Prognostic significance of international normalised ratio and prothrombin time in Chinese acute ischaemic stroke patients

BackgroundWe investigated the association between international normalised ratio (INR) and prothrombin time (PT) levels on hospital admission and in-hospital outcomes in acute ischaemic stroke (AIS) patients.MethodsA total of 3175 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. We divided patients into four groups according to their level of admission INR: (<0.92), Q2 (0.92–0.98), Q3 (0.98–1.04) and Q4 (≥1.04) and PT. Logistic regression models were used to estimate the effect of INR and PT on death or major disability (modified Rankin Scale score (mRS)>3), death and major disability (mRS scores 4–5) separately on discharge in AIS patients.ResultsHaving an INR level in the highest quartile (Q4) was associated with an increased risk of death or major disability (OR 1.69; 95% CI 1.23 to 2.31; P-trend=0.001), death (OR, 2.64; 95% CI 1.12 to 6.19; P-trend=0.002) and major disability on discharge (OR, 1.56; 95% CI 1.13 to 2.15; P-trend=0.008) in comparison to Q1 after adjusting for potential covariates. Moreover, in multivariable logistic regression models, having a PT level in the highest quartile also significantly increased the risk of death (OR, 2.38; 95% CI 1.06 to 5.32; P-trend=0.006) but not death or major disability (P-trend=0.240), major disability (P-trend=0.606) on discharge.ConclusionsHigh INR at admission was independently associated with death or major disability, death and major disability at hospital discharge in AIS patients and increased PT was also associated with death at hospital discharge.

Features of the hemostasis system in patients with non-alcoholic fatty liver disease

Background. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. In recent years, disorders in the hemostasis system, their role in the progression of liver diseases and the development of cardiovascular complications in NAFLD have been actively studied. The purpose was to investigate the features of the hemostasis system in patients with non-alcoholic fatty liver disease. Materials and methods. We examined 36 individuals with NAFLD (20 women and 16 men) aged 29–73 years. All patients underwent an anthropometric, general clinical, biochemical study of blood serum with the determination of platelets, prothrombin time ratio, international normalized ratio, fibrinogen, ultrasound examination of the abdominal cavity organs with elastometry, followed by statistical data processing. Results. Among patients with NAFLD, class 2 obesity and overweight (30.6 % each), class 1 obesity (27.8 %) prevailed. At the same time, according to the controlled attenuation parameter, 38.9 % of people had a severe degree of steatosis, 33.3 % — moderate and 27.8 % — mild. Regarding the indicators of hemostasis, a significant increase in the level of fibrinogen up to (4.9 ± 0.5) g/l was detected in 44.4 % of patients, its severity tended to grow with an increase in the degree of hepatic steatosis. Conclusions. In 44.4 % of NAFLD patients, with an increase in the degree of hepatic steatosis, the tendency to hypercoagulability has grown with an increase in fibrinogen content by 1.6 times (p < 0.001). Changes in the international normalized ratio, prothrombin time ratio and platelets were determined in isolated cases: more than 83.3 % of patients with NAFLD didn’t have violations of these parameters.

Statistical characteristics of the components of coagulation hemostasis and the degree of oxygenation of rat blood in the normal and at different times of the experimental opioid effect

Background. The problem of non-drug use of opioid drugs occupies a significant place among the current problems of world medicine. Objective. Тo study the hematological parameters of coagulation hemostasis in the norm and the dynamics of their changes at different times of opioid exposure. Methods. The experimental study was performed on sexually mature, outbred male rats in the number of 80 animals, weighing 160-270 g, aged 4.5-7.5 months. Animals were injected intramuscularly with “Nalbuphine” once daily for one day (10-11 hours in the morning) for 98 days. The initial dose of nalbuphine during the first 2 weeks was 0.212 mg / kg, the next 2 (II - IV weeks) - 0.225 mg / kg, the next (IV - VI weeks) - 0.252 mg / kg, the next (VI - VIII weeks) ) - 0.260 mg / kg, the next (VIII - X weeks) - 0.283 mg / kg, the next (X - XII weeks) - 0.3 mg / kg, and during (XII - XIV weeks) - 0.454 mg / kg. Thus, the conditions for chronic opioid exposure were created. Animals are divided into 3 groups. The 1-st group of animals received Nalbuphine for 98 days, with subsequent collection of material (end of 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks and 14 weeks of experimental opioid exposure); The 2-d was the control group, which for 98 days received injections of saline intramuscularly in one period of time (10 - 11 o'clock in the morning). Blood sampling and study of hematological parameters of blood (platelet count, prothrombin time, prothrombin index, time of recalcification of stabilized blood, total fibrinogen, determination of hemoglobin, hematocrit) were performed according to conventional methods. Software R v 4.0.3 and RStudio v 1.2.5042 were used for statistical calculations and graphing. MSOffice Excel 2010 spreadsheets were used to generate the final tables and store the data. Results. The key to the dynamics of changes in the blood parameters of experimental animals was week 6 of the experiment, as most indicators had the highest dynamics up to 6 weeks including further indicators of stability, which was higher (fibrinogen and prothrombin index) or less (prothrombin time, recalcification time and hemoglobin) indicators of the control group. The blood hematocrit of the experimental animals decreased evenly at all study terms to a minimum value at 14 week, and the number of platelets evenly all times increased to a maximum value at the last term of the experiment. This trend in all indicators was confirmed statistically. Conclusion. Our research has made it possible to study first and then observe the dynamics of changes in coagulation hemostasis and the degree of oxygenation of blood in acute, subchronic and chronic periods of experimental opioid exposure with subsequent statistical comparison.

Effect of Time and Haemolysis on Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) Measurement on Blood Samples

Background: Coagulation, also known as blood clotting, is the process by which blood convert from a liquid to a gel, forming a blood clot. It referred to haemostasis, the stopping of blood loss from a damaged vessel, followed by repair. Material and methods: This was cross sectional study conducted at the albawasla medical laboratory, Khartoum, Sudan during the period August to November, 2021 and to evaluate the effect of time and hemolysis on prothrombin time and activated partial thromboplastin time tests. 50 samples (case group) were collected from the patients attending police teaching hospital and requested to the PT and APTT test in addition to that,50 apparently healthy donors with no history of any coagulation problems or any chronic disease were selected as control group. Three ml of venous blood samples were collected in container with Tri Sodium Citrate anticoagulant. The coagulation tests (PT and APTT) were performed using semiautomatic device (coagulometer machine MI). Results: The result of this study revealed that; when compared the measurement of PT and APTT immediately and after one hour there was insignificant differences (p. v.>0.05). also when compared the measurement of PT and APTT between hemolyzed and non-hemolyzed samples there was significant differences ( p. v.<0.05) in addition when compared case and control for the PT and APTT immediately, after one hour, hemolyzed and non-hemolyzed sample there was significant differences ( p. v.<0.05) except the APTT hemolyzed samples and insignificant differences with age and gender ( p. v.>0.05). For the correlation there was significant correlation in the case group for the PT and APTT immediately, after one hour, and hemolyzed samples. Conclusion: In the cases group results showed insignificant differences in the results of PT and APTT between immediate sample and after 1 hour in and significant differences in the results of PT and APTT between hemolyzed and non-hemolyzed samples, also there was insignificant differences between age and gender, immediately, after one hr. and hemolyzed sample in PT and APTT. Keywords: Homeostasis, hemolyzed sample, PT and APTT

Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury

(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients’ clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28–3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31–5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

Assessment of Some Haematological, Coagulation and Immune Parameters among Male Oil Refinery Workers in Port Harcourt, Nigeria

Aim: The aim of this study was to assess the levels of some hematological, coagulation and immune parameters among male oil refinery workers in Port Harcourt, Nigeria. Study Design: This study is a cross-sectional study. Place and Duration of Study: Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Shell Petroleum Development Company of Nigeria Limited and Modular Oil Refinery, Rivers State, between January 2021 and September 2021. Methodology: A total of one hundred (100) subjects (50 oil and gas workers as test subjects and 50 non-oil and gas workers as control subjects), were enrolled in the study. The convenient sampling technique was employed in the study. Venous blood samples were collected from all subjects and tested for Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen concentration, Full Blood Count (FBC) (Haemoglobin (Hb), Packed Cell Volume (PCV), Total White Blood Cell (WBC) count, Lymphocyte, Neutrophils, monocytes and Platelet Count), CD4 cell count, CD3 cell count and CD8 cell count. Data generated were analyzed statistically using Graph-Pad Prism, Version 8.0.2. Results: There was statistically significant decrease (P<.001) in Prothrombin time (PT) (11.55±0.73s), International Normalized Ratio (INR) (0.85±0.05), Fibrinogen (202.4±27.4mg/dl), Platelet count (185.6±37.1(103/μl)) and Neutrophils (46.6±6.4%) in oil refinery workers exposed to gas flare, while there was a statistical significant increase in APTT (31.8±4.15s), Hb (13.7±1.0g/dl), PCV (41.1±3.2%), Monocytes (8.4±3.0%) in subjects exposed to gas flare over control subjects with Prothrombin time(12.23±0.82s), INR(0.90±0.06), Fibrinogen(252.0±57.0mg/dl), platelet count(213.3±49.5(103/μl)) and Neutrophils(52.6±11.7%). Other parameters showed no statistical significant difference at P<.05 in both test and control subjects. Comparison of the mean ± standard deviation of the studied parameters in test subjects based on age using Analysis of Variance showed no statistically significant difference in all parameters at P<.05. Also, Comparison of the mean ± standard deviation of the studied parameters in test subjects based on duration of Exposure using Analysis of Variance showed a significant decrease in CD8 cells as the years of exposure increase (2-5years exposure = 865±319, 6-10years exposure = 579±288, 11-20 years exposure = 591± 286, F- Value = 3.869, P- Value = 0.0278). Conclusion: In conclusion, based on the findings, some haematogical, coagulation and immune parameters increased while others decreased in male oil refinery workers and duration of exposure can also be considered as a risk factor and age was considered not a risk factor as to cause any aberrations in the studied parameters.

EGb 761® Does Not Affect Blood Coagulation and Bleeding Time in Patients with Probable Alzheimer’s Dementia—Secondary Analysis of a Randomized, Double-Blind Placebo-Controlled Trial

Following reports of bleeding upon Ginkgo intake, we assessed whether Ginkgo extract EGb 761® affects coagulation or platelet function or increases the risk of bleeding. In a double-blind, placebo-controlled trial, prothrombin time, activated partial thromboplastin time, international normalized ratio and bleeding time were measured in patients with Alzheimer’s dementia at baseline, weeks 6 and 26. A total of 513 patients were randomized to 120 mg (n = 169) or 240 mg EGb 761® (n = 170) or placebo (n = 174). No relevant changes were found for coagulation parameters and bleeding time. Numbers of bleeding-related adverse events were similar in all groups. Concomitant intake of acetylsalicylic acid was documented for 68 patients in the placebo group and 105 in the EGb 761® groups. Within these groups, the means at baseline and week 26 differed by less than 1 unit for prothrombin time and bleeding time and less than 0.1 unit for international normalized ratio. Data on warfarin treatment in nine patients each taking placebo or EGb 761® did not indicate enhancement of warfarin effects by EGb 761®. No evidence was found that EGb 761® affects hemostasis or increases the bleeding risk. No pharmacodynamic interactions with warfarin or acetylsalicylic acid were found.