scholarly journals Serial EXTEM, FIBTEM, and tPA Rotational Thromboelastometry Observations in the Maastricht Intensive Care COVID Cohort—Persistence of Hypercoagulability and Hypofibrinolysis Despite Anticoagulation

2021 ◽  
Vol 8 ◽  
Author(s):  
Anne-Marije Hulshof ◽  
Renée A. G. Brüggemann ◽  
Mark M. G. Mulder ◽  
Tom W. van de Berg ◽  
Jan-Willem E. M. Sels ◽  
...  
Keyword(s):  
Intensive Care ◽  
Onset Time ◽  
Thromboembolic Events ◽  
Rotational Thromboelastometry ◽  
Lysis Time ◽  
Patients At Risk ◽  
Laboratory Variables ◽  
Clot Formation Time

Background: Coronavirus Disease 2019 (COVID-19) patients often present with thromboembolic events. In COVID-19 patients, routine hemostatic assays cannot correctly identify patients at risk for thromboembolic events. Viscoelastic testing with rotational thromboelastometry (ROTEM) might improve the characterization of COVID-19-associated coagulopathy.Objective: To unravel underlying coagulopathy and fibrinolysis over time as measured by serial assessment heparin-independent (FIBTEM and EXTEM) and fibrinolysis illustrating (tissue plasminogen activator; tPA) ROTEM assays.Patients/Methods: Between April 23 and June 12, consecutive adult patients enrolled within the Maastricht Intensive Care COVID (MaastrICCht) cohort were included, and a comprehensive set of clinical, physiological, pharmaceutical, and laboratory variables were collected daily. Twice per week, EXTEM, FIBTEM, and tPA ROTEM were performed. Clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), lysis onset time (LOT), and lysis time (LT) were determined to assess clot development and breakdown and were compared to routine hemostatic assays.Results: In 36 patients, 96 EXTEM/FIBTEM and 87 tPA ROTEM tests were performed during a 6-week follow-up. CT prolongation was present in 54% of EXTEM measurements, which were not matched by prothrombin time (PT) in 37%. Respectively, 81 and 99% of all EXTEM and FIBTEM MCF values were above the reference range, and median MCF remained elevated during follow-up. The ROTEM fibrinolysis parameters remained prolonged with median LOT consequently >49 min and unmeasurable LT in 56% of measurements, suggesting a severe hypofibrinolytic phenotype.Conclusion: ROTEM tests in COVID-19 ICU patients show hypercoagulability and severe hypofibrinolysis persisting over at least 6 weeks.

scholarly journals Coagulation under Mild Hypothermia Assessed by Thromboelastometry

2021 ◽  
pp. 1-7
Author(s):  
Tobias Nitschke ◽  
Philipp Groene ◽  
Alice-Christin Acevedo ◽  
Tobias Kammerer ◽  
Simon T. Schäfer
Keyword(s):  
Mild Hypothermia ◽  
Onset Time ◽  
Rotational Thromboelastometry ◽  
Lysis Time ◽  
Sample Data ◽  
In Vivo Testing ◽  
Fibrinolytic Capacity ◽  
Clot Formation Time

<b><i>Introduction:</i></b> While previous studies have shown a significant impact of extreme hypo- and hyperthermia on coagulation, effects of much more frequently occurring perioperative mild hypothermia are largely unknown. This study therefore aimed to analyze the effects of mild hypothermia using rotational thromboelastometry in vitro. <b><i>Materials and Methods:</i></b> Twelve healthy volunteers were included in this study. Standard thromboelastometric tests (EXTEM, INTEM, FIBTEM) were used to evaluate coagulation in vitro at 39, 37, 35.5, 35, and 33°C. Beyond standard thromboelastometric tests, we also evaluated the effects of mild hypothermia on the TPA-test (ClotPro, Enicor GmbH, Munich, Germany), a new test which aims to detect fibrinolytic capacity by adding tissue plasminogen activator to the sample. Data are presented as the median with 25/75th percentiles. <b><i>Results:</i></b> Extrinsically activated coagulation (measured by EXTEM) showed a significant increase in clot formation time (CFT; 37°C: 90 s [81/105] vs. 35°C: 109 s [99/126]; <i>p</i> = 0.0002), while maximum clot firmness (MCF) was not significantly reduced. Intrinsically activated coagulation (measured by INTEM) also showed a significant increase in CFT (37°C: 80 s [72/88] vs. 35°C: 94 s [86/109]; <i>p</i> = 0.0002) without significant effects on MCF. Mild hypothermia significantly increased both the lysis onset time (136 s [132/151; 37°C] vs. 162 s [141/228; 35°C], <i>p</i> = 0.0223) and lysis time (208 s [184/297; 37°C] vs. 249 s [215/358; 35°C]; <i>p</i> = 0.0259). <b><i>Conclusion:</i></b> This demonstrates that even under mild hypothermia coagulation is significantly altered in vitro. Perioperative temperature monitoring and management are greatly important and can help to prevent mild hypothermia and its adverse effects. Further investigation and in vivo testing of coagulation under mild hypothermia is needed.

scholarly journals Audit of general intensive care unit of Bangabandhu Sheikh Mujib Medical University

2014 ◽  
Vol 22 (1) ◽  
pp. 12-15
Author(s):  
Debabrata Banik ◽  
AK Huda Quamrul ◽  
Md Rafayet Ullah Siddique ◽  
Md Mizanur Rahman ◽  
Md Rezaul Huda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Identification ◽  
Early Discharge ◽  
Bed Occupancy ◽  
High Dependency ◽  
Patients At Risk ◽  
Step Down ◽  
Medical University

All patients admitted to the Intensive Care Unit of BSMMU between January 2006 and December 2006 on whom data had been entered into the study. A total of 473 admissions with complete records were available. Hospital mortality was 60.6%. Nonsurvivors were older than survivors and had longer ICU stays. Patients admitted from wards had a higher mortality than patients from the operating room/ recovery or the emergency department. Thirty-four percent of patients were in the ICU for >2 days, and they accounted for nearly 81% of bed occupancy. Early identification of patients at risk, both before admission and after discharge from the ICU, may allow treatment to decrease mortality. Research and resources may be best directed at patients who die, despite a relatively low predicted mortality. Many patients die after discharge from ICU and this mortality may be decreased by minimizing inappropriate early discharge to the ward, by the provision of high dependency and step-down units, and by continuing advice and follow-up by the ICU team after the patient has been discharged. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18095 Journal of BSA, 2009; 22(1): 12-15

scholarly journals Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization For COVID-19

2020 ◽  
Author(s):  
Sulaiman Somani ◽  
Felix Richter ◽  
Valentin Fuster ◽  
Jessica De Freitas ◽  
Nidhi Naik ◽  
...  
Keyword(s):  
New York ◽  
Intensive Care ◽  
Respiratory Distress ◽  
Hospital Treatment ◽  
Index Hospitalization ◽  
Readmission Rates ◽  
Treatment Dose ◽  
Discharged Patients

Background: Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. Methods and Findings: Retrospective cohort study of patients with confirmed SARS-CoV-2 discharged alive from five hospitals in New York City with index hospitalization between February 27th-April 12th, 2020, with follow-up of ≥14 days. Significance was defined as P<0.05 after multiplying P by 125 study-wide comparisons. Of 2,864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared to patients who did not return, among those who returned there was a higher proportion of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%). Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs. 6.7 [3.5, 11.5] days; Padjusted=0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; Padjusted=0.001). A trend towards association between absence of in-hospital anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, Padjusted=0.064). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively. Conclusions: Return to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned had higher proportion of COPD and hypertension with shorter LOS on index hospitalization, and a trend towards lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS and anticoagulation are associated with reduced readmissions.

scholarly journals Characterization of People with Diabetes Mellitus Assisted in an Outpatient Follow-up Clinic

10.3823/2400 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Patrícia Simplício de Oliveira ◽  
Carla Lidiane Jácome de Lima ◽  
Josefa Danielma Lopes Ferreira ◽  
Thalys Maynnard Costa Ferreira ◽  
Adriana Lira Rufino de Lucena ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Self Care ◽  
Disease Process ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Cross Sectional ◽  
Positive Attitudes ◽  
Laboratory Variables

Objective: To characterize the profile of people with diabetes, according to sociodemographic, clinical and laboratory variables. Method: Cross-sectional study with a quantitative approach, conducted with 110 people with diabetes mellitus treated at outpatient follow-up of a teaching hospital in João Pessoa - PB, Brazil, during February-June 2015. To collect data, we used a form contemplating sociodemographic, clinical and laboratory variables. For the analysis, we used descriptive statistics often measures for categorical variables, mean and standard deviation for numeric variables. Results: The study revealed that the socio-demographic, clinical and laboratory characteristics increase the risk of morbidity and mortality for people studied, as well as being impediments to the realization of self-care. Conclusion: The importance of achieving education for self-care was evident, for many of these identified factors can be modified when the person with diabetes has knowledge about their health-disease process, promoting positive attitudes in their care.

scholarly journals Anticoagulation after VA-ECMO decannulation, providing new insights

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Maestro-Benedicto ◽  
A Duran-Cambra ◽  
M Vila-Perales ◽  
J Sans-Rosello ◽  
J Carreras-Mora ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Anticoagulation Therapy ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Va Ecmo ◽  
A Prospective Study

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol.  AIM The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation. METHODS We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after). RESULTS Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%. CONCLUSIONS This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis

scholarly journals A closed-loop optogenetic screen for neurons controlling feeding in Drosophila

2021 ◽  
Author(s):  
Celia K S Lau ◽  
Meghan Jelen ◽  
Michael D Gordon
Keyword(s):  
Drosophila Melanogaster ◽  
Expression Pattern ◽  
Sensory Neurons ◽  
Closed Loop ◽  
Higher Order ◽  
Taste Detection ◽  
Proof Of Principle ◽  
Feeding Circuits

Abstract Feeding is an essential part of animal life that is greatly impacted by the sense of taste. Although the characterization of taste-detection at the periphery has been extensive, higher order taste and feeding circuits are still being elucidated. Here, we use an automated closed-loop optogenetic activation screen to detect novel taste and feeding neurons in Drosophila melanogaster. Out of 122 Janelia FlyLight Project GAL4 lines preselected based on expression pattern, we identify six lines that acutely promote feeding and 35 lines that inhibit it. As proof of principle, we follow up on R70C07-GAL4, which labels neurons that strongly inhibit feeding. Using split-GAL4 lines to isolate subsets of the R70C07-GAL4 population, we find both appetitive and aversive neurons. Furthermore, we show that R70C07-GAL4 labels putative second-order taste interneurons that contact both sweet and bitter sensory neurons. These results serve as a resource for further functional dissection of fly feeding circuits.

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