Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples

Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182–499 s, CFT 63–176 s, α-angle 58–78°, A5 28–52 mm, A10 37–61 mm, A20 42–66 mm, MCF 43–67 mm, LI30 97–100%, LI60 87–98% and MCE 75–203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.

Mild Traumatic Brain Injury in Older Adults: Are Routine Second cCT Scans Necessary?

Fall-related hospitalizations among older adults have been increasing in recent decades. One of the most common reasons for this is minimal or mild traumatic brain injury (mTBI) in older individuals taking anticoagulant medication. In this study, we analyzed all inpatient stays from January 2017 to December 2019 of patients aged > 75 years with a mTBI on anticoagulant therapy who received at least two cranial computer tomography (cCT) scans. Of 1477 inpatient stays, 39 had primary cranial bleeding, and in 1438 the results of initial scans were negative for cranial bleeding. Of these 1438 cases, 6 suffered secondary bleeding from the control cCT scan. There was no significance for bleeding related to the type of anticoagulation. We conclude that geriatric patients under anticoagulant medication don’t need a second cCT scan if the primary cCT was negative for intracranial bleeding and the patient shows no clinical signs of bleeding. These patients can be dismissed but require an evaluation for need of home care or protective measures to prevent recurrent falls. The type of anticoagulant medication does not affect the risk of bleeding.

Assessment of Association Between Venous Occlusion and Infection of Cardiac Implantable Electronic Devices

The increasing number of patients treated with cardiac implantable electronic devices (CIEDs) and indications for complex pacing requires system revisions. Currently, data on venous patency in repeat CIED surgery involving lead (re)placement or extraction are largely missing. This study aimed to assess venous patency and risk factors in patients referred for repeat CIED lead surgery, emphasizing CIED infection. All consecutive patients requiring extraction, exchange, or additional placement of ≥1 CIED leads during reoperative procedures from January 2015 to March 2020 were evaluated in this retrospective study. Venography was performed in 475 patients. Venous patency could be assessed in 387 patients (81.5%). CIED infection with venous occlusion was detected in 74 patients compared with venous occlusion without infection in 14 patients ( P < .05). Concerning venous patency, novel oral anticoagulant medication appeared to be protective ( P < .05; odds ratio [OR]: .35). Infection of the CIED appeared to be strongly associated with venous occlusion (OR: 16.0). The sensitivity was only 64.15%, but the specificity was 96.1%. Number of leads involved and previous CIED procedures were not associated with venous occlusion. In conclusion, in patients with CIED, venous occlusion was strongly associated with device infection, but not with the number of leads or previous CIED procedures.

Factors influencing adherence to medication in patients using anticoagulant drug

Funding Acknowledgements Type of funding sources: None. Main funding source(s): Researcher Introduction Anticoagulant drugs are quite narrow in their therapeutic range, which should be closely monitored throughout the treatment. In addition to monitoring the responses to the drug in patients who are taking anticoagulant medication, informing the patient and his family is one of the important responsibilities of the nurse within the scope of the counseling and training roles. Aim The aim of this comparative study is to investigate the factors affecting drug compliance in young adult (18-65 years) and elderly (over 65 years) patients who using anticoagulant drugs. Method This research was carried out descriptively and cross-sectionally in a public hospital between October 1 and December 31, 2018, and was conducted with 100 patients in Cardiovascular Surgery and Cardiology outpatient clinics and clinics. Research data was obtained by; Patient Information Form (55 questions) and Morisky Medication Adherence Scale (9 questions). Results 56% of the patients were female and 44% were male, the mean age of the patients was 63.3 ± 14.67 years. The mean scale score of young adult patients was 5.41 ± 2.44 (compatible) and the mean scale score of elderly patients was found to be 8.95 ± 2.21 (incompatible). 48.2% of the female patients and 54.5% of the male patients were found to be compatible with the treatment. When the relationship between the knowledge level of anticoagulant drugs and their compliance with the treatment according to age group is evaluated; patients in all age groups who expressed their own level of knowledge inadequately, were found to be incompatible with treatment. 46.2% of young adult patients who stated that they had hospitalization due to the drug and 64.3% of young adult patients who stated that they applied to the emergency department, were highly compatible; 93.8% of elderly patients who stated that they had hospitalized and 88.6% of the elderly patients who stated that they applied to the emergency department, had a low compliance. (p ˂0,05) Conclusions and Recommendations: Many factors such as age, education, other people who they live together, level of knowledge about anticoagulant medication, forgetting to use the drug, thinking the treatment damages themselves or not wanting the treatment, carrying information about medication beside themselves and using other medications without asking a doctor were found as many cases which affect the compliance with the treatment. It was found that compliance with treatment in older patients was found to be more incompatible with treatment compared to young adult patients. It is recommended that healthcare professionals in healthcare environments in our country specialize in anticoagulant therapy management and establish certification programs. It is suggested to provide effective continuity of these programs by planning trainings for patients receiving anticoagulant therapy by specialized healthcare professionals.

Atrial Fibrillation Patient’s Treatment Experience: A Qualitative Analysis of Rivaroxaban and Warfarin

Objectives: In the treatment of atrial fibrillation (AF), anticoagulant medications such as warfarin and rivaroxaban are commonly prescribed to help reduce the risk of ischaemic strokes, and other thromboembolic events. Previous research has highlighted various advantages and disadvantages of each of these medications, but there remains an absence of qualitative evidence regarding the lived experiences of AF patients. The present study aims to address this gap and obtain a greater understanding of the patient experience and beliefs surrounding their selected anticoagulant medication. Design: Semi-structured qualitative interviews with a purposive sample of 20 participants (10 warfarin, 10 rivaroxaban). Interviews were transcribed verbatim and thematically analyzed. Results: Data analysis led to the generation of three key themes: positive perceptions of medication, distrust of alternatives, and inconsistencies in support experiences.Conclusions: Positive perceptions of one anticoagulant medication (ACM) and distrust of alternatives may influence patients’ confidence in switching medications. This is potentially problematic where there is a lack of patient engagement in medication changes. Gaps in patient understanding of anticoagulation, including lack of clarity around medications selection, and misconceptions about treatment, were evident. By addressing these misconceptions, clinicians may be better positioned to support people with AF in self-management of their ACM.

Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.

The Spontaneous Retropharyngeal Space Hematoma: How to Manage?

Introduction: Spontaneous Retropharyngeal Hematoma (SRH) is a rare affection which occurs without traumatism. Case report: A 68 years old woman brought to the emergency department with a cervico-thoracic swelling rapidly increasing in size without any previous traumatic history or anticoagulant medication. Complicated by dysphagia and dysphonia without signs of dyspnea. The clinical examination revealed a painful anterior cervico-thoracic swelling with an ecchymotic cupboard on it. Cervico-thoracic CT scan found a voluminous retro-pharyngeal collection, spontaneously hyperdense, extended to the oropharynx and antero-superior mediastinum without further lesions. Biological assessment was without abnormalities. The diagnosis of retropharyngeal hematoma was retained. The treatment was based on corticosteroids and antibiotics drugs with strict clinical and radiological monitoring. With conservative treatment, the evolution was favorable, marked by progressive regression of the hematoma until its disappearance and an absence of recurrence after a retreat of one year. Conclusion: The clinical presentation of a retropharyngeal hematoma out of an evocative context is misleading and lead to radiological investigation without delaying the treatment which varies from supervision to surgery according to respiratory status and evolution under strict control.

Coagulopathy and its effect on treatment and mortality in patients with traumatic intracranial hemorrhage

Background The role of coagulopathy in patients with traumatic brain injury has remained elusive. In the present study, we aim to assess the prevalence of coagulopathy in patients with traumatic intracranial hemorrhage, their clinical features, and the effect of coagulopathy on treatment and mortality. Methods An observational, retrospective single-center cohort of consecutive patients with traumatic intracranial hemorrhage treated at Helsinki University Hospital between 01 January and 31 December 2010. We compared clinical and radiological parameters in patients with and without coagulopathy defined as drug- or disease-induced, i.e., antiplatelet or anticoagulant medication at a therapeutic dose, thrombocytopenia (platelet count < 100 E9/L), international normalized ratio > 1.2, or thromboplastin time < 60%. Primary outcome was 30-day all-cause mortality. Logistic regression analysis allowed to assess for factors associated with coagulopathy and mortality. Results Of our 505 patients (median age 61 years, 65.5% male), 206 (40.8%) had coagulopathy. Compared to non-coagulopathy patients, coagulopathy patients had larger hemorrhage volumes (mean 140.0 mL vs. 98.4 mL, p < 0.001) and higher 30-day mortality (18.9% vs. 9.7%, p = 0.003). In multivariable analysis, older age, lower admission Glasgow Coma Scale score, larger hemorrhage volume, and conservative treatment were independently associated with mortality. Surgical treatment was associated with lower mortality in both patients with and without coagulopathy. Conclusions Coagulopathy was more frequent in patients with traumatic intracranial hemorrhage presenting larger hemorrhage volumes compared to non-coagulopathy patients but was not independently associated with higher 30-day mortality. Hematoma evacuation, in turn, was associated with lower mortality irrespective of coagulopathy.