scholarly journals Characteristics of routine coagulationtesting and thromboelastometry in polytrauma patients at admission

2021 ◽  
Vol 63 (9) ◽  
pp. 1-5
Author(s):  
Thi Hang Tran ◽  
◽  
Thi Thu Hien Trinh ◽  
Van Chinh Nguyen ◽  
An Son Doan ◽  
...  
Keyword(s):  
University Hospital ◽  
Clot Lysis ◽  
Whole Blood Assay ◽  
Coagulation Parameters ◽  
Blood Assay ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Polytrauma Patients ◽  
Old Men ◽  
Routine Coagulation

Background: polytrauma is one of the emergency surgeries with a high mortality rate. One of the leading causes of death is coagulopathy that is not detected early and treated promptly. Thromboelastometry (ROTEM) is a whole blood assay that evaluates the viscoelastic properties during clot formation and clot lysis. This method can detect coagulopathy rapidly and accurately, thereby improving the management of bleeding after trauma. Objectives: describing and evaluating the correlation between ROTEM parameters and routine coagulation tests in polytrauma patients at admission. Method: 110 patients admitted to the Emergency Department, Viet Duc University Hospital from May 2021 to July 2021 were diagnosed with polytrauma. All patients underwent routine coagulation testing and ROTEM parameters at admission. Result: the average age of patients is 41.4±14.7 years old, men accounts for 77.3%, average ISS score is 24.5±6.3. The proportion of the polytrauma patients with coagulopathy by routine coagulation testing was 50.9%. A significant correlation was found between routine coagulation parameters and ROTEM: between APTT with CFT-INTEM (r=0.65; p<0.01); between PT and CFT-EXTEM (r=0.64; p<0.01); between platelet count and MCF-INTEM (r=0.56; p=0.00) and MCF-EXTEM (r=0.57; p=0.00); between fibrinogen level and MCF-INTEM (r=0.71; p=0.00), MCF-EXTEM (r=0.71; p=0.00), and MCF-FIBTEM (r=0.91; p=0.00). Conclusion: proportion of the polytrauma patients with coagulopathy by routine coagulation testing was 50.9%. A significant correlation was found between routine coagulation parameters and ROTEM

scholarly journals The effects of fructose diphosphate on routine coagulation tests in vitro

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Tongqing Chen ◽  
Duan Chen ◽  
Lu Chen ◽  
Zhengxu Chen ◽  
Baolong Wang ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Blood Coagulation ◽  
Detection System ◽  
Coagulation System ◽  
Thrombin Time ◽  
Aggregation Rate ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Routine Coagulation

AbstractTo evaluate the effects of fructose diphosphate (FDP) on routine coagulation tests in vitro, we added FDP into the mixed normal plasma to obtain the final concentration of 0, 1, 2, 3, 4, 5, 6, 10, 15, 20, 25, 30 and 35 mg/mL of drug. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FBG) and thrombin time (TT) of samples were analyzed with blood coagulation analyzers from four different manufacturers(Sysmex, Stago, SEKISUI and Werfen) and their corresponding reagents, respectively. Before the experiment, we also observed whether there were significant differences in coagulation test results of different lots of reagents produced by each manufacturer. At the same time as the four routine clotting tests, the Sysmex blood coagulation analyzer and its proprietary analysis software were used to detect the change of maximum platelet aggregation rate in platelet-rich plasma after adding FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL). The results of PT, aPTT and TT showed a FDP (0–35 mg/mL) concentration-dependent increase and a FBG concentration-dependent decrease. The degree of change (increase or decrease) varied depending on the assay system, with PT and aPTT being more affected by the Sysmex blood coagulation testing instrument reagent system and less affected by CEKISUI, TT less affected by CEKISUI and more affected by Stago, and FBG less affected by Stago and more affected by Sysmex. The results of PT, aPTT and TT were statistically positively correlated with their FDP concentrations, while FBG was negatively correlated. The correlation coefficients between FDP and the coagulation testing systems of Sysmex, Stago, Werfen and SEKISUI were 0.975, 0.988, 0.967, 0.986 for PT, and 0.993, 0.989, 0.990 and 0.962 for aPTT, 0.994, 0.960, 0.977 and 0.982 for TT, − 0.990, − 0.983, − 0.989 and − 0.954 for FBG, respectively. Different concentrations of FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL) had different effects on the maximum aggregation rate of platelet induced by the agonists of adenosine diphosphate (ADP, 5 µmol/L), arachidonic acid (Ara, 1 mmol/L), collagen (Col, 2.5 µg/mL) and epinephrine (Epi,10 µmol/L), but the overall downward trend was consistent, that is, with the increase of FDP concentration, the platelet aggregation rate decreased significantly. Our experimental study demonstrated a possible effect of FDP on the assays of coagulation and Platelet aggregation, which may arise because the drug interferes with the coagulation and platelet aggregation detection system, or it may affect our in vivo coagulation system and Platelet aggregation function, the real mechanism of which remains to be further verified and studied.

Monitoring Treatments with Unfractionated Heparin: CTAD Must Be Used Instead of Citrate as the Anticoagulant Solution When Using Partial-Draw Collection Tubes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2091-2091
Author(s):  
Pierre A. Toulon ◽  
Lién Abecassis ◽  
Motalib Smahi ◽  
Catherine Ternisien
Keyword(s):  
Unfractionated Heparin ◽  
Platelet Activation ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Heparin Therapy ◽  
Factor V ◽  
Test Results ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Routine Coagulation

Abstract Abstract 2091 Poster Board II-68 Collecting small volumes of blood may be necessary, particularly in pediatrics, or in case of difficult or recurrent sampling. The aim of this multicenter study, involving four hemostasis laboratories, was to compare hemostasis test results in plasma samples obtained using partial- and full-draw evacuated polymer collection tubes containing 0.109 M sodium citrate (1 vol./9 vol.) as the anticoagulant solution (VenoSafeTM, Terumo Europe, Leuven, Belgium). For that purpose, blood was collected into one full- and one partial-draw tube from patients on vitamin K antagonists (VKA, n=100), unfractionated heparin (UFH, n=89), or a low molecular weight derivative (LMWH, n=52), as well as from 136 untreated patients, including 13 hemophiliacs. Routine coagulation tests i.e. PT/INR, aPTT, fibrinogen, and factor V, as well as factor VIII and anti-FXa activity when applicable, were measured using the routine techniques at each participating center. In addition, plasma PF-4 level, evaluated using an ELISA, was investigated in a subset of 36 healthy controls. In untreated patients incl. hemophiliacs as well as in those on either VKA or LMWH, no significantly relevant discrepancy (Bland-Altman) was found between tests results obtained using full- and partial-draw tubes. In contrast, anti-FXa activity in patients on UFH was significantly lower in partial- than in full-draw tubes [median=0.33 IU/mL (range: 0.00-1.11) vs. 0.39 (range: 0.05-1.32) respectively, p<0.0001]. Similarly, aPTT was significantly shorter in partial- than in the full-draw tubes, whereas other test results were not significantly different in the two tubes. That discrepancy was likely to be related to higher amount of PF4 released in plasma after increased platelet activation in partial-draw than in full-draw tubes [392 U/mL (range: 138-971) vs. 177 (range: 52-460) respectively, n=36; p<0.005)]. To further support that hypothesis, blood was collected, from 101 patients on UFH and from 104 untreated patients, into one partial-draw collection tube containing CTAD, a mixture of citrate and inhibitors of platelet activation, as the anticoagulant solution and one full-draw citrated tube, obtained from the same manufacturer. Comparison performed according to Bland-Altman of anti-FXa obtained in the two tubes failed to demonstrate any relevant difference, with a mean bias of +0.02 IU/mL that was identical throughout the measuring range of values [median=0.22 IU/mL (range: 0.06-1.16) vs. 0.20 (range: 0.03-1.15) respectively, n=101]. Moreover, in those patients on UFH, aPTT and other routine coagulation tests were not significantly different in the two tubes and the same applied to test results obtained in the plasma from untreated patients. These results suggest that samples collected into partial-draw citrated tubes allow accurate routine coagulation testing in all patients but those requiring UFH assessment, in which their use could lead to a significant underestimation of anticoagulation. In such cases, partial-draw tubes containing CTAD could be validly used to monitor heparin therapy, as well as to perform routine coagulation testing. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Coagulation tests or Standardized questionnaire, which is better as a predictor of bleeding? A prospective study among children before tonsillectomy and/or adenoidectomy.

2020 ◽  
Author(s):  
Muhamed Masalha ◽  
Ari DeRowe ◽  
Salim Mazzawi ◽  
Tzvi chen ◽  
Rami Ghanayim ◽  
...  
Keyword(s):  
Prospective Study ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
A Prospective Study ◽  
Medical Questionnaire ◽  
Age Range ◽  
Routine Coagulation

Abstract Objective: The value of pre-operative coagulation testing for adenotonsillar surgery is controversial. The purpose of this study was to evaluate the role of routine coagulation tests and a standardized questionnaire in children before tonsillectomy and/or adenoidectomy. Results: A total of 143 children were prospectively enrolled in the study between 2013 and 2017, 81 males (56.6%) and 62 females (43.4%), age range 1 to 18 years (median age 5 years). Eighteen bleeding events were documented, three of them required treatment in the operating room. Abnormal coagulation tests were not associated with higher odds of bleeding after surgery. Higher risk of bleeding (p=0.01) was associated with an abnormal standardized medical questionnaire.

Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume

Diagnosis ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 55-60
Author(s):  
Fiamma Balboni ◽  
Stefania Barbui ◽  
Marco Gallo ◽  
Margherita Berardi ◽  
Marco Vezzosi ◽  
...  
Keyword(s):  
Oral Anticoagulant Therapy ◽  
Becton Dickinson ◽  
Coagulation Testing ◽  
Fill Volume ◽  
Coagulation Tests ◽  
Butterfly Needle ◽  
Study Population ◽  
Quality Specifications ◽  
The Difference ◽  
Routine Coagulation

AbstractBackgroundFilling of citrate tubes with appropriate amount of blood is essential for obtaining reliable results of coagulation testing. This study aimed to verify whether results of routine coagulation tests are comparable when the new Becton Dickinson Vacutainer® Citrate Plus tubes are filled at minimum or optimal volume.MethodsThe study population consisted of 133 patients (40 on oral anticoagulant therapy), who had blood collected for routine coagulation testing. Two sequential Vacutainer® Citrate Plus tubes of the same type and lot were drawn. The first tube was collected after a butterfly needle was inserted into the vein, so that the air in the tubing was aspirated into the tube before blood (minimum fill volume), whilst the second was drawn at optimal fill volume. Experiments were repeated using 2.7-mL (n = 86) and 1.8-mL (n = 47) tubes.ResultsProthrombin time (PT) and fibrinogen values were slightly but significantly decreased in tubes with minimum than in those with optimal fill volume. The activated partial thromboplastin time (APTT) was slightly prolonged in tubes with minimum than in those with optimal fill volume, but the difference was not statistically significant. An identical trend was noted in separate analyses for the 2.7-mL and 1.8-mL tubes. Spearman’s correlations between the two fill volumes were always >0.94 and bias was always within the quality specifications.ConclusionsBlood drawing into Vacutainer® Citrate Plus tubes at minimum fill volume does not clinically bias routine coagulation testing.

scholarly journals Pre-analytical practices for routine coagulation tests in European laboratories. A collaborative study from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM)

2019 ◽  
Vol 57 (10) ◽  
pp. 1511-1521 ◽  
Author(s):  
Ann Helen Kristoffersen ◽  
Anne V. Stavelin ◽  
Eva Ajzner ◽  
Gunn B.B. Kristensen ◽  
Sverre Sandberg ◽  
...  
Keyword(s):  
Storage Time ◽  
Correct Diagnosis ◽  
Collaborative Study ◽  
Storage Conditions ◽  
Coagulation Testing ◽  
Fill Volume ◽  
Coagulation Tests ◽  
Time Requirements ◽  
And Storage ◽  
Routine Coagulation

Abstract Background Correct handling and storage of blood samples for coagulation tests are important to assure correct diagnosis and monitoring. The aim of this study was to assess the pre-analytical practices for routine coagulation testing in European laboratories. Methods In 2013–2014, European laboratories were invited to fill in a questionnaire addressing pre-analytical requirements regarding tube fill volume, citrate concentration, sample stability, centrifugation and storage conditions for routine coagulation testing (activated partial thromboplastin time [APTT], prothrombin time in seconds [PT-sec] and as international normalised ratio [PT-INR] and fibrinogen). Results A total of 662 laboratories from 28 different countries responded. The recommended 3.2% (105–109 mmol/L) citrate tubes are used by 74% of the laboratories. Tube fill volumes ≥90% were required by 73%–76% of the laboratories, depending upon the coagulation test and tube size. The variation in centrifugation force and duration was large (median 2500 g [10- and 90-percentiles 1500 and 4000] and 10 min [5 and 15], respectively). Large variations were also seen in the accepted storage time for different tests and sample materials, for example, for citrated blood at room temperature the accepted storage time ranged from 0.5–72 h and 0.5–189 h for PT-INR and fibrinogen, respectively. If the storage time or the tube fill requirements are not fulfilled, 72% and 84% of the respondents, respectively, would reject the samples. Conclusions There was a large variation in pre-analytical practices for routine coagulation testing in European laboratories, especially for centrifugation conditions and storage time requirements.

scholarly journals Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

2013 ◽  
Vol 137 (11) ◽  
pp. 1641-1647 ◽  
Author(s):  
Panutsaya Tientadakul ◽  
Chulalak Kongkan ◽  
Wimol Chinswangwatanakul
Keyword(s):  
Prothrombin Time ◽  
Blood Samples ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Clinically Significant ◽  
Aptt Reagent ◽  
Heparin Neutralization ◽  
Coagulation Analyzer ◽  
Suitable Sequence ◽  
Routine Coagulation

Context.—Heparin contamination in blood samples may cause false prolongation of activated partial thromboplastin time (aPTT) and prothrombin time results. Polybrene can neutralize heparin, but it affects coagulation by itself. Objectives.——To determine the optimal concentration of polybrene to neutralize heparin, to determine the suitable sequence of reagents for the neutralization method performed on the analyzer at the same time as prothrombin time and aPTT testing, and to detect the heparin contamination in blood samples for coagulation tests in our hospital using this method. Design.—Various concentrations of heparin were added to 10 normal and 76 abnormal plasma samples to study the efficacy of polybrene. Two programs of reagent sequencing for aPTT with polybrene performed on the analyzer were tested. Samples suspected of heparin contamination according to our criteria were selected for neutralization during a 3-month period. Results.——The optimal final concentration of polybrene was 25 μg/mL. Polybrene should be added after the aPTT reagent to minimize its interference effect. Even though results of prothrombin time and aPTT after neutralization did not equal those before the spike of heparin, the differences might not be clinically significant. Eighty-one of 4921 samples (1.6%) were selected for aPTT with the neutralization method, and the detection rate of heparin contamination was 84% (68 of 81), giving an overall incidence of 1.4% (68 of 4921). Conclusions.—This method is inexpensive and can be performed rapidly with prothrombin time and aPTT on the automated analyzer, which makes it easy to practice with no need for extra plasma volumes.

Non-Thrombogenicity of Clean Glass Revealed by Native Whole Blood Assay in Bead Columns

1983 ◽  
Vol 50 (04) ◽  
pp. 814-820 ◽  
Author(s):  
J A Bergeron ◽  
J M DiNovo ◽  
A F Razzano ◽  
W J Dodds
Keyword(s):  
Whole Blood ◽  
Glass Bead ◽  
Factor Xii ◽  
Platelet Factor ◽  
Serotonin Content ◽  
Whole Blood Assay ◽  
Vascular Integrity ◽  
Blood Assay ◽  
Standard Contact ◽  
Recalcification Time

SummaryThe previously described native whole blood assay for materials in solution or suspension has been adapted to materials in a bead column configuration. These experiments showed that the glass itself accounts for little or none of the high blood-reactivity observed with conventional glass bead columns. Columns composed solely of soft glass that was “cleaned” by heat treatment (500-595° C 18 hr, electric oven) were benign toward flowing native whole blood for all variables measured (platelet count and platelet-free plasma [C14]-serotonin content, platelet factor 3 and factor XII activities, and recalcification time) with the standard contact protocol. In addition, the effluent successfully maintained perfusion of the isolated kidney, a measure of the ability of platelets to support vascular integrity. Prolonged (30 min) normothermic contact with titrated whole blood increased the subsequent reactivity of initially clean glass toward whole blood albeit to a level much less than that of conventional glass bead columns.

scholarly journals Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to conventional coagulation test in ACLF and Non-ACLF patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jessica Seeßle ◽  
Jan Löhr ◽  
Marietta Kirchner ◽  
Josefin Michaelis ◽  
Uta Merle
Keyword(s):  
Liver Cirrhosis ◽  
Test Performance ◽  
Coagulation System ◽  
Bleeding Events ◽  
Coagulation Parameters ◽  
Normal Limits ◽  
Coagulation Tests ◽  
Prospective Assessment ◽  
Patient Groups ◽  
Coagulation Assay

Abstract Background Patients with liver cirrhosis typically exhibit abnormal coagulation parameters in conventional coagulation tests (CCTs). Rotational thromboelastometry (ROTEM) is a holistic blood coagulation assay. This method provides an insight into the global hemostatic capabilities and has been suggested to provide a better overview of the coagulation system in liver cirrhosis. Methods The goal of this study was to examine hemostasis in patients with stable liver cirrhosis (Non-ACLF) and in acute-on-chronic liver failure (ACLF) by CCT and ROTEM including agreement of both tests and the prospective assessment of test performance based on clinical outcomes in ACLF patients. Therefore, ACLF patients were additionally subgrouped by bleeding events. Fifty-five Non-ACLF patients and twenty-two patients with ACLF were analysed in this prospective cohort study. Results Coagulation parameters analysed by CCT were outside the normal range in Non-ACLF and ACLF patients, but were significantly more aberrant in ACLF patients. Non-ACLF patients analysed by ROTEM revealed parameters largely within the normal limits, while significantly more ROTEM parameters in ACLF patients were affected. Maximum clot firmness (MCF) was significantly divergent between both patient groups and correlated well with levels of fibrinogen and platelet count. Using Cohen’s Kappa coefficient κ, the strength of agreement between CCT and ROTEM analyses was determined to be fair for Non-ACLF patients and moderate for ACLF patients. Bleeding events occurred significantly more often in ACLF group with significantly reduced A10 and MCF. Conclusions For assessing hemostasis in Non-ACLF and ACLF patients the underlying dataset shows advantages of ROTEM over CCT. A10 and MCF represent suitable prognostic parameters in predicting bleeding events in ACLF group.

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