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Johnson AJ, Rozanski EA, de Laforcade AM, Davila C, Rush JE, Guillaumin J. Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism. J Vet Intern Med 2024; 38:2045-2051. [PMID: 38747192 PMCID: PMC11256171 DOI: 10.1111/jvim.17050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). HYPOTHESIS/OBJECTIVES Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. ANIMALS Sixteen cats with ATE and 30 control cats. METHODS Multicenter university-based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically-diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. RESULTS Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30-48°) compared to 47° (14-59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8-32) compared to 22 units (6-38), 24.5 units (11-40) compared to 29 units (10-47) and 29.5 units (13-44) compared to 33.5 units (14-53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.
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Affiliation(s)
- Amanda J. Johnson
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Elizabeth A. Rozanski
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Armelle M. de Laforcade
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Claudia Davila
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - John E. Rush
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Julien Guillaumin
- Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
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Bechensteen BT, Sithiravel C, Strøm-Roum EM, Ruud HK, Kravdal G, Winther JA, Valderhaug TG. Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy Childbirth 2024; 24:229. [PMID: 38566061 PMCID: PMC10985986 DOI: 10.1186/s12884-024-06407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
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Affiliation(s)
- Brit Torunn Bechensteen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | | | - Heidi Kathrine Ruud
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | - Jacob A Winther
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
| | - Tone G Valderhaug
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
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Tsai HJ, Wallace BI, Waljee AK, Hong X, Chang SM, Tsai YF, Cheong ML, Wu AC, Yao TC. Association between antenatal corticosteroid treatment and severe adverse events in pregnant women. BMC Med 2023; 21:413. [PMID: 37907932 PMCID: PMC10617183 DOI: 10.1186/s12916-023-03125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Antenatal corticosteroids are considered the standard of care for pregnant women at risk for preterm birth, but studies examining their potential risks are scarce. We aimed to estimate the associations of antenatal corticosteroids with three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding, in pregnant women. METHODS Of 2,157,321 pregnant women, 52,119 at 24 weeks 0/7 days to 36 weeks 6/7 days of gestation were included in this self-controlled case series study during the study period of 2009-2018. We estimated incidence rates of three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding. Conditional Poisson regression was used to calculate incidence rate ratios (IRRs) for comparing incidence rates of the adverse events in each post-treatment period compared to those during the baseline period among pregnant women exposed to a single course of antenatal corticosteroid treatment. RESULTS Among 52,119 eligible participants who received antenatal corticosteroid treatment, the estimated incidence rates per 1000 person-years were 0.76 (95% confidence interval (CI): 0.69-0.83) for sepsis, 0.31 (95% CI: 0.27-0.36) for heart failure, and 11.57 (95% CI: 11.27-11.87) for gastrointestinal bleeding. The IRRs at 5 ~ 60 days after administration of antenatal corticosteroids were 5.91 (95% CI: 3.10-11.30) for sepsis and 4.45 (95% CI: 2.63-7.55) for heart failure, and 1.26 (95% CI: 1.02-1.55) for gastrointestinal bleeding; and the IRRs for days 61 ~ 180 were 2.00 (95% CI: 1.01-3.96) for sepsis, 3.65 (95% CI: 2.14-6.22) for heart failure, and 1.81 (95% CI: 1.56-2.10) for gastrointestinal bleeding. CONCLUSIONS This nationwide population-based study suggests that a single course of antenatal corticosteroids is significantly associated with a 1.3- to 5.9-fold increased risk of sepsis, heart failure, and gastrointestinal bleeding in pregnant women. Maternal health considerations, including recommendations for adverse event monitoring, should be included in future guidelines for antenatal corticosteroid treatment.
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Affiliation(s)
- Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- National Tsing-Hua University, Hsinchu, Taiwan
| | - Beth I Wallace
- Center for Clinical Management Research, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Center for Clinical Management Research, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center On Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheng-Mao Chang
- Department of Statistics, National Taipei University, Taipei, Taiwan
| | - Yi-Fen Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Mei-Leng Cheong
- National Tsing-Hua University, Hsinchu, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | | | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, 33305, Taiwan.
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Lee J, Eley VA, Wyssusek KH, Kimble RMN, Way M, van Zundert AA. Rotational thromboelastometry (ROTEM ® ) in gestational diabetes mellitus and coagulation in healthy term pregnancy: A prospective observational study in Australia. Aust N Z J Obstet Gynaecol 2022; 62:389-394. [PMID: 34994402 DOI: 10.1111/ajo.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rotational thromboelastometry (ROTEM® ) is a point-of-care test of coagulation. ROTEM® -defined hypercoagulability has been identified in pregnant women and in non-pregnant patients with diabetes mellitus. Pregnancy is known to be a hypercoagulable state, but the influence of gestational diabetes mellitus (GDM) on coagulation is unknown. AIM The aim of this study was to assess the combined effect of pregnancy and GDM on coagulation using ROTEM® and to compare this to healthy pregnant women presenting for elective caesarean delivery. MATERIALS AND METHODS Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with pre-existing conditions affecting coagulation were excluded. Group N included health pregnant women at term and Group G included pregnant women at term with GDM. Data regarding GDM management and glycaemic control were collected. Poor glycaemic control was defined by markers of accelerated fetal growth and elevated fasting or postprandial blood glucose levels. The ROTEM® parameters (extrinsically activated thromboelastometric test (EXTEM) / fibrin polymerisation test (FIBTEM) amplitude at five minutes, coagulation time, maximum clot firmness and clot formation time) were compared between the two groups using Student's t-test. RESULTS There were 75 women in Group N and 21 women in Group G. Mean age and median body mass index values were comparable for both groups. There were no statistical differences found between the EXTEM and FIBTEM parameters analysed for the two groups. CONCLUSIONS There was no association between GDM and increased hypercoagulability as demonstrated by ROTEM® parameters in healthy pregnant women presenting for elective caesarean delivery at term.
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Affiliation(s)
- Julie Lee
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Kerstin H Wyssusek
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca M N Kimble
- The University of Queensland, Brisbane, Queensland, Australia.,Department of Obstetrics, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mandy Way
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andre A van Zundert
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
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O'Keefe D, Lim HY, Tham J, Ho P, Hui L. Assessing maternal clotting function with novel global coagulation assays: A prospective pilot study. Int J Lab Hematol 2020; 43:458-467. [PMID: 33174330 DOI: 10.1111/ijlh.13389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/06/2020] [Accepted: 10/22/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Women are at higher risk of venous thromboembolism (VTE) during pregnancy and the puerperium. Global coagulation assays (GCAs), including thromboelastography (TEG), thrombin generation using the calibrated automated thrombogram (CAT) and fibrin generation using the overall haemostatic potential assay (OHP), provide a more comprehensive assessment of the coagulation process than conventional coagulation assays. We aimed to evaluate the ability of these GCAs to analyse the coagulability among pregnant women of varying VTE risk profile. METHODS Women undergoing term elective caesarean delivery provided a single predelivery blood sample for conventional and novel coagulation testing (TEG, CAT and OHP). Data from 47 healthy nonpregnant women aged 18-45 years were used as controls. RESULTS Sixty women with term singleton pregnancies were included. Samples from pregnant women were hypercoagulable on most GCA parameters compared to nonpregnant controls, demonstrating increased maximum amplitude (clot strength) (71.5 vs 60.6 mm, P < .001) on whole blood TEG and increased endogenous thrombin potential (1895.22 vs 1399.33 nmol/L·min, P < .001) and overall coagulation potential (fibrin generation) (57.58 vs 36.21 units, P < .001) on platelet-poor plasma. Pregnant women with booking BMI ≥ 30 kg/m2 had significantly higher maximum amplitude compared to pregnant women of normal BMI (18.5-25 kg/m2 ) (73.2 vs 66.1 mm, P < .001). CONCLUSIONS Global coagulation assays reliably detect the physiological hypercoagulability of pregnancy. Thromboelastography in particular appears to correlate with obesity in the pregnant population. GCAs may be potential adjuncts to risk factor-based criteria to guide VTE thromboprophylaxis during pregnancy and the puerperium.
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Affiliation(s)
- David O'Keefe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Department of Obstetrics and Gynaecology, Northern Health, Epping, Vic., Australia
| | - Hui Yin Lim
- Department of Haematology, Northern Health, Epping, Vic., Australia.,Northern Pathology Victoria, Northern Health, Epping, Vic., Australia
| | - Johnathan Tham
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Department of Obstetrics and Gynaecology, Northern Health, Epping, Vic., Australia
| | - Prahlad Ho
- Department of Haematology, Northern Health, Epping, Vic., Australia.,Northern Pathology Victoria, Northern Health, Epping, Vic., Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Department of Obstetrics and Gynaecology, Northern Health, Epping, Vic., Australia.,Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Vic., Australia
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6
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Amgalan A, Allen T, Othman M, Ahmadzia HK. Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH. J Thromb Haemost 2020; 18:1813-1838. [PMID: 32356929 DOI: 10.1111/jth.14882] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point-of-care viscoelastic devices that use whole blood samples to assess coagulation and fibrinolysis. These devices have been studied extensively in cardiac surgery, but there is limited robust evidence supporting its use in obstetrics. The hesitancy toward its routine use in obstetrics may be due to the current lack of randomized controlled trials and large observational studies. The study aims to systematically review studies that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide recommendations for future studies to fill current research gaps. We performed a systematic review of studies on viscoelastic testing in obstetrics. Included studies were original research, used TEG or ROTEM during pregnancy or peripartum, and published in English. Ninety-three studies, spanning 31 years from 1989 to 2020 and with a total of 32,817 participants, were included. Sixty-two (66.7%) of the studies used TEG and 31 (33.3%) used ROTEM. To date, there are a total of two randomized controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to guide transfusion therapy for postpartum hemorrhage. TEG and ROTEM can detect the hypercoagulable changes associated with pregnancy. Variability between study protocols and results suggests the need for future large prospective high-quality studies with standardized protocols to investigate the utility of TEG/ROTEM in assessing risk for thrombosis and hemorrhage as well as in guiding prophylaxis and treatment in obstetric patients. This review identifies the gaps and provides concrete recommendations for future studies to fill those gaps.
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Affiliation(s)
| | - Terrence Allen
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, ON, Canada
| | - Homa K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Lee J, Eley VA, Wyssusek KH, Kimble RM, Way M, Cohen J, Zundert AA. The influence of obesity on coagulation in healthy term pregnancy as assessed by rotational thromboelastometry. Aust N Z J Obstet Gynaecol 2020; 60:714-719. [DOI: 10.1111/ajo.13141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/28/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Julie Lee
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Victoria A. Eley
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Kerstin H. Wyssusek
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Rebecca M.N. Kimble
- The University of Queensland Brisbane Australia
- Department of Obstetrics and Gynaecology The Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Mandy Way
- QIMR Berghofer Medical Research Institute Brisbane Australia
| | - Jeremy Cohen
- The University of Queensland Brisbane Australia
- Department of Intensive Care Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
| | - André A. Zundert
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
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Jin QF, Fang QG, Qi JX, Li P. Impact of BMI on Complications and Satisfaction in Patients With Papillary Thyroid Cancer and Lateral Neck Metastasis. Cancer Control 2020; 26:1073274819853831. [PMID: 31480878 PMCID: PMC6727094 DOI: 10.1177/1073274819853831] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study investigates the effect of body mass index (BMI) on complications and satisfaction in patients who underwent thyroidectomy and lateral neck dissection. METHODS We retrospectively reviewed 386 patients with papillary thyroid cancer who underwent total thyroidectomy and lateral neck dissection between January 2013 and December 2016. We compared variables including population characteristics, subjective satisfaction, and complications in nonobese (BMI < 28.0 kg/m2) and obese (BMI ≥ 28.0 kg/m2) patients. RESULTS Obesity was associated with an increased risk of postoperative hemorrhage (POH) (P = .014), accessory nerve injury (P < .001), operative time (P < .001) and infection (P = .013). However, obese patients had higher subjective satisfaction and Vancouver Scar Scale (VSS) scores (P < .05). CONCLUSIONS Obesity was associated with increased risk of POH, injury of the SAN, and infection. Interestingly, we found that obese patients had higher subjective satisfaction and VSS scores.
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Affiliation(s)
- Qiu-Feng Jin
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Qi-Gen Fang
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Jin-Xing Qi
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Peng Li
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
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Yang J, Yang H, Tang A, Liu X, Sun X, Ma J, Zhao J, Ming L. Trimester-specific reference intervals for kaolin-activated thromboelastography (TEG®) in healthy Chinese pregnant women. Thromb Res 2019; 184:81-85. [DOI: 10.1016/j.thromres.2019.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 12/29/2022]
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Abstract
Obesity has reached epidemic proportions and is a well-recognised risk factor for venous thromboembolism (VTE). This article summarises the current understanding of obesity and debates how obesity induces this increased risk of VTE. Obesity is associated with prothrombotic changes which have been well-characterised and include increased levels of plasminogen activator-1, von Willebrand factor, fibrinogen and evidence of increased coagulation and platelet activation; however, these changes do not seem to account for all the increased risk. Accumulating evidence suggests a significant role for increased tissue factor expression and signalling in this relationship, with increased tissue factor expression present in adipose and possibly systemic tissues, induced by adipose generated cytokines. Lastly, there is a strong suggestion that decreased venous flow due to venous enlargement may play the major role in increased VTE risk with obesity.
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An observational study of haemostatic changes, leptin and soluble endoglin during pregnancy in women with different BMIs. Blood Coagul Fibrinolysis 2017; 28:50-55. [PMID: 26881854 DOI: 10.1097/mbc.0000000000000535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity increases the risk of venous thromboembolism (VTE) in pregnancy. The pathogenesis is hypothesized to be because of multiple factors including prothrombotic changes, but there has been minimal haemostatic research looking at the combined state of obesity and pregnancy. We aimed to determine whether variation in BMI in the third trimester of pregnancy was associated with prothrombotic changes. We recruited 110 women into four groups depending on their BMI at first antenatal appointment: normal, overweight, obese and morbidly obese. Women with increased risk of VTE, and/or receiving thromboprophylaxis, and/or more than 35 years and those in labour were excluded. Thromboelastography, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, prothrombin fragment 1 + 2, free and total protein S, plasminogen activator inhibitor type 1, tissue plasminogen activator antigen, D-dimers, soluble endoglin and leptin levels were measured. There were no significant differences in haemostatic measures with changing BMI. There was a positive correlation between BMI and both platelet count (correlation coefficient r = 0.214, P = 0.036) and leptin (r = 0.435, P < 0.001), but only leptin had a significant association with BMI once adjusted for age, gestation and parity. Despite recruitment into the morbidly obese group being suboptimal, these findings suggest that in pregnancy, the increased risk of VTE seen in obese mothers is not mediated through increased prothrombotic changes, and thus the increased risk of VTE in obese pregnant women may be because of other mechanisms, for example endothelial dysfunction, inflammation and venous stasis.
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Proteins behaving badly. Substoichiometric molecular control and amplification of the initiation and nature of amyloid fibril formation: lessons from and for blood clotting. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 123:16-41. [DOI: 10.1016/j.pbiomolbio.2016.08.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 02/08/2023]
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13
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Ahmadzia HK, Lockhart EL, Thomas SM, Welsby IJ, Hoffman MR, James AH, Murtha AP, Swamy GK, Grotegut CA. Using antifibrinolytics in the peripartum period - concern for a hypercoagulable effect? J Neonatal Perinatal Med 2017; 10:1-7. [PMID: 28304315 DOI: 10.3233/npm-16139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Although antifibrinolytic agents are used to prevent and treat hemorrhage, there are concerns about a potential increased risk for peripartum venous thromboembolism. We sought to determine the impact of tranexamic acid and ɛ-aminocaproic acid on in vitro clotting properties in pregnancy. METHODS Blood samples were obtained from healthy pregnant, obese, and preeclamptic pregnant women (n = 10 in each group) prior to delivery as well as from healthy non-pregnant controls (n = 10). Maximum clot firmness (MCF) and clotting time (CT) were measured using rotation thromboelastometry in the presence of tranexamic acid (3, 30, or 300 μg/mL) or ɛ-aminocaproic acid (30, 300, or 3000 μg/mL). ANOVA and regression analyses were performed. RESULTS Mean whole blood MCF was significantly higher in healthy pregnant vs. non-pregnant women (66.5 vs. 57.5 mm, p < 0.001). Among healthy pregnant women, there was no significant difference between mean MCF (whole blood alone, and with increasing tranexamic acid doses = 66.5, 66.1, 66.4, 66.3 mm, respectively; p = 0.25) or mean CT (409, 412, 420, 424 sec; p = 0.30) after addition of tranexamic acid. Similar results were found using ɛ-aminocaproic acid. Preeclamptic women had a higher mean MCF after the addition of ɛ-aminocaproic acid and tranexamic acid (p = 0.05 and p = 0.04, respectively) compared to whole blood alone. CONCLUSIONS Pregnancy is a hypercoagulable state, as reflected by an increased MCF compared to non-pregnant women. Addition of antifibrinolytic therapy in vitro does not appear to increase MCF or CT for non-pregnant, pregnant, and obese women. Whether antifibrinolytics are safe in preeclampsia may require further study.
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Affiliation(s)
- H K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - E L Lockhart
- Department of Pathology, Division of Pathology Clinical Services, Duke University, Durham, NC, USA
| | - S M Thomas
- Department of Biostatistics, Duke University, Durham, NC, USA
| | - I J Welsby
- Department of Anesthesiology, Division of Cardiac Anesthesiology, Duke University, Durham, NC, USA
| | - M R Hoffman
- Department of Pathology, Division of General Pathology, Duke University Durham, NC, USA
| | - A H James
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - A P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - G K Swamy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - C A Grotegut
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
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Shreeve NE, Barry JA, Deutsch LR, Gomez K, Kadir RA. Changes in thromboelastography parameters in pregnancy, labor, and the immediate postpartum period. Int J Gynaecol Obstet 2016; 134:290-3. [DOI: 10.1016/j.ijgo.2016.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/23/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
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15
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Tekkesin N, Tekkesin M, Kaso G. Thromboelastography for the monitoring of the antithrombotic effect of low-molecular-weight heparin after major orthopedic surgery. Anatol J Cardiol 2016; 15:932-7. [PMID: 26574762 PMCID: PMC5336946 DOI: 10.5152/akd.2014.5723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Low-molecular-weight heparins (LMWHs) are commonly used to prevent and manage postoperative thromboembolism. In general, monitoring of anticoagulant activity by anti-Xa testing is not done properly. Thromboelastography (TEG) evaluates the viscoelastic properties of blood during coagulation. The clinical application of TEG variables in monitoring LMWH treatment is not yet well defined. Methods: This prospective study was designed to systematically examine the correlation between anti-Xa and basic TEG parameters in monitoring LMWH treatment. We furthermore evaluated for the first time the usefulness of a composite TEG parameter, coagulation index (CI). Thirty patients undergoing unilateral or bilateral total knee replacement, admitted to the intensive care unit on a therapeutic dosage of subcutaneous enoxaparin (30-mg injections administered twice daily), were included into the study. TEG parameters and anti-Xa levels were measures at baseline and 4, 12, and 24 hours after the injection. Results: This study demonstrates a significant correlation between CI and plasma anti-Xa activity in surgical patients treated with enoxaparin. Although the correlation was significant between r time and anti-Xa level only at Hour 4, CI was significant for each time interval (p<0.05). CI increased immediately after T0, peaking at Hour 4, and remained elevated (relative to baseline) at Hour 24 but still did not return to admission levels. Conclusion: The current study may be an important first step in order to use CI to measure LMWH activity. Meanwhile, the value and usefulness of TEG in predicting bleeding or thrombotic complications following major orthopedic surgery merit further investigation.
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Affiliation(s)
- Nilgün Tekkesin
- Department of Biochemistry, Central Laboratory, Memorial Şişli Hospital; İstanbul-Turkey.
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Vaught AJ. Critical Care for the Obstetrician and Gynecologist: Obstetric Hemorrhage and Disseminated Intravascular Coagulopathy. Obstet Gynecol Clin North Am 2016; 43:611-622. [PMID: 27816150 DOI: 10.1016/j.ogc.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obstetric hemorrhage accounts for 5% all deliveries in the United States and accounts for high maternal morbidity and mortality. Many hemorrhages are secondary to uterine atony and are quickly ameliorated with appropriate uterotonic use. However, for a subset of cases, severe hemorrhage may require advanced resuscitative techniques, and innovative procedural and surgical techniques. This article guides a provider through such a resuscitation.
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Affiliation(s)
- Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 228, Baltimore, MD 21287, USA.
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Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors. PLoS One 2015; 10:e0144551. [PMID: 26658430 PMCID: PMC4676605 DOI: 10.1371/journal.pone.0144551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022] Open
Abstract
Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe), longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI), the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with postoperative bleeding and poor outcomes and merits careful attention. Practitioners should monitor plasma fibrinogen levels in patients with risk factors for postoperative fibrinogen deficiency. In addition, postoperative fibrinogen deficiency should be remediated as soon as possible to reduce postoperative bleeding, especially when postoperative bleeding is confirmed.
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Kell DB, Pretorius E. The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen). Integr Biol (Camb) 2015; 7:24-52. [PMID: 25335120 DOI: 10.1039/c4ib00173g] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the two phenomena are usually studied separately, we summarise a considerable body of literature to the effect that a great many diseases involve (or are accompanied by) both an increased tendency for blood to clot (hypercoagulability) and the resistance of the clots so formed (hypofibrinolysis) to the typical, 'healthy' or physiological lysis. We concentrate here on the terminal stages of fibrin formation from fibrinogen, as catalysed by thrombin. Hypercoagulability goes hand in hand with inflammation, and is strongly influenced by the fibrinogen concentration (and vice versa); this can be mediated via interleukin-6. Poorly liganded iron is a significant feature of inflammatory diseases, and hypofibrinolysis may change as a result of changes in the structure and morphology of the clot, which may be mimicked in vitro, and may be caused in vivo, by the presence of unliganded iron interacting with fibrin(ogen) during clot formation. Many of these phenomena are probably caused by electrostatic changes in the iron-fibrinogen system, though hydroxyl radical (OH˙) formation can also contribute under both acute and (more especially) chronic conditions. Many substances are known to affect the nature of fibrin polymerised from fibrinogen, such that this might be seen as a kind of bellwether for human or plasma health. Overall, our analysis demonstrates the commonalities underpinning a variety of pathologies as seen in both hypercoagulability and hypofibrinolysis, and offers opportunities for both diagnostics and therapies.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, 131, Princess St, Manchester M1 7DN, Lancs, UK.
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Vitamin K1 monitoring in pregnancies after bariatric surgery: a prospective cohort study. Surg Obes Relat Dis 2014; 10:885-90. [DOI: 10.1016/j.soard.2014.04.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/22/2014] [Accepted: 04/24/2014] [Indexed: 01/28/2023]
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