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Xun K, Qiu H, Jia M, Lin L, He M, Li D, Jin D. Treatment Effect of Regional Sodium Citrate Anticoagulation in Elderly Patients With High-Risk Bleeding Receiving Continuous Renal Replacement Therapy. Clin Appl Thromb Hemost 2021; 27:10760296211050640. [PMID: 34719982 PMCID: PMC8559185 DOI: 10.1177/10760296211050640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the safety and efficacy of regional citrate anticoagulation (RCA) on elderly patients at high risk of bleeding after continuous renal replacement therapy (CRRT). Methods A total of 31 patients at high risk of bleeding who received CRRT in the intensive care unit were collected. The patients were divided into RCA group (n = 17) and no anticoagulation group (NA, n = 14) according to whether RCA was used or not. The levels of creatinine (Cr), blood urea nitrogen (BUN), prothrombin time (PT), activated partial thromboplastin time (APTT), total calcium (tCa), ionized calcium ion (iCa2+), sodium ion (Na+), bicarbonate ion (HCO3−), tCa/iCa2+ ratio, and pH were observed after treatment. The filter use time, number of filters used, filter obstruction events, clinical outcomes, and safety evaluation indexes were compared post-treatment. Results After treatment, serum Cr and BUN levels, APTT and PT levels in the RCA group were significantly lower than the NA group. The tCa, iCa2+, HCO3−, tCa/iCa2+, and pH were within the normal range after RCA treatment while Na+ levels saw a significant increase. In the RCA group, the filter using time was significantly longer, with significantly reduced numbers of filter use within 72 h and filter disorder events. Additionally, patients in the RCA group showed significant recovery of renal function and a significant reduction in bleeding events and in-hospital mortality. Conclusion RCA treatment significantly improves clinical outcome of patients at high risk of bleeding after CRRT, safely and effectively prolongs the filter life and avoids coagulation incidences.
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Affiliation(s)
- Kang Xun
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Hong Qiu
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Miao Jia
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Lihua Lin
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Meiling He
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Damei Li
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Donghua Jin
- The People's Hospital of Suzhou New District, Suzhou, China
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Gao J, Wang F, Wang Y, Jin D, Tang L, Pan K. A mode of CVVH with regional citrate anticoagulation compared to no anticoagulation for acute kidney injury patients at high risk of bleeding. Sci Rep 2019; 9:6607. [PMID: 31036927 PMCID: PMC6488647 DOI: 10.1038/s41598-019-42916-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/10/2019] [Indexed: 12/21/2022] Open
Abstract
The study was designed to assess a practical mode of postdilution continuous venovenous hemofiltration (CVVH) with regional citrate anticoagulation (RCA) using a calcium-containing replacement solution, and to compare it with a CVVH mode with no anticoagulation (NA). Both methods were employed in our center for acute kidney injury (AKI) patients at high risk of bleeding. Fifty-six patients were equally allocated into the RCA-CVVH group and the NA-CVVH group. The study displayed no significant differences between groups involving baseline characteristics, severity level, blood gas analysis, hepatic/renal/coagulative functions, electrolytes, hemoglobin concentration, and platelet counts before or after continuous renal replacement therapy (CRRT). Compared to the NA-CVVH group, the RCA-CVVH group had a lower level of transfused packed red blood cells and platelet as well as a longer filter lifespan. The result showed no substantial differences between groups in terms of the mean supporting time and cost involving CRRT per person, the length of ICU and hospital stays, and the ICU survival. Homeostasis was basically preserved at a target range during the RCA post-CVVH procedure. Serious complications did not arise during the RCA process. RCA postdilutional CVVH is a safe and effective mode for application in AKI patients with a high risk of bleeding, and it can extend the filter lifespan and decrease blood loss, compared with the NA mode for CRRT. Further studies are needed to evaluate this mode for CRRT. (Retrospective Registration number ChiCTR1800016462, Registration date 2/6/2018)
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Affiliation(s)
- Jianping Gao
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Feng Wang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yonggang Wang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Dan Jin
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Liping Tang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Konghan Pan
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
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Zenor L, Anderson CJ. Bridge over Troubled Water. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Harvey CJ. Evidence-Based Strategies for Maternal Stabilization and Rescue in Obstetric Hemorrhage. AACN Adv Crit Care 2019; 29:284-294. [PMID: 30185495 DOI: 10.4037/aacnacc2018966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Obstetric hemorrhage is one of the most frequent causes of maternal death in the United States. More than 70% of maternal deaths from hemorrhage are preventable. State and professional quality care organizations have reduced severe maternal morbidity by more than 20% by implementing evidence-based guidelines. Successful hemorrhage management requires collaborative, multidisciplinary teams of trained health care personnel. Hemorrhage management's primary goal is to stop the bleeding before the occurrence of maternal hypovolemia, acidosis, coagulopathy, and death. Uterine atony is the primary cause of obstetric hemorrhage and can be managed with uterotonic agents, placement of noninvasive uterine tamponade balloons, and surgical procedures if needed. Women experiencing massive hemorrhage should be treated according to resuscitation care guidelines with avoidance of hypothermia, acidosis, and coagulopathy. Use of a massive transfusion protocol is warranted for best outcomes. Resources for institutional adoption of current collaborative standards for managing obstetric hemorrhage are identified in this article.
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Affiliation(s)
- Carol J Harvey
- Carol J. Harvey is Clinical Specialist, Women's Services and Patient Care Administration, Northside Hospital, 1000 Johnson Ferry Rd, Atlanta, GA 30342
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Sharp G, Young CJ. Point‐of‐care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer for surgeons. ANZ J Surg 2018; 89:291-295. [DOI: 10.1111/ans.14836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/28/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Gary Sharp
- Department of Colorectal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Department of Colorectal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Discipline of SurgeryThe University of Sydney Sydney New South Wales Australia
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Abstract
This article reviews treatments and strategies that can be used to reduce, or as adjuncts to, blood transfusion to manage blood volumes in patients who are critically ill. Areas addressed include iatrogenic anemia, fluid management, pharmaceutical agents, hemostatic agents, hemoglobin-based oxygen carriers, and management of patients for whom blood is not an option.
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Affiliation(s)
- Deborah J Tolich
- Blood Management, Cleveland Clinic Health System, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Kelly McCoy
- Blood Management, Cleveland Clinic Health System, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Etchill E, Sperry J, Zuckerbraun B, Alarcon L, Brown J, Schuster K, Kaplan L, Piper G, Peitzman A, Neal MD. The confusion continues: results from an American Association for the Surgery of Trauma survey on massive transfusion practices among United States trauma centers. Transfusion 2016; 56:2478-2486. [DOI: 10.1111/trf.13755] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Eric Etchill
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Jason Sperry
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Brian Zuckerbraun
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Louis Alarcon
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Joshua Brown
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Kevin Schuster
- Yale University School of Medicine; New Haven Connecticut
| | - Lewis Kaplan
- University of Pennsylvania Perelman School of Medicine and Philadelphia VA Medical Center; Philadelphia Pennsylvania
| | - Greta Piper
- New York University Medical Center; New York New York
| | - Andrew Peitzman
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Matthew D. Neal
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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Jeppesen AN, Kirkegaard H, Ilkjær S, Hvas AM. Influence of temperature on thromboelastometry and platelet aggregation in cardiac arrest patients undergoing targeted temperature management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:118. [PMID: 27129380 PMCID: PMC4851809 DOI: 10.1186/s13054-016-1302-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/19/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Coagulation can be visualised using whole blood coagulation analyses such as thromboelastometry and platelet aggregation tests; however, the role of temperature in the analyses is ambiguous. The aim was to examine whether temperature influences the whole blood coagulation tests. METHODS We included 40 patients treated with targeted temperature management (33 ± 1 °C) after out-of-hospital cardiac arrest. The blood samples were obtained on hypothermia and normothermia. Each blood sample was analysed simultaneously at 33 °C and 37 °C by thromboelastography (ROTEM®) employing the assays EXTEM®, INTEM®, FIBTEM® and HEPTEM®, and by Multiplate®Analyzer, using COLtest®, ADPtest®, ASPItest® and TRAPtest® as agonists. Data on antithrombotic drugs were collected systematically from medical records, and data were analysed using repeated measurement analysis of variance (ANOVA). RESULTS The ROTEM® analyses showed increased clotting time, lower maximum velocity and increased time to maximum velocity (all p values <0.02) when performed at 33 °C compared with 37 °C, irrespective of the patients being hypothermic (median 33.1 °C) or normothermic (median 37.5 °C). However, EXTEM® time to maximum velocity showed no difference between the analyses performed at 33 °C and 37 °C when the patients were hypothermic (p = 0.83). No differences were found in maximum clot firmness (all p values >0.09) analysed at 33 °C and 37 °C, independent of the body temperature. In the hypothermic blood sample, no difference was found when using the COLtest®, ASPItest® or TRAPtest® to compare platelet aggregation analysed at 33 °C and 37 °C (all p values >0.19), but platelet aggregation was significantly higher using the ADPtest® (p < 0.001) when analysed at 33 °C. In the normothermic blood sample, the TRAPtest® showed no difference (p = 0.73) when performed at 33 °C; however, significantly lower aggregation was found using the COLtest® and ASPItest® (all p values <0.001), while a higher aggregation at 33 °C was found using the ADPtest® (p = 0.003). CONCLUSION ROTEM® analyses seemed not to be dependent on body temperature but showed a slower initiation of coagulation when analysed at 33 °C compared with 37 °C. The Multiplate®Analyzer results were dependent on the temperature used in the analyses and the body temperature. In whole blood coagulation tests, the temperature used in the analyses should be kept at 37 °C irrespective of the patient's body temperature being 33 °C or 37 °C.
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Affiliation(s)
- Anni Nørgaard Jeppesen
- Research Centre for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000, Aarhus C, Denmark. .,Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000, Aarhus C, Denmark.,Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Susanne Ilkjær
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Anne Mette Hvas
- Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Rasoamampianina LE, Rafanomezantsoa TA, Rakotondrainibe A, Rajaonera AT, Randriamanantany ZA, Alson OR, Raveloson NE. [Disorders of hemostasis in surgical intensive care at the University Hospital Joseph Ravoahangy Andrianavalona Antananarivo]. Pan Afr Med J 2015; 22:114. [PMID: 26848361 PMCID: PMC4733491 DOI: 10.11604/pamj.2015.22.114.6220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/25/2015] [Indexed: 11/11/2022] Open
Abstract
Les troubles de l'hémostase sont fréquemment observés en réanimation. L'objectif de cette étude est d'en déterminer l'incidence, les étiologies et la prise en charge pour en diminuer le risque de morbi-mortalité. Etude rétrospective sur une période de huit mois en réanimation chirurgicale du CHUA HUJRA. Les dossiers étudiés étaient ceux contenant tous les premiers bilans d'hémostase lors de l'admission du patient en réanimation, avec un âge supérieur à 15 ans. Etaient exclus les dossiers des post opérés (malade ayant subi une intervention chirurgicale). Les dossiers retenus pour l'étude étaient ceux qui ont présenté une ou plusieurs anomalies au niveau du bilan d'hémostase. Cent cinquante-cinq dossiers ont été colligés dont 20,64% ont présenté un trouble de l'hémostase. Les patients de sexe féminin (53,12%) étaient les plus concernés, avec une population âgée en moyenne de 49±19 ans. Trois patients (9,37%) ont présenté une notion de diathèse hémorragique à l'interrogatoire. Les différents troubles de l'hémostase étaient: une diminution du taux de prothrombine (100%), un taux de céphaline activé allongé (78,12%), un international normalized ratio élevé (43,75%) et des thrombopénies (40,62%). Chez 3,12% de ces cas, des accidents hémorragiques ont survenu. La plupart de ces troubles de l'hémostase étaient présents au décours d'hémorragies digestives (46,87%) dont la prise en charge était constituée par l'administration de vitamine K1 (68,75%) et de transfusion de plasma frais congelé (65,62%). D'autres pathologies ont été également incriminées. Une incidence de 15,62% de mortalité a été retrouvée. L'existence des troubles de l'hémostase en réanimation constitue un facteur pronostique imposant un dépistage et une prise en charge précoces et adéquats pour pouvoir en réduire le taux de mortalité.
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Affiliation(s)
| | | | | | | | | | - Olivat Rakoto Alson
- UPFR Hématologie Biologique HJRA, Faculté de Médecine Université Antananarivo, Madagascar
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