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Gosselin RC. From Field Study to Clinical Practice, a Personal Historical Experience Using the PFA-100 Analyzer for Platelet Function Testing. Semin Thromb Hemost 2024; 50:672-675. [PMID: 38122807 DOI: 10.1055/s-0043-1777795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Robert C Gosselin
- Thrombosis & Hemostasis Center, University of California, Davis Health System, Sacramento, California
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Arı M, Sağdilek E, Kılınç E, Cansev M, Özlük K. Effects of uridine and nucleotides on hemostasis parameters. J Thromb Thrombolysis 2023; 55:626-633. [PMID: 36961669 DOI: 10.1007/s11239-023-02793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Several purinergic receptors have been identified on platelets which are involved in hemostatic and thrombotic processes. The aim of the present study was to investigate the effects of uridine and its nucleotides on platelet aggregation and hemostasis in platelet-rich plasma (PRP) and whole blood. The effects of uridine, UMP, UDP, and UTP at different final concentrations (1 to 1000 µM) on platelet aggregation were studied using an aggregometer. In PRP samples, platelet aggregation was induced by ADP, collagen and epinephrine 3 min after addition of uridine, UMP, UDP, UTP and saline (as a control). All thromboelastogram experiments were performed at 1000 µM final concentrations of uridine and its nucleotides in whole blood. UDP and UTP were also tested in thromboelastogram with PRP. Our results showed that UDP, and especially UTP, inhibited ADP- and collagen-induced aggregation in a concentration-dependent manner. In whole blood thromboelastogram experiments, UDP stimulated clot formation while UTP suppressed clot formation. When thromboelastogram experiments were repeated with PRP, UTP's inhibitory effect on platelets was confirmed, while UDP's stimulated clot forming effect disappeared. Collectively, our data showed that UTP inhibited platelet aggregation in a concentration-dependent manner and suppressed clot formation. On the other hand, UDP exhibited distinct effects on whole blood or PRP in thromboelastogram. These data suggest that the difference on effects of UTP and UDP might have arisen from the different receptors that they stimulate and warrant further investigation with regard to their in vivo actions on platelet aggregation and hemostasis.
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Affiliation(s)
- Merve Arı
- Vocational School of Health Services, KTO Karatay University, Konya, Turkey
| | - Engin Sağdilek
- School of Medicine, Department of Biophysics, Bursa Uludağ University, Bursa, 16059, Turkey.
| | - Evren Kılınç
- School of Medicine, Department of Biophysics, Acıbadem University, İstanbul, Turkey
| | - Mehmet Cansev
- School of Medicine, Department of Pharmacology, Bursa Uludağ University, Bursa, Turkey
| | - Kasım Özlük
- School of Medicine, Department of Physiology, Bursa Uludağ University, Bursa, Turkey
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Favaloro EJ, Gosselin RC, Pasalic L, Lippi G. Hemostasis and Thrombosis: An Overview Focusing on Associated Laboratory Testing to Diagnose and Help Manage Related Disorders. Methods Mol Biol 2023; 2663:3-38. [PMID: 37204701 DOI: 10.1007/978-1-0716-3175-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Hemostasis is a complex but balanced process that permit normal blood flow, without adverse events. Disruption of the balance may lead to bleeding or thrombotic events, and clinical interventions may be required. Hemostasis laboratories typically offer an array of tests, including routine coagulation and specialized hemostasis assays used to guide clinicians for diagnosing and managing patients. Routine assays may be used to screen patients for hemostasis-related disturbances but may also be used for drug monitoring, measuring efficacy of replacement or adjunctive therapy, and other indications, which may then be used to guide further patient management. Similarly, "specialized" assays are used for diagnostic purposes or may be used to monitor or measure efficacy of a given therapy. This chapter provides an overview of hemostasis and thrombosis, with a focus on laboratory testing that may be used to diagnose and help manage patients suspected of hemostasis- and thrombosis-related disorders.
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Affiliation(s)
- Emmanuel J Favaloro
- School of Medical Sciences, Faculty of Medicine and Health University of Sydney, Westmead Hospital, Westmead, NSW, Australia.
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga, Wagga, NSW, Australia.
| | - Robert C Gosselin
- Hemostasis & Thrombosis Center, Davis Health System, University of California, Sacramento, CA, USA
| | - Leonardo Pasalic
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Gosselin RC. Preanalytical Variables in Hemostasis Testing. Methods Mol Biol 2023; 2663:39-50. [PMID: 37204702 DOI: 10.1007/978-1-0716-3175-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Hemostasis testing performed in clinical laboratories are critical for assessing hemorrhagic and thrombotic disorders. The assays performed can be used to provide the information required for diagnosis, risk assessment, efficacy of therapy, and therapeutic monitoring. As such, hemostasis tests should be performed to the highest level of quality, including the standardization, implementation, and monitoring of all phases of the testing, which include the preanalytical, analytical, and post-analytical phases. It is well established that the preanalytical phase is the most critical component of the testing process, being the hands-on activities, including patient preparation for blood collection, as well as the actual blood collection, including sample identification and the post-collection handling to include sample transportation, processing, and storage of samples when testing is not performed immediately. The purpose of this article is to provide an update to the previous edition of coagulation testing-related preanalytical variables (PAV) and, when properly addressed and performed, can reduce the most common causes of errors in the hemostasis laboratory.
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Affiliation(s)
- Robert C Gosselin
- Hemostasis & Thrombosis Center, University of California, Davis Health System, Sacramento, CA, USA
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Du X, Chen F, Gan L, Liu Y, Zheng Y, Xing L, Zhou Q. Development and verification of a novel blood viscoelastic monitoring method based on reciprocating motion of magnetic bead. BIOMED ENG-BIOMED TE 2022; 68:211-223. [PMID: 36563350 DOI: 10.1515/bmt-2022-0225] [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: 06/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Blood coagulation function is an essential index in clinical examination, and it is of great significance to evaluate blood coagulation function comprehensively. Based on the blood viscoelasticity theory and hydrodynamics, we proposed a method to monitor the whole blood coagulation process based on the reciprocating motion of the magnetic bead (magnetic bead method for short). We have established a mathematical model between the moment acting on the magnetic bead and the viscoelasticity of blood in the process of blood coagulation. The change of blood viscoelasticity acks on the magnetic bead in the form of moment changes, which shows that the amplitude of the motion of the magnetic bead varies with the change of blood viscoelasticity. Designed and verified a blood coagulation monitoring device based on the reciprocating movement of the magnetic bead and discussed the device's parameters through the orthogonal experiment. Lastly, the TEG5000 was used as the control group to test the thromboelasticity of four groups of thromboelastography quality control products in the same batch and 10 groups of human whole blood. It verified that our device has good repeatability, and has good consistency with TEG5000, it has particular application potential as a new blood coagulation monitoring method.
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Affiliation(s)
- Xinyu Du
- Department of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Fupan Chen
- Department of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Lijin Gan
- Anjian Technology (Chongqing) Co. Ltd, Chongqing, China
| | - Yong Liu
- Chongqing Nanfang Numerical Control Equipment Co. Ltd, Chongqing, China
| | - Yu Zheng
- Department of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Linghua Xing
- Department of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Qi Zhou
- Department of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
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Myers SP, Dyer MR, Hassoune A, Brown JB, Sperry JL, Meyer MP, Rosengart MR, Neal MD. Correlation of Thromboelastography with Apparent Rivaroxaban Concentration: Has Point-of-Care Testing Improved? Anesthesiology 2020; 132:280-290. [PMID: 31939843 DOI: 10.1097/aln.0000000000003061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Concern remains over reliable point-of-care testing to guide reversal of rivaroxaban, a commonly used factor Xa inhibitor, in high-acuity settings. Thromboelastography (TEG), a point-of-care viscoelastic assay, may have the ability to detect the anticoagulant effect of rivaroxaban. The authors ascertained the association of apparent rivaroxaban concentration with thromboelastography reaction time, i.e., time elapsed from blood sample placement in analyzer until beginning of clot formation, as measured using TEG and TEG6S instruments (Haemonetics Corporation, USA), hypothesizing that reaction time would correlate to degree of functional factor Xa impairment. METHODS The authors prospectively performed a diagnostic accuracy study comparing coagulation assays to apparent (i.e., indirectly assessed) rivaroxaban concentration in trauma patients with and without preinjury rivaroxaban presenting to a single center between April 2016 and July 2018. Blood samples at admission and after reversal or 24 h postadmission underwent TEG, TEG6S, thrombin generation assay, anti-factor Xa chromogenic assay, prothrombin time (PT), and ecarin chromogenic assay testing. The authors determined correlation of kaolin TEG, TEG6S, and prothrombin time to apparent rivaroxaban concentration. Receiver operating characteristic curve compared capacity to distinguish therapeutic rivaroxaban concentration (i.e., greater than or equal to 50 ng/ml) from nontherapeutic concentrations. RESULTS Eighty rivaroxaban patients were compared to 20 controls. Significant strong correlations existed between rivaroxaban concentration and TEG reaction time (ρ = 0.67; P < 0.001), TEG6S reaction time (ρ = 0.68; P < 0.001), and prothrombin time (ρ = 0.73; P < 0.001), however reaction time remained within the defined normal range for the assay. Rivaroxaban concentration demonstrated strong but not significant association with coagulation assays postreversal (n = 9; TEG reaction time ρ = 0.62; P = 0.101; TEG6S reaction time ρ = 0.57; P = 0.112) and small nonsignificant association for controls (TEG reaction time: ρ = -0.04; P = 0.845; TEG6S reaction time: ρ = -0.09; P = 0.667; PT-neoplastine: ρ = 0.19; P = 0.301). Rivaroxaban concentration (area under the curve, 0.91) and TEG6S reaction time (area under the curve, 0.84) best predicted therapeutic rivaroxaban concentration and exhibited similar receiver operating characteristic curves (P = 0.180). CONCLUSIONS Although TEG6S demonstrates significant strong correlation with rivaroxaban concentration, values within normal range limit clinical utility rendering rivaroxaban concentration the gold standard in measuring anticoagulant effect.
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Affiliation(s)
- Sara P Myers
- From the Department of General Surgery, The University of Pittsburgh Medical Center (S.P.M., M.R.D., A.H., J.B.B., J.L.S., M.R.R., M.D.N.) the Institute for Transfusion Medicine (M.P.M.) the Pittsburgh Surgical Outcomes Research Center, University of Pittsburgh (M.R.R.), Pittsburgh, Pennsylvania
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Ranucci M, Baryshnikova E. Sensitivity of Viscoelastic Tests to Platelet Function. J Clin Med 2020; 9:E189. [PMID: 32284512 PMCID: PMC7019879 DOI: 10.3390/jcm9010189] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
Viscoelastic tests provide a dynamic assessment of coagulation, by exploring the time to clot formation and the clot strength. Using specific activators or inhibitors, additional factors can be explored, like the fibrinogen contribution to clot strength. Since the early days, various attempts have been done to measure platelet function with viscoelastic test. In general, the difference between the maximum clot strength and the fibrinogen contribution is considered an index of platelet contribution. However, this parameter does not clearly split platelet count from function; additionally, the extensive thrombin generation of standard activated viscoelastic tests activates platelet through the protease activated receptors, bypassing the other pathways. For this reason, standard viscoelastic tests cannot be used to assess platelet reactivity under the effects of aspirin or P2Y12 inhibitors. To overcome this limitation, a specific test was developed (thromboelastography platelet mapping). This test has been compared with the gold standard of light transmission aggregometry and with other point-of-care tests, with conflicting results. In general, the use of viscoelastic tests to assess the effects of antiplatelet agents is still limited. Conversely, platelet contribution to clot strength in the setting of coagulopathic bleeding is considered an important parameter to trigger platelet transfusion or desmopressin.
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Affiliation(s)
- Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy;
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Giorni C, Costopoulos M, Bachelot‐Loza C, Belleville‐Rolland T, Pouard P, Raisky O, Pascreau T, Borgel D, Lasne D. Platelet-mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study. Res Pract Thromb Haemost 2017; 1:120-127. [PMID: 30046680 PMCID: PMC6058205 DOI: 10.1002/rth2.12010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/26/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The complex hemostatic changes associated with Berlin Heart (BH) implantation in children require a challenging antithrombotic treatment. The aim of this retrospective analysis was to evaluate the thromboelastography (TEG)-platelet mapping (PM) assay to monitor antiplatelet therapy in children implanted with a BH. METHODS TEG-PM was performed in 4 BH-implanted patients receiving dipyridamole and aspirin, and 9 healthy volunteers. Patients' antiplatelet therapy was adjusted to TEG-PM results. Light transmission aggregometry (LTA) was also available for 2 of these patients. RESULTS Between 2009 and 2014, 4 BH-implanted patients received a dual antiplatelet therapy monitored by TEG-PM. In 2 patients, 18 of 34 tracings were atypical, because the maximum amplitude due to fibrin never stabilized, which made difficult antiplatelet therapy adjustment as recommended by BH's guidelines. To overcome this difficulty, TEG-PM and LTA were next performed in parallel. However, both methods led to different decisions to adjust antiplatelet therapy in 57% of the cases. In order to better understand this atypical tracing, TEG-PM was also performed in 9 volunteers and surprisingly 3 of them had the same atypical tracing. This atypical tracing was corrected by adding apyrase, suggesting that adenosine diphosphate (ADP) participates to spontaneous platelet activation in heparinized samples. In addition, we evidenced a high variability in the responses of TEG-PM with ADP in volunteers. CONCLUSIONS Antiplatelet therapy monitoring in BH-implanted children remains challenging, as TEG-PM is sensitive to several preanalytical and analytical conditions.
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Affiliation(s)
- Chiara Giorni
- Pediatric Intensive CareCardiac Surgery and Perfusion UnitParisFrance
| | - Myrto Costopoulos
- Laboratoire d'HématologieAP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
| | | | - Tiphaine Belleville‐Rolland
- Laboratoire d'HématologieAP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- INSERM UMR‐S1140ParisFrance
- Paris Descartes UniversitySorbonne Paris CitéParisFrance
| | - Philippe Pouard
- Pediatric Intensive CareCardiac Surgery and Perfusion UnitParisFrance
| | - Olivier Raisky
- Pediatric Intensive CareCardiac Surgery and Perfusion UnitParisFrance
| | - Tiffany Pascreau
- Laboratoire d'HématologieAP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- INSERM UMR‐S1176University Paris‐SudUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance
| | - Delphine Borgel
- Laboratoire d'HématologieAP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- INSERM UMR‐S1176University Paris‐SudUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance
| | - Dominique Lasne
- Laboratoire d'HématologieAP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- INSERM UMR‐S1176University Paris‐SudUniversité Paris‐SaclayLe Kremlin‐BicêtreFrance
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