scholarly journals Emergency Surgery in a Critically Ill Patient with Major Drug-Induced Bleeding and Severe Ischaemic Heart Failure

2017 ◽  
Vol 3 (1) ◽  
pp. 34-38
Author(s):  
Dana Tomescu ◽  
Mihai Popescu
Keyword(s):  
Emergency Surgery ◽  
Light Transmission ◽  
High Risk Patient ◽  
Critically Ill Patient ◽  
Severe Bleeding ◽  
Drug Induced ◽  
Surgical Ward ◽  
Light Transmission Aggregometry ◽  
Drug Eluting ◽  
Recent Acute Myocardial Infarction

Abstract Introduction: Anticoagulant overdose frequently occurs in elderly populations especially in remote areas where medical services are scarce. When emergency surgery is required, such patients offer major anaesthetic challenges. Case presentation: We describe the case of an elderly patient admitted to a surgical ward with acute abdominal pain, on dual anti-platelet therapy and acenocoumarol for a recent acute myocardial infarction treated percutaneously with two drug-eluting stents. Laboratory tests showed severe anticoagulant overdose with uncoagulable INR. The decision was made to use of both light transmission aggregometry [LTA] for platelet function testing and thromboelastography to aid in the management of perioperative haemostasis in order to prevent both severe bleeding and stent thrombosis. Surgery revealed haemoperitoneum, volvulus of the ileum and a venous mesenteric infarction. Intraoperative blood loss was minimal and no blood products were administered. Postoperative course was uneventful without either thrombotic or haemorrhagic complications and the patient was discharged from the Postanaesthesia Care Unit on postoperative day two. Conclusion: The use of aggregometry and thrombography helped in both evaluation and management of haemostasis of a high-risk patient by goal-directed administration of pro-and anti-coagulants.

Comparison of VASP-phosphorylation assay to light-transmission aggregometry in assessing inhibition of the platelet ADP P2Y12 receptor

2006 ◽  
Vol 96 (12) ◽  
pp. 767-773 ◽  
Author(s):  
Agnieszka Pampuch ◽  
Giovanni de Gaetano ◽  
Chiara Cerletti
Keyword(s):  
Light Transmission ◽  
Platelet Reactivity ◽  
Flow Cytometric Analysis ◽  
Individual Variability ◽  
P2y12 Receptor ◽  
Reactivity Index ◽  
Drug Induced ◽  
Light Transmission Aggregometry ◽  
Adp Receptor

SummaryThere is need to improve platelet function testing to monitor the response to antiplatelet drugs. We compared flow-cytometric analysis of intraplatelet vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) to light-transmission aggregometry for the detection of drug-induced in-vitro inhibition of the platelet P2Y12 ADP receptor on 22 healthy subjects (10 males, 12 females, 28.5 ± 6.6 years). The platelet reactivity index (PRI) of VASP was calculated both from mean fluorescence intensity (MFI) and percent of fluorescence-positive platelets in the presence of PGE1 with or without ADP (10 µM). Platelet aggregation was induced by ADP (1.25, 2.5 and 5 µM). Cangrelor, a competitive inhibitor of the P2Y12 receptor, preincubated 5 minutes, induced a concentration-dependent inhibition of platelet ADP-receptor function in both tests. Indeed PRI (%) based on either MFI or percent platelets gated were highly correlated with each other (r = 0.97, p<0.0001) and with aggregation in- duced by ADP. The IC50 of cangrelor against each of the three ADP concentrations used in aggregometry increased from 5.8 ± 3.4 nM to 23.1 ± 4.0 nM and to 98 ± 25 nM, respectively. The IC50 of cangrelor based on VASP-P was within the same range (25.5 ± 7.7 nM). No correlation was observed between IC50 values of cangrelor and ADP concentrations giving 50% effect (EC50) in the absence of the drug. However, at 10 nM cangrelor seven subjects could be identified by the VASP-P assay as “low responders” to the drug (PRI> 50%), and six of them also had an aggregation response to 5 µM ADP > 50%. These six subjects showed the lowest ADP EC50 values in the absence of the drug, possibly reflecting high sensitivity of their platelet P2Y12 receptors to ADP. In conclusion, both the VASP-P assay and light-transmission aggregometry detect in a comparable way in-vitro pharmacological inhibition of the platelet P2Y12 ADP receptor and its individual variability.

Inter-individual variability in clopidogrel inhibition effect on platelet aggregation

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Hussein Ali Sahib ◽  
Bassim Irhiem Mohammed ◽  
Ban A. Abdul Majid
Keyword(s):  
Cardiovascular Disease ◽  
Platelet Aggregation ◽  
Coronary Care Unit ◽  
Light Transmission ◽  
Individual Variability ◽  
Study Group ◽  
Inhibition Effect ◽  
Light Transmission Aggregometry ◽  
Coronary Care ◽  
Skewness And Kurtosis

Despite the unmistakable beneficial effect of clopidogrel on platelet aggregation,still there are some patient poorly responds to clopidogrel that may lead to worse cardiovascular clinical events.One hundred and twenty seven patients with cardiovascular disease (ACS,stroke,or TIA) were enrolled as a study group. Patients were recruited at coronary care unit (CCU) of Al-Yarmouk Teaching Hospital. Paletlet assessment was done by using light transmission aggregometry. between the patients that enrolled in this study there are significant inter-individual variability both skewness and Kurtosis were negative (-0.450,-0.130) respectively. 24% of patient enrolled in this study were hyporesponder.

Malondialdehyde Assay in the Evaluation of Aspirin Antiplatelet Effects

Pharmacology ◽  
2018 ◽  
Vol 103 (1-2) ◽  
pp. 23-29 ◽  
Author(s):  
Amin Polzin ◽  
Lisa Dannenberg ◽  
Theresa Schneider ◽  
Betül Knoop ◽  
David Naguib ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Operating Characteristic ◽  
Light Transmission ◽  
Platelet Reactivity ◽  
Area Under The Curve ◽  
Healthy Individuals ◽  
Antibody Assay ◽  
Light Transmission Aggregometry ◽  
Artery Disease

Aspirin is essential in secondary prevention of patients after myocardial infarction and with coronary artery disease. However, impaired pharmacodynamic response to aspirin is frequent (high on-treatment platelet reactivity [HTPR]). This leads to an enhanced prevalence of cardiovascular events and to an impaired clinical outcome. The current specific assays to evaluate aspirin antiplatelet effects are complex, time-consuming and demand for a high laboratory expertise. Therefore, we developed a potentially bedside assay based on the determination of malondialdehyde (MDA). MDA is a by-product of the thromboxane (TX) formation, which is synthesized in equimolar concentrations. In this study, we compared this MDA assay to the conventional assays in determination of pharmacodynamic aspirin response. For this, aspirin antiplatelet effects were measured in 22 healthy individuals and 63 aspirin treated patients using TX B2 formation enzyme-linked antibody assay, arachidonic acid induced light transmission aggregometry (LTA) and the new fluorometric MDA assay. In patients, MDA levels correlated well with TX formation (R = 0.81; 95% CI 0.69–0.88; p < 0.001) and LTA (R = 0.84; CI 0.74–0.91; p < 0.001). Receiver operating characteristic analyses revealed that the MDA assay does detect HTPR to aspirin sufficiently (area under the curve: 0.965; p < 0.001). The optimal cut-off was > 128 nmol/L (sensitivity of 100%, specificity of 91%). The new MDA assay is reliable in detecting HTPR. It is highly specific in the evaluation of antiplatelet effects by aspirin. This promising and potential bedside assay needs to be evaluated in clinical practice.

Light Transmission Aggregometry

2014 ◽  
pp. 51-57
Author(s):  
Paul A. Gurbel ◽  
Martin Gesheff ◽  
Kevin P. Bliden ◽  
Udaya S. Tantry
Keyword(s):  
Light Transmission ◽  
Light Transmission Aggregometry

scholarly journals Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

2018 ◽  
Vol 27 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Jan Hartinger ◽  
Robert Novotny ◽  
Jana Bilkova ◽  
Tomas Kvasnicka ◽  
Petr Mitas ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Light Transmission ◽  
Platelet Reactivity ◽  
Peripheral Artery ◽  
Primary Resistance ◽  
Impedance Aggregometry ◽  
Number Of Patients ◽  
Light Transmission Aggregometry ◽  
Daily Dose ◽  
Induced Aggregation

Objective: To evaluate the effects of dipyrone on sensitivity to aspirin (acetylsalicylic acid [ASA]) in patients who underwent peripheral artery vascular reconstruction. Subjects and Methods: Impedance aggregometry and light transmission aggregometry were used to determine the effects of dipyrone on ASA treatment in 21 patients. Blood samples were drawn in a 7-day period after the surgery. The cut-off value for high on-treatment platelet reactivity (HTPR) was set at < 65% of aggregation inhibition for impedance aggregometry. For light transmission aggregometry the cut-off value for arachidonic acid-induced aggregation was set at > 20% of aggregating platelets, and the cut-off value for epinephrine-induced aggregation was > 44% of aggregating platelets. The cut-off value for each method was derived from a large number of patients treated with a daily dose of 100 mg of ASA. Results: We found HTPR in 14 (67%) of the 21 patients. None had primary resistance to ASA, i.e., after the addition of ASA in vitro all samples showed antiplatelet efficacy. Regression analysis showed a possible correlation between lower efficacy of ASA treatment and higher daily doses of dipyrone (p = 0.005 for impedance aggregometry, p = 0.04 for light transmission aggregometry), higher platelet count (p = 0.005 for impedance aggregometry), and shorter time from surgery (p = 0.03 for impedance aggregometry). Conclusion: HTPR occurs in 67% of ASA-treated patients after lower limb vascular surgery. The occurrence of HTPR correlates with the daily dose of dipyrone. Therefore, dipyrone should not be used as a postoperative analgesic in ASA-treated patients after peripheral artery revascularisation due to its influence on the effectiveness of ASA.

scholarly journals A simplified flow cytometric method for detection of inherited platelet disorders—A comparison to the gold standard light transmission aggregometry

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0211130 ◽  
Author(s):  
Kristoffer Navred ◽  
Myriam Martin ◽  
Lina Ekdahl ◽  
Eva Zetterberg ◽  
Nadine Gretenkort Andersson ◽  
...  
Keyword(s):  
Gold Standard ◽  
Light Transmission ◽  
Flow Cytometric Method ◽  
Flow Cytometric ◽  
Light Transmission Aggregometry ◽  
Platelet Disorders

scholarly journals The Role of Human Platelet Preparation for Toll-Like Receptors 2 and 4 Related Platelet Responsiveness

TH Open ◽  
2019 ◽  
Vol 03 (02) ◽  
pp. e94-e102 ◽  
Author(s):  
Juergen Koessler ◽  
Marius Niklaus ◽  
Katja Weber ◽  
Angela Koessler ◽  
Sabine Kuhn ◽  
...  
Keyword(s):  
Light Transmission ◽  
Platelet Rich Plasma ◽  
Toll Like Receptors ◽  
Preparation Methods ◽  
Expression Levels ◽  
Basal Expression ◽  
Healthy Donors ◽  
Light Transmission Aggregometry ◽  
Bacterial Patterns ◽  
Study Designs

Background Like immune cells, platelets express the repertoire of toll-like receptors (TLR), among them TLR2 and TLR4, which are important for the recognition of bacterial patterns. Receptor-mediated functional effects in platelets have been investigated, but reliable conclusions are tampered due to heterogeneous study designs with variable platelet preparation methods. This study compares TLR2- and TLR4-dependent platelet responsiveness in platelet-rich plasma (PRP) and in washed platelets (WPs). Material and Methods Fresh peripheral blood samples from healthy donors served for the preparation of PRP and WP. Basal and agonist-stimulated TLR2 and TLR4 expression levels were evaluated by flow cytometry. Light transmission aggregometry was used to investigate functional effects of TLR2 and TLR4 stimulation with Pam3CSK4 or LPS (lipopolysaccharides from Escherichia coli) as ligands. The capacity of chemokine release was determined by immunoassays. Results Pam3CSK4 and LPS (in combination with thrombin) were able to induce aggregation in WP, but not in PRP, with threshold concentrations of 15 µg/mL. Basal expression levels of TLR2 and TLR4 were higher in WP than in PRP, increasing several-fold rapidly and persistently upon platelet activation with potent agonists. Pam3CSK4 (15 µg/mL) or LPS led to the submaximal release of RANTES, PF4, PDGF, NAP-2, and sCD40L from WP. In PRP, secretory effects are less pronounced for RANTES, PDGF, or PF4, and not detectable for NAP-2 or sCD40L. Conclusion The effects mediated by TLR2 and TLR4 stimulation are dependent on platelet preparation, an important issue for experimental designs and for manufacturing of platelet concentrates in transfusion medicine.

Sign in / Sign up

Export Citation Format

Share Document