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Dumitrescu G, Januszkiewicz A, Ågren A, Magnusson M, Sparrelid E, Rooyackers O, Wernerman J. Fibrinogen and albumin synthesis rates in major upper abdominal surgery. PLoS One 2022; 17:e0276775. [PMID: 36301906 PMCID: PMC9612515 DOI: 10.1371/journal.pone.0276775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
Plasma fibrinogen and albumin concentrations initially decrease after abdominal surgery. On postoperative days 3-5 fibrinogen concentration returns to the preoperative level or even higher, while albumin stays low. It is not known if these altered plasma concentrations reflect changes in synthesis rate, utilization, or both. In particular a low albumin plasma concentration has often been attributed to a low synthesis rate, which is not always the case. The objective of this study was to determine fibrinogen and albumin quantitative synthesis rates in patients undergoing major upper abdominal surgery with and without intact liver size. Patients undergoing liver or pancreatic resection (n = 9+6) were studied preoperatively, on postoperative days 1 and 3-5. De novo synthesis of fibrinogen and albumin was determined; in addition, several biomarkers indicative of fibrinogen utilization were monitored. After hemihepatectomy, fibrinogen synthesis was 2-3-fold higher on postoperative day 1 than preoperatively. On postoperative days 3-5 the synthesis level was still higher than preoperatively. Following major liver resections albumin synthesis was not altered postoperatively compared to preoperative values. After pancreatic resection, on postoperative day 1 fibrinogen synthesis was 5-6-fold higher than preoperatively and albumin synthesis 1.5-fold higher. On postoperative days 3-5, synthesis levels returned to preoperative levels. Despite decreases in plasma concentrations, de novo synthesis of fibrinogen was markedly stimulated on postoperative day 1 after both hemihepatectomies and pancreatectomies, while de novo albumin synthesis remained grossly unchanged. The less pronounced changes seen following hepatectomies were possibly related to the loss of liver tissue.
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Affiliation(s)
- Gabriel Dumitrescu
- Division of Anaesthesia, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Anna Januszkiewicz
- Division of Anaesthesia, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ågren
- Department of Molecular Medicine and Surgery, MMK, Clinical Chemistry and Coagulation, Karolinska Institutet, Stockholm, Sweden
| | - Maria Magnusson
- Department of Molecular Medicine and Surgery, MMK, Clinical Chemistry and Coagulation, Karolinska Institutet, Stockholm, Sweden
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olav Rooyackers
- Division of Anaesthesia, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Wernerman
- Division of Anaesthesia, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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2
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Taune V, Skeppholm M, Ågren A, Wikman A, Hillarp A, Wallén H. Rapid Detection of Apixaban by a ROTEM-Based Approach and Reversibility with Andexanet Alfa or DOAC-Stop. TH Open 2022; 6:e238-e247. [PMID: 36046206 PMCID: PMC9423941 DOI: 10.1055/s-0042-1751072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/09/2022] [Indexed: 11/04/2022] Open
Abstract
Background
A rapid test to detect apixaban treatment would be useful in acute situations such as major bleeding, urgent surgery, or in acute thrombosis.
Objective
This article aims to study if the viscoelastic test rotational thromboelastometry (ROTEM) can rapidly detect apixaban in whole blood using modified triggers based on factor Xa (FXa) or Russell viper venom (RVV).
Method
ROTEM clotting time (CT) was measured in samples from 40 patients on apixaban treatment, and in vitro in samples spiked with apixaban (20–500 ng/mL). Commercially available trigger Ex-tem was compared with modified triggers based on FXa or RVV. Reversibility of apixaban in the samples was studied; CT was measured with and without addition of DOAC-Stop or andexanet alfa, respectively, and the difference in CT was calculated (CT
diff
).
Results
Using FXa as trigger, we detected apixaban concentrations at 20 ng/mL and above with 100% sensitivity and 100% specificity in patient samples and in vitro. Corresponding data for Ex-tem were 92% sensitivity and 100% specificity in patients, and 94% sensitivity and 100% specificity in vitro, and for RVV 97% sensitivity and 94% specificity in patients, and 97% sensitivity and 100% specificity in vitro, respectively. CT
diff
data were similar. Patient sample data were obtained within 20 minutes from sampling.
Conclusion
Apixaban at low therapeutic concentrations was detected within 20 minutes, and with high sensitivity and specificity. A trigger based on FXa outperformed the commercial trigger Ex-tem and a trigger based on RVV. ROTEM with a FXa-based trigger is a promising method to detect apixaban bedside in acute settings.
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Affiliation(s)
- Viktor Taune
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mika Skeppholm
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ågren
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Wikman
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Hillarp
- Department of Translational Medicine, Clinical Chemistry Malmö, Lund University, Malmö, Sweden
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Håkan Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
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3
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Almskog LM, Wikman A, Svensson J, Bottai M, Kotormán M, Wahlgren CM, Wanecek M, van der Linden J, Ågren A. Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study. TH Open 2022; 6:e50-e59. [PMID: 35265789 PMCID: PMC8901374 DOI: 10.1055/a-1725-9221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022]
Abstract
Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
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Affiliation(s)
- Lou M. Almskog
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Address for correspondence Lou M. Almskog Department of Molecular Medicine and Surgery, Karolinska University HospitalStockholm, 171 67Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Svensson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mariann Kotormán
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Wanecek
- Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jan van der Linden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ågren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Coagulation Unit, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Sciences, Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden
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4
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Zenlander R, Havervall S, Magnusson M, Engstrand J, Ågren A, Thålin C, Stål P. Neutrophil extracellular traps in patients with liver cirrhosis and hepatocellular carcinoma. Sci Rep 2021; 11:18025. [PMID: 34504150 PMCID: PMC8429678 DOI: 10.1038/s41598-021-97233-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/20/2021] [Indexed: 12/20/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are web-like structures consisting of DNA, histones and granule proteins, released from neutrophils in thrombus formation, inflammation, and cancer. We asked if plasma levels of the NET markers myeloperoxidase (MPO)-DNA and citrullinated histone H3 (H3Cit)-DNA, are elevated in liver cirrhosis and hepatocellular carcinoma (HCC) and if the levels correlate with clinical parameters. MPO-DNA, H3Cit-DNA, and thrombin–antithrombin (TAT) complex, as a marker of coagulation activity, were measured using ELISA in plasma from 82 patients with HCC, 95 patients with cirrhosis and 50 healthy controls. Correlations were made to clinical parameters and laboratory data and patients were followed for a median of 22.5 months regarding thrombosis development. H3Cit-DNA was significantly (p < 0.01) elevated in plasma from cirrhosis (66.4 ng/mL) and HCC (63.8 ng/mL) patients compared to healthy controls (31.8 ng/mL). TAT levels showed similar pattern (3.1, 3.7, and 0.0 µg/mL respectively, p < 0.01). MPO-DNA was significantly (p < 0.01) elevated in cirrhosis patients (0.53 O.D.) as compared to controls (0.33 O.D.). Levels of MPO-DNA and H3Cit-DNA correlated positively with Child–Pugh and MELD score. TAT was increased in all Child–Pugh and MELD groups. In multivariable logistic regression, Child B and C liver cirrhosis were independent predictors of elevated H3Cit-DNA in plasma. Levels of MPO-DNA and H3Cit-DNA were similar in patients with or without history of thrombosis, or thrombus formation during follow-up. In conclusion, plasma markers of NET formation are elevated in liver cirrhosis and correlate to the degree of liver dysfunction in patients with liver cirrhosis and/or HCC. The presence of HCC did not further increase the plasma levels of NET markers as compared to patients with cirrhosis only.
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Affiliation(s)
- Robin Zenlander
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden. .,Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden. .,Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.
| | - Sebastian Havervall
- Division of Gastroenterology, Department of Specialized Medicine, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Maria Magnusson
- Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ågren
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Thålin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.,Department of Internal Medicine and Infectious Diseases, Danderyd Hospital, Stockholm, Sweden
| | - Per Stål
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
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5
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Sjöström A, Wersäll JD, Warnqvist A, Farm M, Magnusson M, Oldner A, Ågren A, Antovic J, Bruzelius M. Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined-An Observational Study on Anticoagulation Shift in COVID-19. Thromb Haemost 2021; 121:1610-1621. [PMID: 33831964 DOI: 10.1055/a-1477-3829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020. OBJECTIVES To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation. METHODS Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records. RESULTS Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10-17.5 and 3.11; 95% CI: 1.20-8.10, respectively). If platelet count increased more than 35 × 109/L per day, the mortality and thrombotic risk decreased (OR: 0.16; 95% CI: 0.06-0.41, and OR: 0.36; 95% CI: 0.17-0.80). After implementation of updated hospital-wide recommendations, the daily mean significantly decreased regarding D-dimer levels while platelet counts rose; -1.93; 95% CI: -1.00-2.87 mg/L FEU (fibrinogen-equivalent unit) and 65; 95% CI: 54-76 ×109/L, and significant risk reductions for death and thrombosis were observed; OR: 0.48; 95% CI: 0.25-0.92 and 0.35; 95% CI: 0.17-0.72. CONCLUSION In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.
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Affiliation(s)
- Anna Sjöström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
| | | | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Farm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
| | - Maria Magnusson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Oldner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ågren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jovan Antovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
| | - Maria Bruzelius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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6
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Almskog LM, Wikman A, Svensson J, Wanecek M, Bottai M, van der Linden J, Ågren A. Rotational thromboelastometry results are associated with care level in COVID-19. J Thromb Thrombolysis 2020; 51:437-445. [PMID: 33068277 PMCID: PMC7568025 DOI: 10.1007/s11239-020-02312-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/06/2023]
Abstract
High prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The primary aim of this study was to test whether rotational thromboelastometry (ROTEM) at admission indicates hypercoagulopathy and predicts the disease severity, assessed as care level, in COVID-19 patients. The study was designed as a prospective, observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: (1) regular wards or (2) wards with specialized ventilation support. Conventional coagulation tests, blood type and ROTEM were taken at admission. 60 patients were included; age 61 (median), 67% men, many with comorbidities (e.g. hypertension, diabetes). The ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with in healthy controls (p < 0.001) and higher in severely ill patients compared with in patients at regular wards (p < 0.05). Our results suggest that hypercoagulopathy is present early in patients with mild to moderate disease, and more pronounced in severe COVID-19 pneumonia. Non-O blood types were not overrepresented in COVID-19 positive patients. ROTEM variables showed hypercoagulopathy at admission and this pattern was more pronounced in patients with increased disease severity. If this feature is to be used to predict the risk of thromboembolic complications further studies are warranted.
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Affiliation(s)
- Lou M Almskog
- Department of Anaesthesiology and Intensive Care, Capio St Göran's Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital and Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michael Wanecek
- Department of Anaesthesiology and Intensive Care, Capio St Göran's Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan van der Linden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ågren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Coagulation Unit, Division of Hematology and Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. .,Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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7
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Ågren A, Edgren G, Hjemdahl P, Gryfelt G, Östlund A, Wikman A. Results of in vitro whole blood coagulation assays using ROTEM and the flow-chamber T-TAS system are affected by hematocrit. Thromb Res 2020; 194:98-100. [DOI: 10.1016/j.thromres.2020.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
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8
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Almskog LM, Hammar U, Wikman A, Östlund A, Svensson J, Wanecek M, Ågren A. A retrospective register study comparing fibrinogen treated trauma patients with an injury severity score matched control group. Scand J Trauma Resusc Emerg Med 2020; 28:5. [PMID: 31964405 PMCID: PMC6975055 DOI: 10.1186/s13049-019-0695-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, although the clinical effects are not well known. In this study we describe demographic and clinical outcome data in a cohort of trauma patients receiving FC, compared to a matched control group, who did not receive FC. METHODS This retrospective, single-center, observational study included adult trauma patients admitted to a level 1-trauma center in Sweden between January 2013 and June 2015. The study population consisted of patients to whom FC was administrated within 24 h (n = 138, "Fib+"). Patients with Injury Severity Score (ISS) > 49 and/or deceased within 1 h from arrival were excluded (n = 30). Controls (n = 108) were matched for age, gender and ISS ("Fib-"). Primary outcome was mortality (24 h-/30 days-/1 year-), and secondary outcomes were blood transfusions, thromboembolic events and organ failure. RESULTS The Fib+ group, despite having similar ISS as Fib-, had higher prevalence of penetrating trauma and lower Glasgow Coma Scale (GCS), indicating more severe injuries. Patients receiving FC had a higher mortality after 24 h/ 30 days/ 1 year compared to controls (Fib-). However, in a propensity score matched model, the differences in mortality between Fib+ and Fib- were no longer significant. Blood transfusions were more common in the Fib+ group, but no difference was observed in thromboembolic events or organ failure. In both groups, low as well as high P-fibrinogen levels at arrival were associated with increased mortality, with the lowest mortality observed at P-fibrinogen values of 2-3 g/l. CONCLUSIONS Despite equal ISS, patients receiving FC had a higher mortality compared to the control group, presumably associated to the fact that these patients were bleeding and physiologically deranged on arrival. When applying a propensity score matching approach, the difference in mortality between the groups was no longer significant. No differences were observed between the groups regarding thromboembolic events or organ failure, despite higher transfusion volumes in patients receiving FC.
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Affiliation(s)
- Lou M Almskog
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden
| | - Ulf Hammar
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anders Östlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Svensson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Michael Wanecek
- Department of Physiology and Pharmacology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anna Ågren
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Danderyd, 18288, Stockholm, Sweden.
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden.
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9
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Schmidt DE, Chaireti R, Bruzelius M, Holmström M, Antovic J, Ågren A. Correlation of thromboelastography and thrombin generation assays in warfarin-treated patients. Thromb Res 2019; 178:34-40. [DOI: 10.1016/j.thromres.2019.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/13/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
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10
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Taune V, Skeppholm M, Ågren A, Gryfelt G, Malmström RE, Wikman A, Van Ryn J, Wallén H. Rapid determination of anticoagulating effects of dabigatran in whole blood with rotational thromboelastometry and a thrombin-based trigger. J Thromb Haemost 2018; 16:2462-2470. [PMID: 30288934 DOI: 10.1111/jth.14308] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Indexed: 01/16/2023]
Abstract
Essentials A rapid test to detect thrombin inhibition by dabigatran would be valuable in acute situations. A thrombin-based trigger was applied in whole blood using rotation thromboelastometry. Effects of dabigatran were assessed in vitro and in samples from patients on dabigatran. The test produced data rapidly and was sensitive to dabigatran concentrations from 20 to 500 ng mL-1 . SUMMARY: Background Rapid determination of the anticoagulant effect of dabigatran is essential in emergency situations. Objective To study a viscoelastic test (rotational thromboelastometry [ROTEM]) for rapid determination of dabigatran effects in whole blood samples. Method ROTEM measurements were performed with comparison of two triggers (thrombin-based versus the commercial tissue factor-based trigger Ex-tem) in samples from 10 healthy donors spiked with dabigatran (20-500 ng mL-1 ) and in samples from 35 patients receiving dabigatran treatment; 10 healthy subjects served as controls. Clotting time (CT) and the difference in CT without versus with addition of the dabigatran antidote idarucizumab (CTdiff ) were measured. Addition of idarucizumab reveals the contribution of dabigatran to ROTEM measurements and its potential reversibility. Results In vitro studies showed that thrombin CT and thrombin CTdiff were more sensitive than Ex-tem CT and Ex-tem CTdiff in detecting dabigatran in whole blood samples. In patient samples, when thrombin CT and thrombin CTdiff were used, it was possible to detect dabigatran with a cut-off of dabigatran at 20 ng mL-1 , whereas, when Ex-tem CT and Ex-tem CTdiff were used, the method was less sensitive. Data from patient samples were obtained within 15 min of blood sampling. Conclusions ROTEM CT with a thrombin-based trigger is more sensitive to dabigatran effects than Ex-tem CT, and detects anticoagulant effects of drug concentrations in the low-very low therapeutic range. Analysis with idarucizumab (CTdiff ) reveals dabigatran-specific effects. As data are rapidly obtained, this method could, with further development and validation of its performance, be suitable for detecting clinically significant dabigatran effects in emergency situations.
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Affiliation(s)
- V Taune
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - M Skeppholm
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - A Ågren
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - G Gryfelt
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - R E Malmström
- Department of Medicine Solna, Karolinska Institutet & Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - A Wikman
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Van Ryn
- Department of Medicine, Boehringer Ingelheim International GmbH, Biberach an der Riss, Germany
| | - H Wallén
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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11
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Berntorp E, Ågren A, Aledort L, Blombäck M, Cnossen MH, Croteau SE, von Depka M, Federici AB, Goodeve A, Goudemand J, Mannucci PM, Mourik M, Önundarson PT, Rodeghiero F, Szántó T, Windyga J. Fifth Åland Island conference on von Willebrand disease. Haemophilia 2018; 24 Suppl 4:5-19. [DOI: 10.1111/hae.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
- E. Berntorp
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Lund University; Malmö Sweden
| | - A. Ågren
- Coagulation Unit; Department of Medicine; Division of Haematology; Karolinska University Hospital; Stockholm Sweden
| | - L. Aledort
- Department of Hematology and Medical Oncology; Mount Sinai Hospital; New York NY USA
| | - M. Blombäck
- Department of Molecular Medicine and Surgery; Karolinska University Hospital; Stockholm Sweden
| | - M. H. Cnossen
- Erasmus University Medical Center - Sophia Children's Hospital Rotterdam; Rotterdam The Netherlands
| | - S. E. Croteau
- Boston Children's Hospital; Boston Hemophilia Center; Harvard Medical School; Boston MA USA
| | | | - A. B. Federici
- Department of Oncology and Oncologic Hematology, Haematology and Transfusion Medicine; L. Sacco University Hospital; University of Milan; Milan Italy
| | - A. Goodeve
- Haemostasis Research Group; University of Sheffield; Sheffield UK
- Sheffield Diagnostic Genetics Service; Sheffield Children's NHS Foundation Trust; Sheffield UK
| | - J. Goudemand
- Department of Haematology; Lille University Hospital; Lille France
| | - P. M. Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; IRCCS Cà Grande Maggiore Policlinico Hospital Foundation; Milan Italy
| | - M. Mourik
- Department of Molecular Cell Biology; Leiden University Medical Center; Leiden The Netherlands
| | - P. T. Önundarson
- Landspitali University Hospital; University of Iceland School of Medicine; Reykjavik Iceland
| | - F. Rodeghiero
- Department of Cell Therapy and Hematology; San Bortolo Hospital; Vicenza Italy
| | - T. Szántó
- Coagulation Disorders Unit; Departments of Hematology and Clinical Chemistry (HUSLAB Laboratory Services); Helsinki University Central Hospital; Helsinki Finland
| | - J. Windyga
- Department of Disorders of Hemostasis and Internal Medicine; Institute of Hematology and Transfusion Medicine; Warsaw Poland
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12
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Ågren A, Antovic J, Strandberg K, Frisk T, Löfstedt P, Strindfors G, Celsing F. [Not Available]. Lakartidningen 2018; 115:EYWT. [PMID: 29558005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Anna Ågren
- Institutionen för medicin, Karolinska Institutet - Koagulationsmottagningen, Hematologiskt Centrum, Karolinska Universitetssjukhuset Stockholm, Sweden - , Sweden
| | - Jovan Antovic
- Karolinska universitetslaboratoriet Klinisk kemi avdelningen - Stockholm, Sweden Karolinska universitetslaboratoriet Klinisk kemi avdelningen - Stockholm, Sweden
| | - Karin Strandberg
- Klinisk kemi - Laboratoriemedicin i Skåne Malmö, Sweden Klinisk kemi - Laboratoriemedicin i Skåne Malmö, Sweden
| | - Tony Frisk
- Barnkliniken - Astrid Lindgrens barnsjukhus Stockholm, Sweden Barnkliniken - Astrid Lindgrens barnsjukhus Stockholm, Sweden
| | - Pia Löfstedt
- Anestesikliniken, Södersjukhuset - Stockholm, Sweden Anestesikliniken, Södersjukhuset - Stockholm, Sweden
| | - Gita Strindfors
- Kvinnokliniken, Södersjukhuset - Stockholm, Sweden Kvinnokliniken, Södersjukhuset - Stockholm, Sweden
| | - Fredrik Celsing
- Hematologiskt Centrum, Karolinska Universitetssjukhuset - Stockholm, Sweden Hematologiskt Centrum, Karolinska Universitetssjukhuset - Stockholm, Sweden
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13
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Holmström M, Schmidt DE, Hosokawa K, Blombäck M, Hjemdahl P, Ågren A. Monitoring of coagulation factor therapy in patients with von Willebrand disease type 3 using a microchip flow chamber system. Thromb Haemost 2017; 117:75-85. [DOI: 10.1160/th16-06-0430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/23/2016] [Indexed: 01/22/2023]
Abstract
SummaryPatients with type 3 von Willebrand disease (VWD-3) have no measurable levels of VW factor (VWF) and usually require treatment with VWF-FVIII concentrate to prevent and/or stop bleeding. Even though the patients are treated prophylactically, they may experience bleeding symptoms. The aim of this study was to evaluate the effect of VWF-FVIII concentrate treatment in VWD-3 patients with the Total Thrombus Analysis System (T-TAS®), which measures thrombus formation under flow conditions. Coagulation profiles of 10 VWD-3 patients were analysed using T-TAS before and 30 minutes after VWF-FVIII concentrate (Haemate®) injection. Results were compared to VWF- and FVIII activity in plasma, and results with thromboelastometry and ris-tocetin-activated platelet impedance aggregometry (Multiplate®) in whole blood. For comparison, 10 healthy controls were also analysed with T-TAS. A median dose of 27 (range 15–35) IU/kg of VWF-FVIII concentrate increased VWF- and FVIII activity as expected. T-TAS thrombus formation was enhanced when a tissue factor/collagen-coated flow chamber was used at low shear, but treatment effects at high shear using a collagen-coated flow chamber were minimal. Whole blood coagulation assessed by thromboelastometry was normal and did not change (p > 0.05) but ristocetin-induced platelet aggregation improved (p < 0.001). In conclusion, T-TAS detects effects of VWF-FVIII concentrate treatment on coagulation-dependent thrombus formation at low shear, but minor effects are observed on platelet-dependent thrombus formation at high shear. The poor prediction of bleeding by conventional laboratory monitoring in VWD-3 patients might be related to insufficient restoration of platelet-dependent thrombus formation.
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14
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Schmidt DE, Bruzelius M, Majeed A, Odeberg J, Holmström M, Ågren A. Whole blood ristocetin-activated platelet impedance aggregometry (Multiplate) for the rapid detection of Von Willebrand disease. Thromb Haemost 2017; 117:1528-1533. [PMID: 28692107 DOI: 10.1160/th17-02-0129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/09/2017] [Indexed: 12/22/2022]
Abstract
Von Willebrand disease (VWD) is the most common bleeding disorder, but no bedside tests specific for Von Willebrand factor are available. The objective of this study was to evaluate the diagnostic accuracy of whole blood ristocetin-induced platelet aggregometry (WB-RIPA) in VWD. WB-RIPA was performed in VWD patients (n=100) and healthy controls (n=17) using the Multiplate® platelet impedance aggregometry platform. The diagnostic properties of the test were described as sensitivity/specificity, positive and negative predictive value, and ROC area under the curve (AUC). Patients with VWD had impaired platelet aggregation by WB-RIPA. At a cut-off of 98 U, the test sensitivity and specificity of WB-RIPA for VWD was 0.95 and 0.53. A cut-off of 60 U provided a specificity of 1.00 with reduced sensitivity of 0.76. All patients with type 3 VWD and >90 % of patients with type 2 VWD were accurately distinguished from the controls. Incorrect classifications were attributable to patients with type 1 VWD, showing partly overlapping WB-RIPA results with healthy controls. Remarkably, these patients had lower bleeding scores and higher VWF activity than other type 1 VWD patients. Overall, WB-RIPA discriminated VWD patients from healthy controls accurately with a ROC AUC of 0.94. These results show that WB-RIPA is a promising diagnostic test for VWD, especially when timely results are required. Depending on the chosen test threshold, WB-RIPA could be clinically used as a rule out test, or to suggest patients in whom further testing for VWD is warranted.
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Affiliation(s)
| | | | | | | | | | - Anna Ågren
- Anna Ågren, MD, PhD, Coagulation Unit, Hematology Center, Karolinska University Hospital, 171 76 Stockholm, Sweden, Tel.: +46 8 51773373, Fax: +46 8 51775084, E-mail:
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15
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Schmidt DE, Halmin M, Wikman A, Östlund A, Ågren A. Relative effects of plasma, fibrinogen concentrate, and factor XIII on ROTEM coagulation profiles in an in vitro model of massive transfusion in trauma. Scand J Clin Lab Invest 2017. [PMID: 28632435 DOI: 10.1080/00365513.2017.1334128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Massive traumatic haemorrhage is aggravated through the development of trauma-induced coagulopathy, which is managed by plasma transfusion and/or fibrinogen concentrate administration. It is yet unclear whether these treatments are equally potent in ensuring adequate haemostasis, and whether additional factor XIII (FXIII) administration provides further benefits. In this study, we compared ROTEM whole blood coagulation profiles after experimental massive transfusion with different transfusion regimens in an in vitro model of dilution- and transfusion-related coagulopathy. Healthy donor blood was mixed 1 + 1 with six different transfusion regimens. Each regimen contained RBC, platelet concentrate, and either fresh frozen plasma (FFP) or Ringer's acetate (RA). The regimens were further augmented through addition of a low- or medium-dose fibrinogen concentrate and FXIII. Transfusion with FFP alone was insufficient to maintain tissue-factor activated clot strength, coincidental with a deficiency in fibrin-based clot strength. Fibrinogen concentrate conserved, but did not improve coagulation kinetics and overall clot strength. Only combination therapy with FFP and low-dose fibrinogen concentrate improved both coagulation kinetics and fibrin-based clot strength. Administration of FXIII did not result in an improvement of clot strength. In conclusion, combination therapy with both FFP and low-dose fibrinogen concentrate improved clotting time and produced firm clots, representing a possible preferred first-line regimen to manage trauma-induced coagulopathy when RBC and platelets are also transfused. Further research is required to identify optimal first-line transfusion fluids for massive traumatic haemorrhage.
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Affiliation(s)
- David E Schmidt
- a Department of Medicine, Division of Haematology, Coagulation Unit , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - Märit Halmin
- b Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.,c Department of Anesthesiology and Intensive Care , Danderyd Hospital , Stockholm , Sweden
| | - Agneta Wikman
- d Department of Clinical Immunology and Transfusion Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - Anders Östlund
- e Department of Anaesthesiology and Intensive Care , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - Anna Ågren
- a Department of Medicine, Division of Haematology, Coagulation Unit , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
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16
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Dumitrescu G, Januszkiewicz A, Ågren A, Magnusson M, Wahlin S, Wernerman J. Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation. Medicine (Baltimore) 2017; 96:e7101. [PMID: 28591054 PMCID: PMC5466232 DOI: 10.1097/md.0000000000007101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a better overview of the coagulation system in these patients. It has now been suggested that coagulation as reflected by tromboelastomety may also be used for prognostic purposes. The objective of our study was to investigate whether thrombelastometry may discriminate the degree of liver insufficiency according to the scoring systems Child Pugh and Model for End-stage Liver Disease (MELD).Forty patients with chronic liver disease of different etiologies and stages were included in this observational cross-sectional study. The severity of liver disease was evaluated using the Child-Pugh score and the MELD score, and blood samples for biochemistry, conventional coagulation tests, and ROTEM were collected at the time of the final assessment for liver transplantation. Statistical comparisons for the studied parameters with scores of severity were made using Spearman correlation test and receiver-operating characteristic (ROC) curves.Spearman correlation coefficients indicated that the thromboelastometric parameters did not correlate with Child-Pugh or MELD scores. The ROC curves of the thromboelastometric parameters could not differentiate advanced stages from early stages of liver cirrhosis.Standard ROTEM cannot discriminate the stage of chronic liver disease in patients with severe chronic liver disease.
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Affiliation(s)
- Gabriel Dumitrescu
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital
| | - Anna Januszkiewicz
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital
| | - Anna Ågren
- Department of Medicine, Division of Hematology, Coagulation Unit, Karolinska University Hospital
| | - Maria Magnusson
- CLINTEC, Division of Pediatrics, Astrid Lindgren Children's Hospital
- MMK, Clinical Chemistry and Blood Coagulation Research, Karolinska Institute
| | - Staffan Wahlin
- Division of Hepatology, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Wernerman
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital
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17
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Taune V, Wallén H, Ågren A, Gryfelt G, Sjövik C, Wintler AM, Malmström RE, Wikman A, Skeppholm M. Whole blood coagulation assays ROTEM and T-TAS to monitor dabigatran treatment. Thromb Res 2017; 153:76-82. [DOI: 10.1016/j.thromres.2017.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 03/15/2017] [Indexed: 01/19/2023]
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18
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Schmidt DE, Majeed A, Bruzelius M, Odeberg J, Holmström M, Ågren A. A prospective diagnostic accuracy study evaluating rotational thromboelastometry and thromboelastography in 100 patients with von Willebrand disease. Haemophilia 2016; 23:309-318. [DOI: 10.1111/hae.13121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 01/15/2023]
Affiliation(s)
- D. E. Schmidt
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
- University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Majeed
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - M. Bruzelius
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - J. Odeberg
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - M. Holmström
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - A. Ågren
- Division of Haematology; Department of Medicine; Coagulation Unit; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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19
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Kjellander C, Sennström MKB, Stiller V, Ågren A. [Sickle cell anemia causes varied symptoms and high morbidity. Serious prognosis in the most common genetic disease in the world]. Lakartidningen 2015; 112:DCPM. [PMID: 25734427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sickle cell anemia is a life-threatening disease, and the most common genetic disease in the world. The prevalence of sickle cell anemia in Sweden is unknown. Sickle cell anemia is an important disease, because of its variable complications, in many medical and surgical specialties. The overview highlights common medical problems encountered in sickle cell anemia presented through a case report of a pregnant woman.
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Affiliation(s)
- Christian Kjellander
- Institutionen för medicin, Karolinska Institutet - Hematologiskt Centrum, Karolinska Universitetssjukhuset Stockholm, Sweden Karolinska Institutet, Institutionen för Medicin, Solna - Centrum för Hematologi Stockholm, Sweden
| | - Maria K B Sennström
- Institutionen för kvinnors och barns hälsa, Karolinska Institutet - Kvinnokliniken, Karolinska Universitetssjukhuset Stockholm, Sweden Institutionen för kvinnors och barns hälsa, Karolinska Institutet - Kvinnokliniken Stockholm, Sweden
| | - Viveka Stiller
- Klinisk immunologi och transfusionsmedicin, Karolinska Universitetssjukhuset - Stockholm, Sweden Klinisk immunologi och transfusionsmedicin, Karolinska Universitetssjukhuset - Stockholm, Sweden
| | - Anna Ågren
- Institutionen för medicin, Karolinska Institutet - Koagulationsmottagningen, Hematologiskt Centrum, Karolinska Universitetssjukhuset Stockholm, Sweden - , Sweden
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20
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Ågren A, Wikman A, Östlund A, Edgren G. In Response. Anesth Analg 2014; 119:1453. [DOI: 10.1213/ane.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Tehrani S, Jörneskog G, Ågren A, Lins PE, Wallén H, Antovic A. Fibrin clot properties and haemostatic function in men and women with type 1 diabetes. Thromb Haemost 2014; 113:312-8. [PMID: 25318636 DOI: 10.1160/th14-05-0404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/10/2014] [Indexed: 11/05/2022]
Abstract
The increased risk of vascular complications in type 1 diabetes may in part be explained by changes in haemostatic function. In the present study, we investigated the fibrin clot properties in patients with type 1 diabetes in relation to sex and microvascular complications. The study included 236 patients (107 women) aged between 20-70 years and without any history of cardiovascular disease. Fibrin clot properties, assessed by determination of the permeability coefficient (Ks) and turbidimetric clotting and lysis assays, did not differ between men and women. Compared with men, women had worse glycaemic control as well as higher levels of prothrombin fragment 1+2 and peak thrombin generation in vitro, indicating increased thrombin generation both in vivo and in vitro. Subgroup analyses of patients younger than 30 years revealed less permeable fibrin clots and prolonged lysis time in females compared with age-matched men. Patients with microvascular complications had higher fibrinogen concentrations and denser and less permeable fibrin clots. Thus, we conclude that in vitro fibrin clot properties in patients with type 1 diabetes without cardiovascular disease are not different between the sexes, but associate with prevalence of microvascular complications. Tighter fibrin clot formation in younger women, as suggested by our results, may affect their future cardiovascular risk and should be investigated in a larger population.
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Affiliation(s)
- Sara Tehrani
- Sara Tehrani, MD, Division of Medicine, Danderyd Hospital, 18288 Stockholm, Sweden, Tel.: +46 8 123 55000, Fax: +46 8 123 56187, E-mail:
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22
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Vikerfors A, Svenungsson E, Ågren A, Mobarrez F, Bremme K, Holmström M, Eelde A, Bruzelius M, Elgue G, Wallén H, Antovic A. Studies of fibrin formation and fibrinolytic function in patients with the antiphospholipid syndrome. Thromb Res 2014; 133:936-44. [DOI: 10.1016/j.thromres.2014.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/10/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022]
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24
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Ågren A, Wikman AT, Holmström M, Östlund A, Edgren G. Thromboelastography (TEG®) compared to conventional coagulation tests in surgical patients – a laboratory evaluation. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:214-20. [DOI: 10.3109/00365513.2013.765960] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Tehrani S, Wallen N, Elgue G, Majeed K, Henriksson P, Ågren A, Adamson U, Lins PE, Jörneskog G, Antovic A. OC-04 Gender aspects of fibrin clot structure in patients with type 1 diabetes mellitus. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Antovic A, Wallèn NH, Elgue G, Majeed K, Henriksson P, Ågren A, Adamson U, Lins PE, Jörneskog G. C0284 Does a tight fibrin clot in premenopausal women with type 1 diabetes explain the lack of gender difference in cardiovascular disease? Thromb Res 2012. [DOI: 10.1016/j.thromres.2012.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Vikerfors A, Mobarrez F, Bremme K, Holmström M, Ågren A, Eelde A, Bruzelius M, Antovic A, Wallén H, Svenungsson E. Studies of microparticles in patients with the antiphospholipid syndrome (APS). Lupus 2012; 21:802-5. [PMID: 22635239 DOI: 10.1177/0961203312437809] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study circulating platelet, monocyte and endothelial microparticles (PMPs, MMPs and EMPs) in patients with antiphospholipid syndrome (APS) in comparison with healthy controls. MATERIAL AND METHOD Fifty-two patients with APS and 52 healthy controls were investigated. MPs were measured on a flow cytometer (Beckman Gallios) and defined as particles sized < 1.0 µm, negative to phalloidin, positive to lactadherin and positive to either CD42a (PMPs), CD144 (EMPs) or CD14 (MMPs). Exposure of CD142 (TF) was measured on CD144 positive MPs. RESULTS Total number of MPs (i.e. lactadherin positive particles) was higher in APS patients versus controls (p < 0.001). An increased number of EMPs (p < 0.001), increased TF-positive EMPs (p < 0.001) and increased MMPs (p < 0.001) were also observed. PMP numbers did not differ between the groups. None of the MP types differed in numbers between obstetric and thrombotic APS patients. CONCLUSION We observed a high number of EMPs expressing TF in APS patients. The numbers of MMPs and total EMPs were also higher as compared with healthy controls but in contrast to previous reports, the number of PMPs did not differ between groups.
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Affiliation(s)
- A Vikerfors
- Karolinska Institutet, Department of Medicine Solna, Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
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28
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Majeed A, Eelde A, Ågren A, Schulman S, Holmström M. Thromboembolic safety and efficacy of prothrombin complex concentrates in the emergency reversal of warfarin coagulopathy. Thromb Res 2012; 129:146-51. [DOI: 10.1016/j.thromres.2011.07.024] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/04/2011] [Accepted: 07/12/2011] [Indexed: 11/25/2022]
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29
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Ågren A, Buffam I, Jansson M, Laudon H. Importance of seasonality and small streams for the landscape regulation of dissolved organic carbon export. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jg000381] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Ågren
- Department of Ecology and Environmental Science; Umeå University; Umeå Sweden
| | - I. Buffam
- Department of Forest Ecology; Swedish University of Agricultural Sciences; Umeå Sweden
| | - M. Jansson
- Department of Ecology and Environmental Science; Umeå University; Umeå Sweden
| | - H. Laudon
- Department of Ecology and Environmental Science; Umeå University; Umeå Sweden
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