time, thrombin clotting time, Echis time, antithrombin activity, and fibrinogen concentration using Instrumentation Laboratory ACL-TOP analyzers). Differences between activated partial thromboplastin time and prothrombin time reagents were investigated using mixed-effects regression, comparing maximum coefficients-of-variation with assay-specific allowable variation. RIs (lower/upper limits 2.5th of 97.5th percentiles) were generated using the following 2 methods: within discrete age-groups (neonates [&lt;1 month], infants [1 month–1 year], young children [1–5 years], older children [6–10 years], and adolescents [11–16 years]), and modeled as functions of age and/or sex using quantile regression, including significant fractional polynomial and interaction terms. Results.— Variation between prothrombin time and activated partial thromboplastin time assays using different reagents was clinically significant. Reagent-analyzer specific pediatric RIs were generated using data from 254 children. Discrete and model-based RIs varied by age for all coagulation parameters and TEG 6s variables in all assays. Conclusions.— We report reagent-analyzer specific pediatric RIs for TEG 6s and coagulation parameters. Observed variation reinforces recommendations for laboratory-specific RIs. These findings improve accuracy of interpretation of clinical results, provide a foundation for comparison and validation of tests in pathology and illustrate feasibility and advantages of model-based RI approaches.

scholarly journals The Sub – Acute Effects of Raw Honey on Prothrombin Time, Activated Partial Thromboplastin Time and Platelet Values in Albino Wistar Rats

2020 ◽  
pp. 68-73
Author(s):  
Akudo Chidinma Ohale ◽  
Emmanuel Ifeanyi Obeagu ◽  
Happiness Alaribe Mark ◽  
Chidindu C. Mmadu- Okoli ◽  
Chukwuebuka Brian Ugo- Ezepue ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Wistar Rats ◽  
Venous Blood ◽  
Activated Partial Thromboplastin Time ◽  
Control Group ◽  
Statistical Significant Difference ◽  
Significant Difference ◽  
Value Determination ◽  
Raw Honey

For centuries honey has been regarded as wonderful gift of nature in which the properties of an excellent food, beneficial alike to adults and children, are combined with medicinal properties. Surprisingly, its sub-acute effect on coagulation is unknown. Hence; this present study aims at evaluating the effects of raw honey on coagulation in albino wistar rats. Thirty (30), 3-4 months old albino wistar rats both males and females were used for the study. The experimental animals were divided into five (A, B, C, D, E) groups with six rats per group. The test groups (B-E) were gavaged with graded doses (625, 1250, 2500, 5000 mg/kg body weight) respectively of the raw honey once daily for nine days. Group A served as control. Two (2) animals were bled from each group after 3, 6 and 9 days through the ocular plexus. Four (4) ml of venous blood was collected. Two (2) ml was delivered into 0.25ml trisodium citrate anticoagulant bottle for determination of Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). The remaining two (2) ml was delivered into K3EDTA anticoagulant bottle for platelet value determination. There was no statistical significant difference (P > 0.05) recorded in all the parameters investigated among the test groups when compared with the control group on Day 3. However, group B revealed a statistical significant decrease (P < 0.05) in PT when compared with the control group on Day 6. In addition, no statistical significant difference (P>0.05) was recorded on Day 9 when all the parameters investigated among the test groups were compared with the control group. Furthermore, there was no exposure related statistical significant difference (P>0.05) in the test groups in PT and APTT in the ANOVA.  However, there was a time related significant difference (P<0.05) in platelet value of group C when Days 3, 6 and 9 were compared. It can be concluded that raw honey possesses a sub-acute coagulation stimulatory potentials which is likely to be dose and duration related.

EFFECTS OF NICKEL CHLORIDE ON INDICES OF HEMOCOAGULATION AND LIPID PEROXIDATION IN RATS

2019 ◽  
pp. 83-90
Author(s):  
Э.М. Гаглоева ◽  
В.Б. Брин ◽  
С.В. Скупневский ◽  
Н.В. Боциева ◽  
Т.В. Молдован
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Enzymes ◽  
Platelet Aggregation ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Nickel Chloride ◽  
Activated Partial Thromboplastin Time ◽  
Fibrinogen Concentration ◽  
Thrombin Time ◽  
Hemostasis System

Цель исследования - изучить состояние системы гемостаза при хронической интоксикации хлоридом никеля, исследовать взаимосвязь показателей гемокоагуляции с процессами липопероксидации у крыс в эксперименте. Методика. Опыты проводили на крысах-самцах Вистар (n=50, 230-250 г). Раствор NiCl2 (5 мг/кг) вводили внутрижелудочно ежедневно в течение 2 нед, 1 и 2 мес. По завершении эксперимента исследовали состояние тромбоцитарного и коагуляционного звеньев гемостаза, антикоагулянтную и фибринолитическую активность крови, а также определяли активность процессов перекисного окисления липидов и антиоксидантных ферментов. Результаты. Установлено, что через 2 нед и 1 мес интоксикации у крыс отмечались гиперкоагуляционные изменения показателей свертывающей системы крови: повышение агрегационной активности тромбоцитов, увеличение концентрации фибриногена, снижение активированного частичного тромбопластинового времени (АЧТВ) и протромбинового времени. В этот период регистрировалось увеличение антитромбиновой и фибринолитической активности крови. Через 2 мес наблюдалось подавление активности клеточного звена гемостаза - тромбоцитопения, ослабление степени АДФ-индуцируемой агрегации тромбоцитов. Выявлялась тенденция к уменьшению концентрации фибриногена. На фоне снижения АЧТВ и тромбинового времени отмечалось увеличение протромбинового времени. В то же время регистрировалось угнетение противосвертывающего звена системы гемостаза (снижалась активность антитромбина III), наблюдалось истощение резервных возможностей фибринолитического звена (замедление фXIIа-зависимого эуглобулинового лизиса) и увеличение содержания растворимых фибрин мономерных комплексов, что свидетельствует о наличии тромбинемии. Через 2 нед, один и два месяца интоксикации у животных выявлялись корреляционные связи между основными показателями системы гемостаза и активностью процессов перекисного окисления липидов и антиоксидантных ферментов. Заключение. Полученные данные подтверждают наличие взаимосвязи активности процессов липопероксидации и системы гемостаза, в том числе при хронической никелевой интоксикации. Результаты исследования позволяют рекомендовать применение антиоксидантов для разработки способов коррекции гемостатических сдвигов при воздействии на организм тяжелых металлов. The aim. To study the state of the hemostasis system in chronic nickel intoxication and to investigate the relationship between hemocoagulation indices and lipoperoxidation processes in rats. Methods. Experiments were carried out on male Wistar rats (n=50, 230-250 g). A solution of nickel chloride (5 mg/kg) was administered daily intragastrically for two weeks, one and two months. At the end of the experiments, indices of platelet and coagulation hemostasis systems, anticoagulant and fibrinolytic activity of blood plasma, and activities of lipid peroxidation and antioxidant enzymes were studied. Results. Hypercoagulative changes in indices of the coagulation system were observed in rats after two weeks and one month of intoxication, including increased platelet aggregation and fibrinogen concentration and shortened activated partial thromboplastin time and prothrombin time. During the same period, increased antithrombin and fibrinolytic activities were observed. The depressed activity of the cellular component of hemostasis evident as thrombocytopenia and impaired ADP-induced platelet aggregation was detected after two months of intoxication. A tendency to decrease in fibrinogen concentration was observed. The shortened activated partial thromboplastin time and thrombin time were associated with prolonged prothrombin time. At the same time, inhibition of the anticoagulant component of hemostasis (decreased antithrombin III activity), exhaustion of the fibrinolysis system reserve (delayed fXIIa-dependent euglobulin lysis), and a significant increase in soluble fibrin monomeric complexes indicative of thrombinemia were observed. After two weeks, one and two months of nickel intoxication, a correlation was found between the major indices of the hemostasis system and the activities of lipid peroxidation and antioxidant enzymes. Conclusion. The study confirmed a relationship between the lipid peroxidation activity and the hemostasis system, specifically in chronic nickel intoxication. This result allows to recommend the use of antioxidants in developing methods for correction of hemostatic induced affected by heavy metals.

Antihemostatic Effect of Hsien-Ho-T'sao (Agrimonia pilosa)

1984 ◽  
Vol 12 (01n04) ◽  
pp. 116-123 ◽  
Author(s):  
Jih-Pyang Wang ◽  
Mei-Feng Hsu ◽  
Che-Ming Teng
Keyword(s):  
Prothrombin Time ◽  
Blood Coagulation ◽  
Partial Thromboplastin Time ◽  
Bleeding Time ◽  
Fibrinogen Level ◽  
Platelet Rich Plasma ◽  
Water Extract ◽  
Activated Partial Thromboplastin Time ◽  
Thrombin Time

Bleeding time in rats was markedly prolonged after the adminstration of the water extract of Hsien-Ho-T'sao. This antihemostatic effect was more marked in the group of i.p. injection of the drug than in the group of p.o. administration for 2 to 7 consecutive days. Blood coagulation studies showed that plasma prothrombin time, activated partial thromboplastin time and stypven time were prolonged, while thrombin time adnd fibrinogen level were not changed. The thromboelastographic recording showed that reation time was prolonged and maximal elasticity of clot was decreased. In addition, ADP- and collagen- induced aggregations of platelet-rich plasma was suppressed. In conclusion, the prolongation of the bleeding time might be due to both anticoagulant and antiplatelet action of the drug.

The effect of 0.01% atropine on ocular axial elongation for myopia children: a meta-analysis

2021 ◽  
Author(s):  
Yan Yu ◽  
Jiasu Liu
Keyword(s):  
Publication Bias ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Axial Elongation ◽  
Funnel Plots ◽  
Mean Differences ◽  
Q Statistic ◽  
Regression Tests ◽  
Review Manager

Objectives: This meta-analysis aimed to identify the therapeutic effect of 0.01% atropine with on ocular axial elongation for myopia children. Methods: We searched PubMed, Cochrane Library, and CBM databases from inception to July 2021. Meta-analysis was conducted using STATA version 14.0 and Review Manager version 5.3 softwares. We calculated the weighted mean differences(WMD) to analyze the change of ocular axial length (AL) between orthokeratology combined with 0.01% atropine (OKA) and orthokeratology (OA) alone. The Cochran's Q-statistic and I2 test were used to evaluate potential heterogeneity between studies. To evaluate the influence of single studies on the overall estimate, a sensitivity analysis was performed. We also performed sub group and meta-regression analyses to investigate potential sources of heterogeneity. We conducted Begger's funnel plots and Egger's linear regression tests to investigate publication bias. Results: Nine studies that met all inclusion criteria were included in this meta-analysis. A total of 191 children in OKA group and 196 children in OK group were assessed. The pooled summary WMD of AL change was -0.90(95%CI=-1.25~-0.55) with statistical significance(t=-5.03, p<0.01), which indicated there was obvious difference between OKA and OK in myopic children. Subgroup analysis also showed that OKA treatment resulted in significantly less axial elongation compared to OK treatment alone according to SER. We found no evidence for publication bias. Conclusions:  Our meta-analysis indicates 0.01% atropine atropine is effective in slowing axial elongation in myopia children with orthokeratology.

scholarly journals ASSESSMENT OF COAGULATION PROFILE IN PATIENTS WITH LIVER CIRRHOSIS AND ATRIAL FIBRILLATION

2021 ◽  
Vol 121 (1) ◽  
pp. 22-31
Author(s):  
Alіna Baylo ◽  
Vadym Shypulіn ◽  
Volodymyr Chernyavskyi ◽  
Luiza Parunyan
Keyword(s):  
Atrial Fibrillation ◽  
Liver Cirrhosis ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Fibrinolytic System ◽  
Thrombin Time ◽  
Group I ◽  
D Dimer

The comorbid course of liver cirrhosis and atrial fibrillation causes higher levels of hospitalizations, mortality and ischemic stroke. According to current data, hemostasis in patients with liver cirrhosis is in a rebalanced dynamic state, but there are no data on the effect of atrial fibrillation on the hemostasis in patients with liver cirrhosis. Aims of the study. To assess abnormalities in primary, secondary haemostasis and fibrinolytic system in patients with liver cirrhosis and atrial fibrillation by using standard laboratory coagulation parameters and to investigate their changes depending on the stage of liver cirrhosis A, B, C according to Child-Pugh score. Materials and methods. A cross-sectional prospective study was conducted with the inclusion of 106 patients aged 42 to 83 years: group I (n = 70) - with liver cirrhosis and atrial fibrillation, II (n = 36) - with liver cirrhosis, which were distributed depending on the Child-Pugh score stages of cirrhosis and 20 healthy individuals. The levels of platelets, activated partial thromboplastin time, international normalized ratio, prothrombin time, thrombin time, fibrinogen, D-dimer were assessed on a Steellex M200 coagulometer. Statistical analysis (IBM SPSS Statistics) was performed. Results. The level of platelets in patients of group I was reduced by 37.4% (200 ± 8.33 vs. 274.7 ± 3.4; p,000.001), an activated partial thromboplastin time was prolonged by 38.6% (44.35 ± 1.39 vs. 32.01 ± 0.63, p˂0.001), prothrombin time was prolonged by 73.5% (19.4 ± 0.87 vs. 11.18 ± 0.53, p˂0.001), thrombin time was prolonged by 2.07 (25, 7 ± 1.31 vs. 12.4 ± 0.66, p˂0.001), the international normalized ratio was increased by 24.3% (1.38 ± 0.04 vs.1.11 ± 0.01, p˂0.001) compared to control. The fibrinogen level was 20.9% higher (4.17 ± 0.17 vs. 3.45 ± 0.11, p˂0.001) than in control group and was 83.7% higher (4.17 ± 0.17 vs. 2.27 ± 0.13, p˂0.001) than in group II. The D-dimer level was 83% higher than in control (675 ± 22.3 vs. 368.8 ± 21.85, p˂0.001) and 44% higher (675 ± 22.3 vs. 469 ± 37.18, p ˂0.001) compared with group II. Conclusions. In patients with liver cirrhosis and atrial fibrillation abnormalities of primary hemostasis are detected due to decrease of platelets on the background of portal hypertension. At the secondary stage of hemostasis indicators of external and internal coagulation mechanisms are prolonged due to the reduced synthesis of coagulation factors by the liver. Increased level of fibrinogen is determined at the stage of compensated and subcompensated cirrhosis with a gradual decrease at the stage of decompensation. The high activity of the fibrinolytic system is observed due to increase in the D-dimer levels, which may indicate a prothrombotic state in these patients.

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