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Chae R, Nguyen C, Archdeacon C, Wattley L, Sisak S, Price A, Perez E, Schuster R, Lentsch A, Caldwell C, Goodman M, Pritts T. Whole blood storage duration alters fibrinogen levels and thrombin formation. J Trauma Acute Care Surg 2024; 97:39-47. [PMID: 38531825 PMCID: PMC11199101 DOI: 10.1097/ta.0000000000004317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Whole blood resuscitation for hemorrhagic shock in trauma represents an opportunity to correct coagulopathy in trauma while also supplying red blood cells. The production of microvesicles in stored whole blood and their effect on its hemostatic parameters have not been described in previous literature. We hypothesized that microvesicles in aged stored whole blood are procoagulant and increase thrombin production via phosphatidylserine. METHODS Whole blood was obtained from male C57BL/6 male mice and stored in anticoagulant solution for up to 10 days. At intervals, stored whole blood underwent examination with rotational thromboelastography, and platelet-poor plasma was prepared for analysis of thrombin generation. Microvesicles were prepared from 10-day-old whole blood aliquots and added to fresh whole blood or platelet-poor plasma to assess changes in coagulation and thrombin generation. Microvesicles were treated with recombinant mouse lactadherin prior to addition to plasma to inhibit phosphatidylserine's role in thrombin generation. RESULTS Aged murine whole blood had decreased fibrin clot formation compared with fresh samples with decreased plasma fibrinogen levels. Thrombin generation in plasma from aged blood increased over time of storage. The addition of microvesicles to fresh plasma resulted in increased thrombin generation compared with controls. When phosphatidylserine on microvesicles was blocked with lactadherin, there was no difference in the endogenous thrombin potential, but the generation of thrombin was blunted with lower peak thrombin levels. CONCLUSION Cold storage of murine whole blood results in decreased fibrinogen levels and fibrin clot formation. Aged whole blood demonstrates increased thrombin generation, and this is due in part to microvesicle production in stored whole blood. One mechanism by which microvesicles are procoagulant is by phosphatidylserine expression on their membranes.
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Affiliation(s)
- Ryan Chae
- From the Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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2
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Ise H, Oyama K, Ushioda R, Hirofuji A, Kamada K, Yoshida Y, Akhyari P, Kamiya H. Hypothermic circulatory arrest at 20 ℃ does not deteriorate coagulopathy compared to 28 ℃ in a pig model. J Artif Organs 2024:10.1007/s10047-024-01449-9. [PMID: 38780671 DOI: 10.1007/s10047-024-01449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
It is believed that a lower temperature setting of hypothermic circulatory arrest (HCA) in thoracic aortic surgery causes coagulopathy, resulting in excessive bleeding. However, experimental studies that eliminate clinical factors are lacking. The objective of this study is to investigate the influence of the temperature setting of HCA on coagulation in a pig model. Ten pigs were divided into the following two groups: moderate temperature at 28 °C (group M, n = 5) or lower temperature at 20 °C (group L, n = 5). Two hours of HCA during a total of 4 h of cardiopulmonary bypass (CPB) were performed. Blood samples were obtained at the beginning (T1) and the end (T2) of the surgery, and coagulation capability was analyzed through standard laboratory tests (SLTs) and rotational thromboelastometry (ROTEM). In SLTs, hemoglobin, fibrinogen, platelet count, prothrombin time, and activated partial thromboplastin time were analyzed. In ROTEM analyses, clotting time and clot formation time of EXTEM, maximum clot firmness (MCF), and maximum clot elasticity (MCE) of EXTEM and FIBTEM were analyzed. Fibrinogen decreased significantly in both groups (group M, p = 0.008; group L, p = 0.0175) at T2, and FIBTEM MCF and MCE also decreased at T2. There were no differences regarding changes in parameters of SLTs and ROTEM between groups. CPB decreases coagulation capacity, contributed by fibrinogen. However, a lower temperature setting of HCA at 20 °C for 2 h did not significantly affect coagulopathy compared to that of HCA at 28 °C after re-warming to 37 °C.
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Affiliation(s)
- Hayato Ise
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
- Department of Cardiac Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Kyohei Oyama
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Ryohei Ushioda
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keisuke Kamada
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuri Yoshida
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Payam Akhyari
- Department of Cardiac Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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3
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Beaudoin PL, Carles G. Template for Diced Cartilage with Platelet-Rich Fibrin (PRF) in Rhinoplasty: An Easy Solution for Millimetric Camouflage of the Full Dorsal Esthetic Unit. Facial Plast Surg 2023; 39:707-713. [PMID: 36696918 DOI: 10.1055/a-2019-5433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Dorsal irregularities are one of the most common issues in modern rhinoplasty. Rhinoplasty surgeons propose placing interface grafts lining the hole dorsum to ensure a natural unoperated look. Diced cartilage embedded in Choukroun's platelet-rich fibrin (PRF) scaffold being one of the most recent innovations in the field. However, no method has been described to help with the creation of thin, malleable, and reproductive graft with millimetric precision using that technique. The senior author details his protocol and his experience with a newly developed template for the creation of reproductive grafts with standard size and thickness, using diced cartilage, injectable PRF (iPRF), and advanced PRF (aPRF), for full dorsal camouflage and lining in rhinoplasty. This retrospective case series was conducted to evaluate the results looking at the dorsal esthetic unit at a minimum of 6 months for patients who beneficiated from a millimetric dorsal augmentation from 1 to 2mm using diced cartilage with iPRF and aPRF. The author reports his experience with 54 cases operated from April 2018 to May 2022 using his newly developed template.The template is an innovative technique to allow faster and more reliable fabrication of soft grafts using diced cartilage with both iPRF and aPRF. This novel approach allows for millimetric dorsal augmentation from 1 to 2mm with great precision and high reproductivity with good esthetic outcome.
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Affiliation(s)
- Pier-Luc Beaudoin
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Quebec, Canada
| | - Guillaume Carles
- Institut de Chirurgie Esthétique de Montpellier, Montpellier, France
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4
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Jeppesen AN, Duez C, Kirkegaard H, Grejs AM, Hvas AM. Fibrinolysis in Cardiac Arrest Patients Treated with Hypothermia. Ther Hypothermia Temp Manag 2023; 13:112-119. [PMID: 36473198 DOI: 10.1089/ther.2022.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypothermia affects coagulation, but the effect of hypothermia on fibrinolysis is not clarified. Imbalance in the fibrinolytic system may lead to increased risk of bleeding or thrombosis. Our aim was to investigate if resuscitated cardiac arrest patients treated with hypothermia had an unbalanced fibrinolysis. A prospective cohort study, including 82 patients were treated with hypothermia at 33°C ± 1°C after out-of-hospital cardiac arrest. Blood samples were collected at 24 hours (hypothermia) and at 72 hours (normothermia). Samples were analyzed for fibrin D-dimer, tissue plasminogen activator (tPA), plasminogen, plasminogen activator Inhibitor-1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and an in-house dynamic fibrin clot formation and lysis assay.Compared with normothermia, hypothermia significantly increased plasminogen activity (mean difference = 10.4%, 95% confidence interval [CI] 7.9-12.9), p < 0.001), PAI-1 levels (mean difference = 275 ng/mL, 95% CI 203-348, p < 0.001), and tPA levels (mean difference = 1.0 ng/mL, 95% CI 0.2-1.7, p = 0.01). No differences between hypothermia and normothermia were found in TAFI activity (p = 0.59) or in the fibrin D-dimer levels (p = 0.08). The fibrin clot lysis curves showed three different patterns: normal-, flat-, or resistant clot lysis curve. At hypothermia 45 (55%) patients had a resistant clot lysis curve and 33 (44%) patients had a resistant clot lysis curve at normothermia (p = 0.047). Comatose, resuscitated, cardiac arrest patients treated with hypothermia express an inhibited fibrinolysis even after rewarming. This could potentially increase the thromboembolic risk. ClinicalTrials.gov ID: NCT02258360.
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Affiliation(s)
- Anni Nørgaard Jeppesen
- Anesthesia Section, Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Christophe Duez
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Otolaryngology, Head and Neck Surgery, and Aarhus University Hospital, Aarhus N, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Anders Morten Grejs
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark
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5
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DeAnda A, Yates SG. Commentary: Come in from the cold. J Thorac Cardiovasc Surg 2023; 165:552-553. [PMID: 33863498 DOI: 10.1016/j.jtcvs.2021.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, UTMB-Galveston, Galveston, Tex.
| | - Sean G Yates
- Division of Transfusion Medicine and Hemostasis, Department of Pathology, UT Southwestern, Dallas, Tex
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6
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Chen L, Yu L, Liu Y, Xu H, Ma L, Tian P, Zhu J, Wang F, Yi K, Xiao H, Zhou F, Yang Y, Cheng Y, Bai L, Wang F, Zhu Y. Space-time-regulated imaging analyzer for smart coagulation diagnosis. Cell Rep Med 2022; 3:100765. [PMID: 36206751 PMCID: PMC9589004 DOI: 10.1016/j.xcrm.2022.100765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
The development of intelligent blood coagulation diagnoses is awaited to meet the current need for large clinical time-sensitive caseloads due to its efficient and automated diagnoses. Herein, a method is reported and validated to realize it through artificial intelligence (AI)-assisted optical clotting biophysics (OCB) properties identification. The image differential calculation is used for precise acquisition of OCB properties with elimination of initial differences, and the strategy of space-time regulation allows on-demand space time OCB properties identification and enables diverse blood function diagnoses. The integrated applications of smartphones and cloud computing offer a user-friendly automated analysis for accurate and convenient diagnoses. The prospective assays of clinical cases (n = 41) show that the system realizes 97.6%, 95.1%, and 100% accuracy for coagulation factors, fibrinogen function, and comprehensive blood coagulation diagnoses, respectively. This method should enable more low-cost and convenient diagnoses and provide a path for potential diagnostic-markers finding. An ultraportable optofluidic analyzer empowers convenient coagulation diagnoses The system enables optical clotting biophysics (OCB) properties acquisition and process Coagulation function diagnoses uses intelligent OCB properties identification Space-time regulation of OCB properties endow it capability to diverse diagnoses
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Affiliation(s)
- Longfei Chen
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Renmin Hospital, Wuhan University, Wuhan 430060, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Le Yu
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Renmin Hospital, Wuhan University, Wuhan 430060, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Yantong Liu
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Renmin Hospital, Wuhan University, Wuhan 430060, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Hongshan Xu
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Linlu Ma
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Pengfu Tian
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Jiaomeng Zhu
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Fang Wang
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Kezhen Yi
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Hui Xiao
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yi Yang
- Key Laboratory of Artificial Micro- and Nano- Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Renmin Hospital, Wuhan University, Wuhan 430060, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China.
| | | | - Long Bai
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310002, China
| | - Fubing Wang
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yimin Zhu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310002, China
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Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis? CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Gandhi JK, Heinrich L, Knoff DS, Kim M, Marmorstein AD. Alteration of fibrin hydrogel gelation and degradation kinetics through addition of azo dyes. J Biomed Mater Res A 2021; 109:2357-2368. [PMID: 33973708 DOI: 10.1002/jbm.a.37218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
Fibrin is a degradable biopolymer with an excellent clinical safety profile. Use of higher mechanical strength fibrin hydrogels is limited by the rapid rate of fibrin polymerization. We recently demonstrated the use of higher mechanical strength (fibrinogen concentrations >30 mg/ml) fibrin scaffolds for surgical implantation of cells. The rapid polymerization of fibrin at fibrinogen concentrations impaired our ability to scale production of these fibrin scaffolds. We serendipitously discovered that the azo dye Trypan blue (TB) slowed fibrin gelation kinetics allowing for more uniform mixing of fibrinogen and thrombin at high concentrations. A screen of closely related compounds identified similar activity for Evans blue (EB), an isomer of TB. Both TB and EB exhibited a concentration dependent increase in clot time, though EB had a larger effect. While gelation time was increased by TB or EB, overall polymerization time was unaffected. Scanning electron microscopy showed similar surface topography, but transmission electron microscopy showed a higher cross-linking density for gels formed with TB or EB versus controls. Based on these data we conclude that addition of TB or EB during thrombin mediated fibrin polymerization slows the initial gelation time permitting generation of larger more uniform fibrin hydrogels with high-mechanical strength.
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Affiliation(s)
- Jarel K Gandhi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren Heinrich
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knoff
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Minkyu Kim
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA.,Department of Materials Science, University of Arizona, Tucson, Arizona, USA.,BIO5 Institute, University of Arizona, Tucson, Arizona, USA
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Coleman JR, Moore EE, Samuels JM, Cohen MJ, Silliman CC, Ghasabyan A, Chandler J, Butenas S. Whole Blood Thrombin Generation in Severely Injured Patients Requiring Massive Transfusion. J Am Coll Surg 2021; 232:709-716. [PMID: 33548446 DOI: 10.1016/j.jamcollsurg.2020.12.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the prevalence of hypocoagulability after injury, the majority of trauma patients paradoxically present with elevated thrombin generation (TG). Although several studies have examined plasma TG post injury, this has not been assessed in whole blood. We hypothesize that whole blood TG is lower in hypocoagulopathy, and TG effectively predicts massive transfusion (MT). STUDY DESIGN Blood was collected from trauma activation patients at an urban Level I trauma center. Whole blood TG was performed with a prototype point-of-care device. Whole blood TG values in healthy volunteers were compared with trauma patients, and TG values were examined in trauma patients with shock and MT requirement. RESULTS Overall, 118 patients were included. Compared with healthy volunteers, trauma patients overall presented with more robust TG; however, those arriving in shock (n = 23) had a depressed TG, with significantly lower peak thrombin (88.3 vs 133.0 nM; p = 0.01) and slower maximum rate of TG (27.4 vs 48.3 nM/min; p = 0.04). Patients who required MT (n = 26) had significantly decreased TG, with a longer lag time (median 4.8 vs 3.9 minutes, p = 0.04), decreased peak thrombin (median 71.4 vs 124.2 nM; p = 0.0003), and lower maximum rate of TG (median 15.8 vs 39.4 nM/min; p = 0.01). Area under the receiver operating characteristics (AUROC) analysis revealed lag time (AUROC 0.6), peak thrombin (AUROC 0.7), and maximum rate of TG (AUROC 0.7) predict early MT. CONCLUSIONS These data challenge the prevailing bias that all trauma patients present with elevated TG and highlight that deficient thrombin contributes to the hypocoagulopathic phenotype of trauma-induced coagulopathy. In addition, whole blood TG predicts MT, suggesting point-of-care whole blood TG can be a useful tool for diagnostic and therapeutic strategies in trauma.
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Affiliation(s)
- Julia R Coleman
- Department of Surgery, University of Colorado-Denver, Aurora, CO
| | - Ernest E Moore
- Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO.
| | - Jason M Samuels
- Department of Surgery, University of Colorado-Denver, Aurora, CO
| | - Mitchell J Cohen
- Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO
| | - Christopher C Silliman
- Department of Surgery, University of Colorado-Denver, Aurora, CO; Vitalant Research Institute, Vitalant Denver, Denver, CO
| | - Arsen Ghasabyan
- Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO
| | - James Chandler
- Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO
| | - Saulius Butenas
- Department of Biochemistry, University of Vermont, Burlington, VT
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10
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Mitrophanov AY, Szlam F, Sniecinski RM, Levy JH, Reifman J. Controlled Multifactorial Coagulopathy: Effects of Dilution, Hypothermia, and Acidosis on Thrombin Generation In Vitro. Anesth Analg 2020; 130:1063-1076. [PMID: 31609256 DOI: 10.1213/ane.0000000000004479] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Coagulopathy and hemostatic abnormalities remain a challenge in patients following trauma and major surgery. Coagulopathy in this setting has a multifactorial nature due to tissue injury, hemodilution, hypothermia, and acidosis, the severity of which may vary. In this study, we combined computational kinetic modeling and in vitro experimentation to investigate the effects of multifactorial coagulopathy on thrombin, the central enzyme in the coagulation system. METHODS We measured thrombin generation in platelet-poor plasma from 10 healthy volunteers using the calibrated automated thrombogram assay (CAT). We considered 3 temperature levels (31°C, 34°C, and 37°C), 3 pH levels (6.9, 7.1, and 7.4), and 3 degrees of dilution with normal saline (no dilution, 3-fold dilution, and 5-fold dilution). We measured thrombin-generation time courses for all possible combinations of these conditions. For each combination, we analyzed 2 scenarios: without and with (15 nM) supplementation of thrombomodulin, a key natural regulator of thrombin generation. For each measured thrombin time course, we recorded 5 quantitative parameters and analyzed them using multivariable regression. Moreover, for multiple combinations of coagulopathic conditions, we performed routine coagulation tests: prothrombin time (PT) and activated partial thromboplastin time (aPTT). We compared the experimental results with simulations using a newly developed version of our computational kinetic model of blood coagulation. RESULTS Regression analysis allowed us to identify trends in our data (P < 10). In both model simulations and experiments, dilution progressively reduced the peak of thrombin generation. However, we did not experimentally detect the model-predicted delay in the onset of thrombin generation. In accord with the model predictions, hypothermia delayed the onset of thrombin generation; it also increased the thrombin peak time (up to 1.30-fold). Moreover, as predicted by the kinetic model, the experiments showed that hypothermia increased the area under the thrombin curve (up to 1.97-fold); it also increased the height of the thrombin peak (up to 1.48-fold). Progressive acidosis reduced the velocity index by up to 24%; acidosis-induced changes in other thrombin generation parameters were much smaller or none. Acidosis increased PT by 14% but did not influence aPTT. In contrast, dilution markedly prolonged both PT and aPTT. In our experiments, thrombomodulin affected thrombin-generation parameters mainly in undiluted plasma. CONCLUSIONS Dilution with normal saline reduced the amount of generated thrombin, whereas hypothermia increased it and delayed the time of thrombin accumulation. In contrast, acidosis in vitro had little effect on thrombin generation.
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Affiliation(s)
- Alexander Y Mitrophanov
- From the The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland.,DoD Biotechnology High Performance Computing Software Applications Institute (BHSAI), Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Ft Detrick, Maryland
| | - Fania Szlam
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Roman M Sniecinski
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jaques Reifman
- DoD Biotechnology High Performance Computing Software Applications Institute (BHSAI), Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Ft Detrick, Maryland
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Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management. Anesthesiology 2020; 131:186-208. [PMID: 31021845 DOI: 10.1097/aln.0000000000002700] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.
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12
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Torres Acosta ND, Noman A, Gohar A, Balakrishnan G. Accidental Hypothermia Associated with Intracardiac Thrombi. Cureus 2019; 11:e4512. [PMID: 31259121 PMCID: PMC6590859 DOI: 10.7759/cureus.4512] [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] [Indexed: 11/05/2022] Open
Abstract
Accidental hypothermia and thrombosis are rarely associated and encountered. A 66-year-old male and 62-year-old male were both admitted with accidental hypothermia. Patient 1 had a rectal temperature of 28.5 °Celcius (C). After 1 day of hospitalization, he developed worsening shortness of breath due to worsening pulmonary edema. Further investigation with echocardiogram showed large left ventricular thrombi as well and global hypokinesis and apical akinesis. Patient 2 had a rectal temperature of 28.5 °C, he was also discovered to have a multifactorial shock. Echocardiogram for shock evaluation showed small apical thrombus as well as global hypokinesis. Hypothermia has been associated with hypocoagulability rather than hypercoagulability secondary to platelet dysfunction and clotting factor enzyme derangements. Moreover, hypothermia has also been associated with myocardial dysfunction that could have predisposed the development of intracardiac thrombi. Further research needs to be done to help better understand these possible association.
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Affiliation(s)
- Noel D Torres Acosta
- Internal Medicine, University of Missouri Kansas City School of Medicine, Truman Medical Center, Kansas City, USA
| | - Anas Noman
- Internal Medicine, University of Missouri Kansas City School of Medicine, Truman Medical Center, Kansas City, USA
| | - Ashraf Gohar
- Pulmonary and Critical Care, University of Missouri Kansas City School of Medicine, Truman Medical Center, Kansas City, USA
| | - Gautam Balakrishnan
- Pulmonary and Critical Care, University of Missouri Kansas City School of Medicine, Truman Medical Center, Kansas City, USA
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13
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Huang Y, Zhang Y, Feng L, He L, Guo R, Xue W. Synthesis of N-alkylated chitosan and its interactions with blood. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 46:544-550. [DOI: 10.1080/21691401.2017.1328687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yuchen Huang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Yi Zhang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Longbao Feng
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Liumin He
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Wei Xue
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institute, Department of Biochemistry and Molecular Biology, Guangzhou, China
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14
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Bernasconi M, Koegelenberg CF, Koutsokera A, Ogna A, Casutt A, Nicod L, Lovis A. Iatrogenic bleeding during flexible bronchoscopy: risk factors, prophylactic measures and management. ERJ Open Res 2017; 3:00084-2016. [PMID: 28656131 PMCID: PMC5478796 DOI: 10.1183/23120541.00084-2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/18/2017] [Indexed: 12/19/2022] Open
Abstract
Significant iatrogenic bleeding during flexible bronchoscopy is fortunately rare and usually self-limiting. Life-threatening bleeding, however, can occur, especially after conventional or cryoprobe-assisted transbronchial biopsy. The aim of this review is to provide the practising pulmonologist with a concise overview of the incidence, severity and risk factors for bleeding, to provide sensible advice on prophylactic measures and to suggest a plan of action in the case of significant bleeding. Bronchoscopy units should have a standardised approach and plan of action in the case of life-threatening haemorrhage. Wedging the bronchoscope in the bleeding segment, turning the patient in an anti-Trendelenburg position and onto the side in order for the bleeding lung to be in the dependent position, installing vasoconstrictors and using a tamponade balloon early are the recommended first-line strategies. Involving a resuscitation team should be considered early in the case of massive bleeding, desaturation and haemodynamic instability.
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Affiliation(s)
- Maurizio Bernasconi
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Dept of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Angela Koutsokera
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Adam Ogna
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Laurent Nicod
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alban Lovis
- Division of Pulmonology, Dept of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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15
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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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16
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Lawrence MJ, Marsden N, Mothukuri R, Morris RHK, Davies G, Hawkins K, Curtis DJ, Brown MR, Williams PR, Evans PA. The Effects of Temperature on Clot Microstructure and Strength in Healthy Volunteers. Anesth Analg 2016; 122:21-6. [PMID: 26440418 DOI: 10.1213/ane.0000000000000992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anesthesia, critical illness, and trauma are known to alter thermoregulation, which can potentially affect coagulation and clinical outcome. This in vitro preclinical study explores the relationship between temperature change and hemostasis using a recently validated viscoelastic technique. We hypothesize that temperature change will cause significant alterations in the microstructural properties of clot. METHODS We used a novel viscoelastic technique to identify the gel point of the blood. The gel point identifies the transition of the blood from a viscoelastic liquid to a viscoelastic solid state. Furthermore, identification of the gel point provides 3 related biomarkers: the elastic modulus at the gel point, which is a measure of clot elasticity; the time to the gel point (TGP), which is a measure of the time required to form the clot; and the fractal dimension of the clot at the gel point, df, which quantifies the microstructure of the clot. The gel point measurements were performed in vitro on whole blood samples from 136 healthy volunteers over a temperature range of 27°C to 43°C. RESULTS There was a significant negative correlation between increases in temperature, from 27°C to 43°C, and TGP (r = -0.641, P < 0.0005). Conversely, significant positive correlations were observed for both the elastic modulus at the gel point (r = 0.513, P = 0.0008) and df (r = 0.777, P < 0.0005) across the range of 27°C to 43°C. When temperature was reduced below 37°C, significant reductions in df and TGP occurred at ≤32°C (Bonferroni-corrected P = 0.0093) and ≤29°C (Bonferroni-corrected P = 0.0317), respectively. No significant changes were observed when temperature was increased to >37°C. CONCLUSIONS This study demonstrates that the gel point technique can identify alterations in clot microstructure because of changes in temperature. This was demonstrated in slower-forming clots with less structural complexity as temperature is decreased. We also found that significant changes in clot microstructure occurred when the temperature was ≤32°C.
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Affiliation(s)
- Matthew James Lawrence
- From the *NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, Wales, United Kingdom; †College of Medicine, Swansea University, Swansea, Wales, United Kingdom; ‡The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, United Kingdom; §Emergency Department, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, Wales, United Kingdom; ‖School of Health Science, Cardiff Metropolitan University, Cardiff, Wales, United Kingdom; and ¶College of Engineering, Swansea University, Swansea, Wales, United Kingdom
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17
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Callum JL, Nascimento B, Alam A. Massive haemorrhage protocol: what's the best protocol? ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J. L. Callum
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
| | - B. Nascimento
- Department of Surgery; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - A. Alam
- Department of Anesthesia; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
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18
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Stahl AR, Kurz MC, Dub L, Holzhausen JM, Sawyer KN. Limb-Threatening Acute Venous Thromboembolism in a Patient Undergoing Postarrest Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2015; 5:228-34. [DOI: 10.1089/ther.2015.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Amanda R. Stahl
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Larissa Dub
- Department of Emergency Medicine, Osceola Regional Medical Center, Kissimmee, Florida
| | - Jenna M. Holzhausen
- Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, Michigan
| | - Kelly N. Sawyer
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
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19
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Jacob M, Hassager C, Bro-Jeppesen J, Ostrowski SR, Thomsen JH, Wanscher M, Johansson PI, Winther-Jensen M, Kjærgaard J. The effect of targeted temperature management on coagulation parameters and bleeding events after out-of-hospital cardiac arrest of presumed cardiac cause. Resuscitation 2015; 96:260-7. [PMID: 26362487 DOI: 10.1016/j.resuscitation.2015.08.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/19/2015] [Accepted: 08/23/2015] [Indexed: 02/08/2023]
Abstract
AIMS Targeted temperature management (TTM) is part of the standard treatment of comatose patients after out-of-hospital cardiac arrest (OHCA) to attenuate neurological injury. In other clinical settings, hypothermia promotes coagulopathy leading to an increase in bleeding and thrombosis tendency. Thus, concern has been raised as to whether TTM can be applied safely, as acute myocardial infarction requiring primary percutaneous coronary intervention (PCI) with the need of effective antiplatelet therapy is frequent following OHCA. This study investigated the influence of TTM at 33 or 36°C on various laboratory and coagulation parameters. METHODS AND RESULTS In this single-center predefined substudy of the TTM trial, 171 patients were randomized to TTM at either 33 or 36°C in the postresuscitation phase. The two subgroups were compared regarding standard laboratory coagulation parameters, thrombelastography (TEG), bleeding, and stent thrombosis events. Platelet counts were lower in the TTM33-group compared to TTM36 (p=0.009), but neither standard coagulation nor TEG-parameters showed any difference between the groups. TEG revealed a normocoagulable state in the majority of patients, while approximately 20% of the population presented as hypercoagulable. Adverse events included 38 bleeding events, one stent thrombosis, and one reinfarction, with no significant difference between the groups. CONCLUSIONS There was no evidence supporting the assumption that TTM at 33°C was associated with impaired hemostasis or increased the frequency of adverse bleeding and thrombotic events compared to TTM at 36°C. We found that TTM at either temperature can safely be applied in the postresuscitation phase after acute myocardial infarction and primary PCI.
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Affiliation(s)
- Marrit Jacob
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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20
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Moradi AM, Aj O, Paydar S, Ketabchi F, Sheid Moosavi SM, Bolandparvaz S, Abassi HR, Tamadon AD, Mehrabani D. The Effect of Blood Loss in the Presence and Absence of Severe Soft Tissue Injury on Hemodynamic and Metabolic Parameters; an Experimental study. EMERGENCY (TEHRAN, IRAN) 2015; 3:150-4. [PMID: 26495405 PMCID: PMC4608348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The effect of severe soft tissue injury on the severity of hemorrhagic shock is still unknown. Therefore, the present study was aimed to determine hemodynamic and metabolic changes in traumatic/hemorrhagic shock in an animal model. METHODS Forty male rats were randomly divided into 4 equal groups including sham, hemorrhagic shock, soft tissue injury, and hemorrhagic shock + soft tissue injury groups. The changes in blood pressure, central venous pressure (CVP) level, acidity (pH), and base excess were dynamically monitored and comparedsented. RESULTS Mean arterial blood pressure decreased significantly in hemorrhagic shock (df: 12; F=10.9; p<0.001) and severe soft tissue injury + hemorrhagic shock (df: 12; F=11.7; p<0.001) groups 15 minutes and 5 minutes after injury, respectively. A similar trend was observed in CVP in severe soft tissue injury + hemorrhagic shock group (df: 12; F=8.9; p<0.001). After 40 minutes, pH was significantly lower in hemorrhagic shock (df: 12; F=6.8; p=0.009) and severe soft tissue injury + hemorrhagic shock (df: 12; F=7.9; p=0.003) groups. Base excess changes during follow ups have a similar trend. (df: 12; F=11.3; p<0.001). CONCLUSION The results of this study have shown that the effect of hemorrhage on the decrease of mean arterial blood pressure, CVP, pH, and base excess is the same in the presence or absence of soft tissue injury.
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Affiliation(s)
- Ali Mohammad Moradi
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Aj
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Shahram Paydar, MD. Trauma Research Center, Shahid Rajaei Trauma Hospital, Shahid Chamran blvd, Shiraz, Iran. Tel/Fax: +987116254206.
| | - Farzaneh Ketabchi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shahram Bolandparvaz
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Abassi
- Department of Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aryan Dokht Tamadon
- Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Mehrabani
- Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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