scholarly journals THE USE OF THROMBODYNAMICS TEST IN DIAGNOSTICS OF HEMOSTASIS DISORDERS IN PATIENTS WITH COVID-19 OF VARYING SEVERITY

2021 ◽  
Author(s):  
Margarita Shpilyuk ◽  
Liubov Krechetova ◽  
Dmitry Nechipurenko ◽  
Olga Beznoshchenko ◽  
Evgeniya Beresneva ◽  
...  
Keyword(s):  
Platelet Count ◽  
Positive Relationship ◽  
Hospital Treatment ◽  
Thrombin Time ◽  
Hemostasis System ◽  
National Medical ◽  
Coronavirus Infection ◽  
Personalized Approach ◽  
The Moment ◽  
D Dimer

Background: At the moment, an urgent and unresolved problem is the search for a diagnostic method for disorders of the hemostasis system in patients against the background of the course of a new coronavirus infection. Presumably, integral tests, in particular, the thrombodynamics test, will make it possible to monitor changes in blood clotting, predict the course of the disease in patients with COVID-19. Aims: to comparative assessment of plasma hemostasis parameters and thrombodynamics test in patients with COVID-19 viral infection of varying severity. Methods: The study included 96 patients with a confirmed diagnosis of COVID-19, hospitalized in an infectious diseases hospital on the basis of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov in the period from 04.23.2020 to 06.20.2020 and discharged at the end of treatment. SARS-CoV-2 was identified by PCR. Patients were stratified by severity into 3 groups: mild course (n = 25), moderate course (n = 54), severe course (n = 17). Diagnostics and treatment of patients was carried out in accordance with the Temporary Methodological Recommendations of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection, versions 5, 6, 7. In the dynamics of treatment, patients were assessed APTT, prothrombin %, prothrombin time and thrombin time, fibrinogen, D-dimer, platelet count and thrombodynamic test (V / Vi / Vst, Tlag, Cs, D). Results: It was found that significant differences before admission and a week after the start of hospital treatment were observed for the thrombin time, D-dimer, platelet count, and thrombodynamic parameters: V / Vst, Cs, D. PT, APTT, TD (Tlag, D)) with the duration of hospital stay. There was a positive relationship between the content of fibrinogen and D (r = 0.6307, p 0.0001) and a strong positive relationship between PT and Tlag (r = 0.7499, p 0.0001). Conclusions: The thrombodynamics test can be recommended as a potential tool for a personalized approach to monitoring the hemostasis system and treating patients with COVID-19.

MATHEMATICAL MODEL TO PREDICT SEVERITY OF CORONAVIRUS INFECTION AND MAIN ANTI-EPIDEMIC MEASURES IN UKRAINE

2020 ◽  
pp. 57-65
Author(s):  
K. A. Kryvonos ◽  
V. S. Maslova ◽  
V. M. Sharapov ◽  
S. M. Vorobyov
Keyword(s):  
Mathematical Model ◽  
Platelet Count ◽  
Elderly Patients ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Regression Equations ◽  
Middle Aged ◽  
Erythrocyte Sedimentation ◽  
Coronavirus Infection ◽  
D Dimer

Currently, the epidemic situation regarding the incidence of coronavirus infection COVID−19 in Ukraine continues to be tense. In order to in−depth study of the problem of clinical features, treatment and prevention of this disease, as well as the development of a mathematical model for predicting the severity of its course, 30 patients aged 18 to 85 years were examined. Among the patients there were young and middle−aged people as well as elderly patients with chronic diseases, namely obesity, hypertension, diabetes. The diagnosis of coronavirus infection was confirmed in all the patients by molecular genetic method, i.e. SARS−CoV−2 RNA was isolated, and in 10 patients − IgM + IgG to SARS was determined by immunochromatographic analysis. With COVID−19, young and middle−aged patients have a fairly mild course with a decrease in platelet count by 7 %, erythrocyte sedimentation rate by 48 %, prothrombin by 14 % and D−dimer by 31 %. The construction of regression equations based on trend lines revealed that in elderly patients after treatment there was a further decrease in the level of D−dimer (20 %), an increase in platelet count (30 %), a decrease in white blood cell count (26 %), neutrophils (38 %), increase in lymphocyte levels by 3 times, decrease in erythrocyte sedimentation rate (by 10 %) and prothrombin parameters (by 15 %). Based on cluster and regression analysis, coefficients were calculated for each prognostic function. It was found that the linear dependence and statistically significant effect on the course of COVID−19 in all patients have leukocytes, erythrocyte sedimentation rate and D−dimer. In order to prevent the spread of coronavirus infection in Ukraine COVID−19 in this March, quarantine was introduced throughout the country, which is being extended to this day. There is no doubt about the importance of recommendations for improving anti−epidemic measures to prevent coronavirus infection throughout Ukraine. Key words: coronavirus infection, COVID−19, clinical blood counts, disease prognosis, anti−epidemic measures in Ukraine.

Hemostasis disorders, thrombosis, antiphospholipid antibodies in patients with covid-19

2021 ◽  
Vol 23 (1) ◽  
pp. 35-42
Author(s):  
Tatiana M. Reshetnyak ◽  
◽  
Tatiana M. Reshetnyak ◽  
Fariza A. Chel'dieva ◽  
Fariza A. Chel'dieva ◽  
...  
Keyword(s):  
Antiphospholipid Antibodies ◽  
Blood Clotting ◽  
International Normalized Ratio ◽  
Thrombin Time ◽  
Prolonged Aptt ◽  
History Of ◽  
Coronavirus Infection ◽  
Hematological Changes ◽  
Acute Phase Reactions ◽  
D Dimer

The article provides an overview of main blood clotting disorders in coronavirus infection 2019 (COVID-19), which is associated with several hematological changes. Patients with COVID-19 develop typically two hemostasis disorders – an increased D-dimer levels and moderate thrombocytopenia, which occur in more than 40% of cases. Other hemostasis abnormalities, which are frequently reported in COVID-19, included prolonged prothrombin time (PT), also expressed as international normalized ratio, prolonged thrombin time, and activated partial thromboplastin time (APTT), which were typical acute phase reactions. Prolonged APTT or PT, and thrombocytopenia are common, especially in patients with severe clinical course. It has been hypothesized that increased D-dimer concentration and prolongation of PT, APTT are associated with higher mortality in patients with COVID-19. Disseminated intravascular coagulation occurs most often in severe cases of COVID-19 (about 2% of all hospitalized patients) and indicates a poor prognosis, i.e. about 90% mortality. It remains unclear whether SARS-CoV-2 can induce antiphospholipid antibodies. An increased incidence of positive lupus anticoagulants was observed in patients with COVID-19, it can be assumed that all patients with COVID-19 in whom antiphospholipid antibodies are revealed should be monitored and receive thromboprophylaxis even with no history of thromboembolism. Keywords: coronavirus infection (COVID-19), hemostasis disorder, antiphospholipid antibodies, antiphospholipid syndrome, thrombosis, anticoagulants For citation: Reshetnyak TM, Chel'dieva FA, Lila AM, Nasonov EL. Hemostasis disorders, thrombosis, antiphospholipid antibodies in patients with COVID-19. Consilium Medicum. 2021; 23 (1): 35–42. DOI: 10.26442/20751753.2021.1.200607

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.

scholarly journals Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alberto Polimeni ◽  
Isabella Leo ◽  
Carmen Spaccarotella ◽  
Annalisa Mongiardo ◽  
Sabato Sorrentino ◽  
...  
Keyword(s):  
Platelet Count ◽  
Meta Analysis ◽  
Severe Disease ◽  
Coagulation Factors ◽  
Primary Analysis ◽  
Severe Group ◽  
Intravascular Coagulopathy ◽  
The Difference ◽  
D Dimer

AbstractCoronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD − 2.15 [− 2.73 to − 1.56], I2 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD − 2.91 [− 3.87 to − 1.96], I2 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I2 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I2 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD − 1.34 [− 2.06 to − 0.62], I2 98%, P < 0.0002) and Survivors groups (SMD − 1.61 [− 2.69 to − 0.54], I2 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.

Student Nurses’ Caring With Awareness in a Higher Education Institution in South Africa

2020 ◽  
pp. 089801012097732
Author(s):  
Lerato Matshaka ◽  
Charlene Downing ◽  
Marie Poggenpoel
Keyword(s):  
Sampling Method ◽  
Positive Relationship ◽  
Student Nurses ◽  
Education Institution ◽  
Study Data ◽  
Student Nurse ◽  
Quantitative Descriptive ◽  
Acting With Awareness ◽  
The Moment ◽  
Self Administered Questionnaire

In caring with awareness, the student nurse is able to be present in the moment, while being with the patient. Such student nurses treat patients holistically, considering the patient’s mind, body, and spirit. Purpose: To elicit the importance of caring with awareness in order to facilitate student nurses’ caring toward patients. Hypothesis: There is a positive relationship between student nurses acting with awareness and caring. Method: A quantitative, descriptive, correlational, and contextual research design with a purposive sampling method was used in the study. Respondents ( n = 56) were student nurses in their third- and fourth-year level of study. Data were collected by use of a self-administered questionnaire. Findings: There was a negative correlation between acting with awareness and caring. There was no difference in caring among third- and fourth-year students. Conclusion: Student nurses may be caring for patients, but it does not necessarily mean they act with awareness in caring. Awareness should be cultivated among student nurses for them to be present in caring and provide holistic caring.

scholarly journals Thromboelastometric evaluation of horses submitted to experimental thrombosis and jugular thrombectomy

2016 ◽  
Vol 36 (8) ◽  
pp. 677-686 ◽  
Author(s):  
Dietrich Pizzigatti ◽  
Daniele S. Gonçalves ◽  
Thays C. Trentin ◽  
Regina K. Takahira ◽  
Ana L.G. Alves ◽  
...  
Keyword(s):  
Platelet Count ◽  
Surgical Treatment ◽  
Alpha Angle ◽  
Fogarty Catheter ◽  
Significance Level ◽  
Treatment Groups ◽  
Significant Difference ◽  
Group 2 ◽  
The Moment ◽  
Α Angle

Abstract: Jugular thrombosis in horses occurs commonly in iatrogenic situations, secondary to endotoxemic clinical condition and disseminated vascular coagulation, potentially leading to death. Thus, hemostatic evaluation becomes necessary and extremely important for monitoring the risks of systemic hypercoagulability and for the efficiency of allopathic and surgical treatment. This paper describes the hemostatic behavior in experimental jugular thrombosis of ten healthy equines, subsequently submitted to two thrombectomy techniques and receiving heparin sodium as anti-rethrombosis therapy. These animals were evaluated for 20 days by thromboelastometry (TEM), platelet count, hematocrit and fibrinogen, at four moments: pre-induction to phlebitis (D0-MPF); three days after thrombophlebitis induction (D3-MFM); 6 days after, - moment of thrombophlebitis - (D9-MT); and 54 (D16) and 126 (D19) hours after thrombectomies (PTM). Thrombectomy was performed via a Vollmar Ring (group 1, n=5) and Fogarty catheter (group 2, n=5). All the animals received heparin (150 UI/kg, SC) every 12 hours, for ten days after the respective thrombectomies. Through the blood samples were evaluated TEM, activated partial thromboplastin time (aPTT) and prothrombin time (PT), dosing of fibrinogen, hematocrit and platelet count at the abovementioned moments. For comparison between groups and moments the t test was applied at 5% significance level. No significant difference was verified between treatment groups at any of the moments. There were reductions in clotting time (CT) and clot formation time (CFT), with increase in maximum lysis (ML) until the moment D9-MT. Evaluation through INTEM® reagent presented prolongations of CT and CFT with reduction of α angle and ML starting from D16 and D19. Similarly, aPTT presented significant differences between moments pre- (D0, 3 and 9) and post- (D16 and 19) anticoagulant and surgical treatment. The platelet numbers were diminished at moments D16 and D19. In evaluation with EXTEM® reagent, prolongation of CT and CFT occurred only between the moments D0 vs. D3 and vs. D9. O PT did not present significant differences. The results obtained demonstrate that experimental jugular thrombophlebitis leads to local clinical alterations, with impairment of tissue and of the extrinsic coagulation pathway (EXTEM® ), but without evidence of systemic hypercoagulability status, since there was no increase of the alpha angle or maximum clot firmness (MCF). Furthermore, TEM was shown useful and more sensitive than conventional coagulation tests (PT, aPTT and fibrinogen) for the monitoring of anticoagulant therapy, as demonstrated in other works.

scholarly journals The evaluation of malignant astrocytoma score (MAS)

2013 ◽  
Vol 70 (5) ◽  
pp. 452-456
Author(s):  
Zeljko Kojadinovic ◽  
Petar Vulekovic ◽  
Djordje Jajic ◽  
Tomislav Cigic ◽  
Vladimir Papic ◽  
...  
Keyword(s):  
Performance Status ◽  
Radiation Therapy Oncology Group ◽  
Scoring Systems ◽  
Hospital Treatment ◽  
Malignant Astrocytoma ◽  
Or Groups ◽  
The Mean ◽  
The Moment ◽  
Astrocytoma Grade Iii

Background/Aim. At the moment there are few scoring systems for malignant astrocytoma but they are not widely accepted. The aim of this study was to evaluate malignant astrocytoma score (MAS) on a new group of patients with malignant astrocytoma, to compare MAS with other prognostic tools and to describe the use of MAS in everyday practice in neurooncology. Methods. The study was performed on 124 patients with supratentorial malignant astrocytoma grade III or IV. They were operated on and subsequently irradiated with 50-60 Gy. Results. The mean age of the patients was 57.3 years. The mean Karnofski performance status (KPS) of the functional inpairment was 54. The removal of the tumor > 90% was done in 59.7% of patients. The mean survival was 9.1 months, and 27.4% of patients had a 12-month survival. The area under receiver operating characteristic (ROC) curve (AUC) of the MAS for predicting 6-, 12- and 18-month survival was 0.754, 0.783 and 0.882, respectively. We compared the MAS with the two mostly cited scoring systems. The AUC for the same prediction for medical research council (MRC) was 0.601, 0.693, 0.772 respectively. For the Radiation Therapy Oncology Group (RTOG) the AUC was 0.732, 0.765, 0.827, respectively. Conclusion. MAS represents a useful scoring system for determining illness severity and prognosis in patients with malignant supratentorial astrocytoma. It can be helpful in comparing single patients or groups of patients, as well as results of different treatments and in controlling the quality of hospital treatment and so on.

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.

scholarly journals Serum Inflammatory Biomarkers in the Diagnosis of Periprosthetic Joint Infections

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1128
Author(s):  
Irene K. Sigmund ◽  
Stephan E. Puchner ◽  
Reinhard Windhager
Keyword(s):  
Platelet Count ◽  
Mean Platelet Volume ◽  
Preoperative Diagnosis ◽  
Clinical Symptoms ◽  
Volume Ratio ◽  
Diagnostic Value ◽  
Inflammatory Biomarkers ◽  
Platelet Volume ◽  
Joint Infections ◽  
D Dimer

Accurate preoperative diagnosis of periprosthetic joint infections (PJIs) can be very challenging, especially in patients with chronic PJI caused by low-virulence microorganisms. Serum parameters, such as serum C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), are—among other diagnostic test methods—widely used to distinguish septic from aseptic failure after total hip or knee arthroplasty and are recommended by the AAOS in the preoperative setting. However, they are systemic parameters, and therefore, unspecific. Nevertheless, they may be the first and occasionally the only preoperative indication, especially when clinical symptoms are lacking. They are easy to obtain, cheap, and are available worldwide. In the last decade, different novel serum biomarkers (percentage of neutrophils, neutrophils to lymphocytes ratio, platelet count to mean platelet volume ratio, fibrinogen, D-Dimer, Il-6, PCT) were investigated to find a more specific and accurate serum parameter in the diagnosis of PJI. This article reviews the diagnostic value of established (serum CRP, ESR, WBC) and ‘novel’ serum inflammatory biomarkers (fibrinogen, D-dimer, interleukin-6 (IL-6), procalcitonin, percentage of neutrophils (%N), neutrophils to lymphocytes ratio (NLR), platelet count to mean platelet volume ratio (PC/mPV)) for the preoperative diagnosis of periprosthetic joint infections.

New coronavirus infection, hemostasis and heparin dosing problems: It is important to say now

2020 ◽  
Author(s):  
А.Ю. Буланов ◽  
Е.В. Ройтман
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight ◽  
Evidence Based ◽  
Low Molecular Weight Heparins ◽  
Heparin Resistance ◽  
Hospital Patients ◽  
Expert’S Opinion ◽  
Coronavirus Infection ◽  
Based Medicine ◽  
D Dimer

В отсутствие достаточной базы доказательной медицины самым ценным становится мнение экспертов, опирающихся на свой опыт и опыт коллег. COVID-19-ассоциированная коагулопатия имеет характер тромбовоспаления. Назначение гепаринов — нефракционированного или, главным образом, низкомолекулярного (НМГ) призвано преодолеть его, поскольку гепарин обладает не только антикоагулянтным эффектом, но и оказывает непрямое и прямое противовоспалительное дейст вие. Поэтому назначение НМГ как минимум в профилактических дозах показано всем госпитализированным пациентам. Система гемостаза у пациентов с COVID-19, прежде всего у тяжелых, требует лабораторной оценки количества тромбоцитов, содержания Д-димера, протромбинового отношения или процентов протромбина по Квику и концентрации фибриногена. Анализ данных показал, что своеобразие коронавирусного гемостаза формирует гиперфибриногенемия, которая становится явным фактором гепаринорезистентности. Для преодоления последней назначение увеличенных (промежуточных или лечебных) доз НМГ выглядит перспективным решением. Достаточность назначения уместно определить либо по анти- Ха активности или (как экспресс-оценка) по тромбоэластрограмме. In the absence of a suffi cient base of evidence-based medicine, the most valuable becomes the expert’s opinion as a mirror of both personal and collegial experience. COVID-19-associated coagulopathy has a character of a thromboinfl ammation. The heparins — unfractionated or mainly low molecular weight heparins (LMWH) are intended to overcome it, since heparins have not only an anticoagulant effect but both an indirect and direct anti-infl ammatory effects as well. So that LMWH are indicated for all in-hospital patients. Patients with COVID-19, especially in severe cases, require laboratory testing of platelet count, D-dimer, prothrombin ratio or prothrombin percents by Quick and fi brinogen. Data analysis showed that a feature of coronavirus hemostasis is hyperfibrinogenemia that becomes an overt factor for heparin resistance. To overcome the latter, an adjusting doses of LMWH toward intermediate or therapeutic looks like a promising way. The suffi ciency of the adjusted LMWH dose is appropriate determining either with anti- Xa activity or thromboelastographically as express testing. Key words: hemostasis, COVID-19-associated coagulopathy, fibrinogen, low molecular weight heparins

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