Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products?

Introduction. This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical re-intervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. Methods. A retrospective review was conducted of 698 patients who underwent CPB at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 – February 16, 2015 (Period I) and May 16, 2015 - May 16, 2016 (Period II). Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II. Intraoperative and postoperative administration blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay and mortality were recorded. Results. Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p <0.001). TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving FFP and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001). Use of TEG was not observed to significantly decrease postoperative blood product usage or mortality. The median length of hospital stay was reduced by 1 day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). Conclusions. Use of TEG-directed transfusion of blood products following CPB appears to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined.

The effects of fructose diphosphate on routine coagulation tests in vitro

To 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.

River water turbidity removal using new natural coagulant aids: case study of Euphrates River, Iraq

For turbidity removal, most of drinking water treatment plants are using coagulants due to the presence of suspended and colloidal materials at the coagulation and flocculation units. Aluminium and sulphates salts are the widely used coagulants, such as Aluminium sulphate (Alum) and ferric chloride. However, several researches have linked Alzheimer's disease to the use of Aluminium sulphate. Hence, scholars have conducted several researches on the possibility to reduce the amount of Aluminium sulphate by using natural material/plants base as coagulant aids. In this study, Mallow's Leaves Extracts (MLE) and Carob's Pods Extracts (CPE) were used as an alternative coagulant aid. Couples of coagulation tests were implemented to find the optimal dosage of Aluminium Sulphates were used as coagulants. The results displayed that the maximum turbidity removal efficiency by adding 100% of each coagulant (i.e., Alum, MLE and CPE) were (61.16%, 51.175% and 37.12%), respectively. In addition, the minimum residual turbidity and maximum turbidity removal efficiency were 4.56 NTU and 97.72% by adding 22.5 Alum and 7.5 MLE presenting 30 mg/l dosing. Further, the minimum residual turbidity and maximum turbidity removal efficiency were 15.4 NTU and 92.3% by adding 22.5 Alum and 7.5 CPE presenting 30 mg/l dosing.

Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19

Coagulopathy is a frequently reported finding in the pathology of coronavirus disease 2019 (COVID-19); however, the molecular mechanism, the involved coagulation factors, and the role of regulatory proteins in homeostasis are not fully investigated. We explored the dynamic changes of nine coagulation tests in patients and controls to propose a molecular mechanism for COVID-19-associated coagulopathy. Coagulation tests including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FIB), lupus anticoagulant (LAC), proteins C and S, antithrombin III (ATIII), D-dimer, and fibrin degradation products (FDPs) were performed on plasma collected from 105 individuals (35 critical patients, 35 severe patients, and 35 healthy controls). There was a statically significant difference when the results of the critical (CRT) and/or severe (SVR) group for the following tests were compared to the control (CRL) group: PTCRT (15.014) and PTSVR (13.846) (PTCRL = 13.383, p &lt; 0.001), PTTCRT (42.923) and PTTSVR (37.8) (PTTCRL = 36.494, p &lt; 0.001), LACCRT (49.414) and LACSVR (47.046) (LACCRL = 40.763, p &lt; 0.001), FIBCRT (537.66) and FIBSVR (480.29) (FIBCRL = 283.57, p &lt; 0.001), ProCCRT (85.57%) and ProCSVR (99.34%) (ProCCRL = 94.31%, p = 0.04), ProSCRT (62.91%) and ProSSVR (65.06%) (ProSCRL = 75.03%, p &lt; 0.001), D-dimer (p &lt; 0.0001, χ2 = 34.812), and FDP (p &lt; 0.002, χ2 = 15.205). No significant association was found in the ATIII results in groups (ATIIICRT = 95.71% and ATIIISVR = 99.63%; ATIIICRL = 98.74%, p = 0.321). D-dimer, FIB, PT, PTT, LAC, protein S, FDP, and protein C (ordered according to p-values) have significance in the prognosis of patients. Disruptions in homeostasis in protein C (and S), VIII/VIIIa and V/Va axes, probably play a role in COVID-19-associated coagulopathy.

Correlation between D-dimer and computed tomography severity score in middle aged young adults with COVID-19 pneumonia: a retrospective study

Background: An unknown pneumonia broke out in Wuhan City in December 2019 and it was confirmed as an acute respiratory infectious disease caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, formerly known as 2019-nCoV). Consumption coagulopathy, which should be obviated in order to decrease mortality, arises in disseminated intravascular coagulation with a decrease in fibrinogen and an increase in D-dimer levels. However, studies on the predictive and prognostic values of coagulation parameters in the setting of patients with COVID-19 are still limited. The objective of this retrospective study was to investigate the correlation of D-dimer and computed tomography severity score in patients with COVID-19 pneumonia.Methods: The present retrospective study was conducted among 108 subjects reported COVID RT-PCR positive admitted during the study period i.e.; January-August 2021 in the department of medicine of Rural Medical College, Loni. Pneumonia was confirmed by Computed tomography (CT) examination and coagulation test completed within 12 hr after admission were enrolled. Coagulation tests, which Fibrinogen (Fib) and D-dimer were performed. CT score was categorized into mild (0-7), moderate (8-16) and advanced grade (17-25 points).Results: The mean age of male and female was 38.52±5.34 and 35.67±3.22 years respectively, with an overall age of 37.79±4.58 years. Mean D-dimer level was 0.54±0.09, 0.91±0.22 and 1.96±0.47 mcg/ml among subjects having mild, moderate and severe CT score respectively. According to multivariate analysis, higher D-dimer (OR:3.61, p<0.01) was significantly associated with CT severity score.Conclusions: Study concluded that the D-dimer level's time point was matched to the time of CT scan, we have reasons to correlate that the D-dimer level may predict the severity of inflammation prior to coagulopathy/thrombosis.