scholarly journals Rotational Thromboelastometry Predicts Care Level in COVID-19: A Prospective, Observational Study.

2020 ◽  
Author(s):  
Lou M. Almskog ◽  
Agneta Wikman ◽  
Jonas Svensson ◽  
Michael Wanecek ◽  
Matteo Bottai ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Healthy Controls ◽  
Care Level ◽  
Rotational Thromboelastometry ◽  
High Prevalence ◽  
Level 1 ◽  
Clot Formation Time ◽  
Maximum Clot Firmness

Abstract BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. ConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

scholarly journals Rotational Thromboelastometry predicts care level in COVID-19

2020 ◽  
Author(s):  
Lou M. Almskog ◽  
Agneta Wikman ◽  
Jonas Svensson ◽  
Michael Wanecek ◽  
Matteo Bottai ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Severe Disease ◽  
Healthy Controls ◽  
Care Level ◽  
Rotational Thromboelastometry ◽  
High Prevalence ◽  
Ventilation Support ◽  
Level 1 ◽  
Clot Formation Time ◽  
Maximum Clot Firmness

AbstractBackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment.ObjectivesTo test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients.MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia.ConclusionROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

scholarly journals Rotational thromboelastometry results are associated with care level in COVID-19

2020 ◽  
Author(s):  
Lou M. Almskog ◽  
Agneta Wikman ◽  
Jonas Svensson ◽  
Michael Wanecek ◽  
Matteo Bottai ◽  
...  
Keyword(s):  
Disease Severity ◽  
Blood Type ◽  
Care Level ◽  
Rotational Thromboelastometry ◽  
Moderate Disease ◽  
High Prevalence ◽  
Coagulation Tests ◽  
Ventilation Support ◽  
Level 1 ◽  
Maximum Clot Firmness

Abstract High prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The primary aim of this study was to test whether rotational thromboelastometry (ROTEM) at admission indicates hypercoagulopathy and predicts the disease severity, assessed as care level, in COVID-19 patients. The study was designed as a prospective, observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: (1) regular wards or (2) wards with specialized ventilation support. Conventional coagulation tests, blood type and ROTEM were taken at admission. 60 patients were included; age 61 (median), 67% men, many with comorbidities (e.g. hypertension, diabetes). The ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with in healthy controls (p < 0.001) and higher in severely ill patients compared with in patients at regular wards (p < 0.05). Our results suggest that hypercoagulopathy is present early in patients with mild to moderate disease, and more pronounced in severe COVID-19 pneumonia. Non-O blood types were not overrepresented in COVID-19 positive patients. ROTEM variables showed hypercoagulopathy at admission and this pattern was more pronounced in patients with increased disease severity. If this feature is to be used to predict the risk of thromboembolic complications further studies are warranted.

scholarly journals Hypercoagulation detected by Rotational Thromboelastometry predicts mortality in COVID-19: A risk model based on a prospective observational study.

TH Open ◽  
2021 ◽  
Author(s):  
Lou Mandelman Almskog ◽  
Agneta Wikman ◽  
Jonas Svensson ◽  
Matteo Bottai ◽  
Mariann Kotorman ◽  
...  
Keyword(s):  
Observational Study ◽  
Prediction Model ◽  
Prospective Observational Study ◽  
Risk Model ◽  
Severe Disease ◽  
Anticoagulation Therapy ◽  
Respiratory Frequency ◽  
Rotational Thromboelastometry ◽  
Risk Of Death

ABSTRACT Background: Severe disease due to COVID-19 has been shown to be associated with hypercoagulation. The aim of this study was to assess Rotational Thromboelastometry (ROTEM®) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods: This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model including variables ROTEM EXTEM-MCF (Maximum Clot Firmness), which in previous data has been suggested a suitable marker of hypercoagulation, age and respiratory frequency was developed using logistic regression to evaluate the probability of death. Results: Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-CT (Coagulation Time) was observed, supporting a SARS-CoV-2 effect on prolonged initiation of coagulation. Conclusions: Here we show that hypercoagulation measured with ROTEM predicts 30-days mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.

Prevalence of Acute Traumatic Coagulopathy in Acutely Traumatized Dogs and Association with Clinical and Laboratory Parameters at Presentation

2021 ◽  
Author(s):  
Yaiza Herrero ◽  
Rahel Jud Schefer ◽  
Benjamin M. Muri ◽  
Nadja E. Sigrist
Keyword(s):  
Clotting Time ◽  
Acute Traumatic Coagulopathy ◽  
Rotational Thromboelastometry ◽  
Clot Strength ◽  
Laboratory Parameters ◽  
Coagulation Abnormalities ◽  
Trauma Triage ◽  
Clot Formation Time ◽  
Maximum Clot Firmness ◽  
Traumatic Coagulopathy

Abstract Objective The aim of this study was to determine the prevalence of acute traumatic coagulopathy (ATC) and identify associated clinical and laboratory parameters including rotational thromboelastometry. Study Design Dogs presenting within 6 hours after trauma were allocated to the ATC or non-ATC group based on thromboelastometry analysis (ex-tem S, in-tem S, fib-tem S). ATC was defined as ≥2 hypocoagulable parameters in 1 profile and ≥ 1 hypocoagulable parameter in an additional profile. Parameters used were ex-tem and in-tem clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis and fib-tem MCF. Clinical and laboratory parameters at presentation, animal trauma triage (ATT) score, transfusion requirement and outcome were compared. Logistic regression was used to identify independent factors associated with ATC. Results Eleven of 33 dogs presented with ATC and showed ex-tem CT and CFT prolongation and reduced MCF amplitude in all profiles (all p < 0.001). pH (p = 0.043) and potassium concentration (p = 0.022) were significantly lower and bleeding (p = 0.027) and plasma transfusions (p = 0.001) more common in dogs with ATC. Time after trauma (p = 0.040) and Animal Trauma Triage score (p = 0.038, including haematocrit as confounding factor) were associated with the presence of ATC. Conclusion Acute traumatic coagulopathy is more common in traumatized dogs than previously reported. Acute traumatic coagulopathy was associated with acidosis, Animal trauma triage score, time after trauma and higher transfusion needs. Coagulation abnormalities include ex-tem CT and CFT prolongations and decreased clot strength.

scholarly journals Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1995
Author(s):  
Georgios N. Katsaras ◽  
Rozeta Sokou ◽  
Andreas G. Tsantes ◽  
Aikaterini Konstantinidi ◽  
Dimitra Gialamprinou ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Extrinsic Pathway ◽  
Term Neonates ◽  
Rotational Thromboelastometry ◽  
Significant Prolongation ◽  
Clot Formation Time ◽  
Maximum Clot Firmness

Background: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). Methods: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia “Aghios Panteleimon”. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Results: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates.

scholarly journals High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study

2017 ◽  
Vol 10 (1) ◽  
Author(s):  
Carleara Ferreira da Rosa Silva ◽  
Rosimere Ferreira Santana ◽  
Beatriz Guitton Renaud Baptista de Oliveira ◽  
Thalita Gomes do Carmo
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Wound Care ◽  
Hospitalized Elderly ◽  
High Prevalence

scholarly journals Salivary CGRP as diagnostic and migraine attack phase monitor biomarker: CGRP (in)dependent attacks

2020 ◽  
Author(s):  
Alicia Alpuente ◽  
Victor J Gallardo ◽  
Laila Asskour ◽  
Edoardo Caronna ◽  
Marta Torres-Ferrus ◽  
...  
Keyword(s):  
Observational Study ◽  
Migraine Attack ◽  
Longitudinal Analysis ◽  
Prospective Observational Study ◽  
Preventive Treatment ◽  
Episodic Migraine ◽  
Healthy Controls ◽  
Temporal Profile ◽  
Attack Phase ◽  
Accompanying Symptoms

ABSTRACTObjectiveTo assess saliva as a substrate to measure CGRP by comparing interictal levels of CGRP in patients with episodic migraine and controls; and to evaluate saliva CGRP temporal profile during migraine attacks.MethodsThis prospective observational study included women with episodic migraine and healthy controls. Participants collected daily saliva samples for 30 consecutive days and 3 additional ones during migraine attacks. 4 timepoints were considered: interictal (72h headache-free), preictal (PRE-24h before the attack), ictal (0h,2h,8h), postictal (POST-24h after the attack). CGRP levels were quantified by ELISA.Results35 women (22 patients, 13 controls) were included. Statistically significant differences were found in interictal salivary levels of CGRP between patients and controls (median[IQR]: 98.0 [86.7] vs. 42.2 [44.7] pg/mL; p=0.010). An increase in CGRP levels during migraine attacks was detected (median[IQR]: preictal 113.5 [137.8], 0h 164.6 [204.5], 2h 101.7 [159.1], 8h 82.6 [166.2], postictal 79.6 [124.3] pg/ml; p<0.001). Patients were classified as having CGRP-dependent (80.0%) and non-CGRP dependent migraine attacks (20.0%) according to the magnitude of change between preictal and ictal phase (0h). Accompanying symptoms were different depending on the type of attack. In the longitudinal analysis, we observed that the amount of CGRP measured during attacks were phase dependent and it was influenced by the frequency of monthly headache days (p=0.02).InterpretationPatients with episodic migraine have higher interictal salivary levels of CGRP than controls. These levels usually increase during a migraine attack, however, not every attack is CGRP-dependent, which in turn, might explain different underline pathophysiology and response to acute and preventive treatment.

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